This was an ongoing discussion in an anonymous physicians Facebook group in the US, where a member shared a deeply personal concern about his postmenopausal wife’s sexual health.
The member wrote that his wife, 60 and postmenopausal, has been struggling with vaginal atrophy and severe dryness. Intercourse has become painful despite lubricant and occasionally causes minimal bleeding. He described a sensation of “hitting a brick wall” a few inches in, leaving both of them distressed. He emphasized that he is supportive and never pressures her, but she feels terrible about the change in their sex life.
According to the post, her gynecologist had already tried multiple options. Oral hormones were discontinued because she felt unwell on them. Vaginal suppositories did not help. She also tried several over the counter products and vaginal dilators without success. Before menopause, she tolerated low dose birth control pills well, and the member wondered whether hormone therapy could still be an option at her age. He added that she still has her ovaries and uterus and asked whether this meant the end of their sex life, inviting suggestions from the group.
One physician responded with highly practical guidance focused on local estrogen therapy:
Vaginal estrogen cream throw away the applicator and put a big ole blob on her index finger and liberally apply all along vaginal opening, cover clitoris and urethral opening and can go a knuckle/knuckle and a half inside the vagina but doesn’t need to try to reach her tonsils. I tell patients “just spackle it all over, doesn’t need to be completely rubbed in”. Do it nightly for 10–14 nights then at least 3x/week, hold off on intercourse for at least the first 2–4 wks. Use coconut oil (from food aisle, needs to be solid at room temp and not hydrolyzed to stay in liquid form) or Crisco for lubricant during intercourse — KY jelly etc is basically a stab to the gynecologist soul. Can also start Osphena as well if that’s not enough.
Am I the lone lady doc on here who agrees with everything above, but, also wants this poor woman left alone with her normally aging vagina? I imagine she’d be happier with snuggles on the couch and a good back rub. Intimacy is more than sex... your desires may not be hers and/or may not be possible anymore
If she did not tolerate oral HRT, did her physician recommend estrogen patches? She will still likely need oral progesterone, though. All great suggestions above. I’m glad you reached out to the group and hope you all find answers! Oh — and consider testosterone for libido??
Physicians in the discussion balanced medical interventions with reminders about consent, comfort, and redefining intimacy.
