[dr.anitahoffer]

Hello everybody,

Just a quick comment about olive oil or any other oil-based lubricants.

IF you are interested in avoiding pregnancy at this point in your lives and are using condoms for contraception, all the oil-based and petroleum-based lubes are a big no-no…because they weaken the condoms, often leading them to break. If avoiding pregnacy is NOT your intention, then they are fine. Many women also swear by coconut oil.

Regards to all,
Dr. anitahoffer

[dr.anitahoffer]

Hello Heather (and everyone else too!)

In 2013, the FDA approved the first pill-based drug (Osphena) for women who experience pain during sex at menopause.
It is taken daily and is designed to treat menopausal symptoms sch as vaginal atrophy that make the vaginal tissue thinner and more fragile, causing pain during sexual intercourse. (Our ovaries stop producing the hormone estrogen at the time of menopause, usually around age 45 or 50.)

Osphena acts like replacement estrogen and makes vaginal tissue thicker and less fragile.

The drug carries a black box warning alerting doctors and patients that Osphena can increase the risk of endometrial cancer, stroke and blood clots. The drug’s prescribing guidelines recommend that it be used for the shortest amount of time possible to achieve patients’ treatment goals.

Common side effects of the drug include hot flashes, vaginal discharge, muscle spasms and excessive sweating.

The FDA approved the drug based on studies involving 1,889 postmenopausal women who were randomly assigned to receive Osphena or placebo (sugar pill). After 12 weeks, women taking the drug had a statistically significant improvement in their symptoms.

Based on the information available to me, Osphena appears to be a drug selectively targeting estrogen-sensitive tissue, and thus not necessarily significantly different from topical estrogen in its various forms. Note the black box warning and warning to use for as short a period of time as possible, which may not make it a good choice to be used on its own for vaginal atrophy, a more appropriate diagnosis than dyspareunia, given that dyspareunia can be caused by many other things, including high tone pelvic floor dysfunction, vaginismus, vulvodynia, and vulvar skin disorders, none of which would be appropriately treated by this.

I hope this information is useful.

Blessings,
Dr. Anitahoffer

[dr.anitahoffer]

Dear Bitesize,

I am sorry you broke up with your boyfriend of the last 4 years but it sounds as if you made the decision carefully and thoughtfully. Staying in a relationship that’s not working, simply because you are afraid to become sexual with a new person is understandable – but in the long run, probably not an ideal solution.

I am writing because I was struck by your saying that you were trying to use only your own natural lubrication. I counsel a lot of women about painful sex and am often surprised that they feel they “shouldn’t need to use lube”. There is nothing wrong with using a lubricant. As I believe you may know, there are many excellent choices out there and it is possible to find one that is just right for your body. Everyone should feel free to use lube. We all need it from time to time…and if it makes you feel good, and more comfortable with penetration there is nothing wrong with it.

Just my two cents!

Dr.anitahoffer

[dr.anitahoffer]

Dear Jessbee (and others!),

I just had to chime in. This is my first post to the V-forum. (I hope the formatting works.)

My name is Dr. Anita Hoffer. I am a sexologist and sex coach. I have two doctorates: one in Reproductive Biology and the other in Human Sexuality and Sex Education.

I work with women of all ages and their sexual concerns. One of the most common sexual concerns I deal with is “dyspareunia” which is just a fancy medical word for “sexual intercourse hurts” or “sex feels like it is impossible”.

A common cause of dyspareunia is vaginismus. The shame and anxiety that goes with this experience is HUGE and can alter the the quality of a woman’s life as well as the life of the couple. Very often, women struggling with this condition are happily married to loving partners who are very understanding…….and in a way, this can add to the difficulty because the women feel guilty and, in addition to everything else, they worry that they are letting their partners down. Often they are so ashamed that they keep their problem a secret and therefore feel they can not ask for help. It is really tragic.

A couple can experience sexual concerns as well as relationship concerns………and the common assumption is that if you fix the relationship problem, the sex will take care of itself. But this is simply not true as many of you know because your relationship is good but the sex is not equally good…or may even be impossible right now. And moreover, sometimes, even after the physical obstacle to sexual intercourse is removed, relationship and self-esteem problems that arose while you were struggling persist.

But in fact this is not surprising! Both types of problems need to be addressed. It stands to reason that after years of struggling with vaginismus, the shame and isolation and anxiety that have built up over time take their toll. Sometimes it may take longer than expected to really and truly enjoy sex after the procedure. And you and your partner may be (understandably) impatient for results now that the long period of being unable to experience penetration has come to an end. This is a perfectly natural response but unfortunately the road to a sexually fulfilling relationship does not always occur in a snap once the dilators are easily inserted. This is what Dr. Pacik refers to as the disconnect between physical success (dilators) and needing to catch up emotionally (enjoying the sexual experience now that this is possible).

That is why I want to say a hearty congratulations to Jessbee and others among you who, recognizing all this, are seeking the advice of therapists and counselors who are familiar with these issues. You are not alone. It can make a huge difference to the success of the journey that you have undertaken with Dr. Pacik’s help.

I have worked with vaginismus patients in person and also on Skype…..and I am familiar with Dr. Pacik’s work and procedure. If I can be helpful to any of you, I would be happy to do so. Please feel free to contact me at aphoffer@earthlink.net and we can set up a time to talk.

Sending you all warm wishes for a very happy holiday season and beyond,
Anita Hoffer

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