His and Her Health

My first time posting and I'm a little embarrassed...but here goes. I'm 56 and went through menopause several years ago. I developed atrophic vaginitis and began using Estrace cream about 2 years ago and am now using Vagifem. They both take care of the pain from intercourse but seem to have an annoying side effect. When I'm using these hormones, I have a devil of a time having an orgasm. The more I use, the harder it becomes. It's as though the estradiol counteracts something or diverts blood flow to somewhere else. I sometimes go off the products and have less trouble with the orgasms, but then things start to hurt and atrophy so I go back to them.

I'm really getting tired of this vicious cycle and would appreciate any ideas. Has anyone else ever heard of this?

Dear Alhena,

Thank you for logging onto our bulletin board. We sincerely hope that you continue to do so and that we can be of help to you.

I've consulted our medical expert, Dr. Mache Seibel and here is his response to your concern.
I sincerely wish you best of health and happy holiday season.

Response from Dr. Seibel:

This must be a very upsetting situation for you and one that is challenging to explain. Here is a possible reason.

Local estrogen placed into the vagina when it is atrophic is absorbed at a much greater rate initially. After a short while, the lining of the vagina thickens and less of the estrogen gets into the bloodstream. Estrace cream is more absorbed than Vagifem. That is a good thing if a person doesn't want to be getting estrogen into their blood stream, but not good if they need it to help with an orgasm.

If there isn't a reason you can't take estrogen, talk with your doctor about taking a small dose orally or as a skin application and see if that helps with your problem. Estrogen locally definitely brings blood to the vagina, not away from it. It could be that as time has gone by since menopause your estrogen levels have gotten lower and you just need a little more than you did two years ago.

Alternatively, you can try a non-hormonal vaginal moisturizer called Replens that is in the women's section in the drug store. Use it daily for one week and then twice per week. If that doesn't help, you might also ask your doctor to check your testosterone levels as well.

Machelle (Mache) Seibel, MD
Professor,
University of Massachusetts Medical School
Founder, HealthRock
www.mseibelmd.com
www.healthrock.com

Thank you so much, Karen and Dr. Seibel!