Have a question about women’s health or menopause? Dr. Patricia Yarberry Allen may have the answer. Click here to send in your question to be posted on WVFC.


Question:
I am 47, married for six months and have a 1-year-old child conceived after five years with the help of fertility treatments. I began trying to have a baby when I knew that I was in love with my husband, even though it seemed at the time that marriage might not ever be in the cards for us. I traveled all over the country until I found a fertility center that could work with me and my schedule, and I did all the fertility treatments by myself since my husband lived in another country at the time.

I have a very high profile job in my industry and have worked toward professional goals and acceptance in a world that has always belonged to men. I must travel and my hours are unpredictable. I have a wonderful live-in nanny, and I never worry about my child’s care while I am working.

My husband is 43 and used to be very successful in his career. With the change in the economy he lost his job and had trouble finding another. He has found a job where he makes only half of what he used to make and, frankly, I am disappointed and find it difficult to discuss what my husband does for a living when I am in social situations.

Since the birth of my son, by c-section, I have not had a period. I have no interest in sex, and even though I have tried to have intercourse to keep the peace, I now find it so painful that I am in tears. I saw my gynecologist, who prescribed Estrace cream for the vagina, but it burned and I stopped taking it.

I tried to talk to her about my many issues, but she just said that I should take hormones and I would soon be my old self. I examined myself recently in a mirror and there are large areas of bright red skin that have become thick. It looks like pictures of psoriasis in medical advertisements. There are tears in some of the genital area, and it burns and itches all the time.

My husband tells me that I am beautiful, even though I have not been able to lose 30 pounds of the weight I gained when I was pregnant. He is an incredible father and really takes over when I am away. He has been very understanding, but he has become distressed that our old life seems unlikely to return.

I had a wonderful sex life from the age of 18 on. I know that I am depressed and now even regret having married my husband. I love my son and my work; those parts of life are fine. But I think that menopause has eliminated my need for sex. I have heard from girlfriends that this is common. I have never been in therapy since I believe that I have the ability to fix my own problems. What do you suggest?
— Donna

Dr. Pat: This is quite a story. On paper, you seem to have acquired everything you wanted. Fabulous job with great prestige and financial rewards, a child of your own and now marriage to a man you once admired as a successful professional and loved enough to go through this long nightmare of fertility treatments by yourself in order to have a child with him.

After years of hormonal treatment and procedures for becoming pregnant, you have acquired, in very short order, a child, a live-in nanny, a husband and menopause. There are many issues to address in your question, but I must be brief in my response to the non-medical problems.

You seem not only disappointed that your husband has lost professional prestige and financial worth, but also that he was not there for you as you created a baby with his sperm and a team of doctors. I suspect that you are really angry with him and have not taken the time to acknowledge this. Can-do people often just make decisions and get on with life. But, they often make terrible mistakes — in your case, thinking about throwing out the husband with the bathwater.

I understand that you have been able to fix everything before, but this time you need a professional to help you sort out your feelings, find a way to accept your husband for his character and love for you, and to get over your anger that he is not the powerful guy you fell in love with. Marriages end for all sorts of reasons, but it would be too bad if you divorced a man simply because you didn’t respect him because of the job he had.

The issue of lost libido and increasingly painful intercourse in your menopausal state is very common. It will take months to recover your physical genital health with the suggestions that I will give you to discuss with your doctor. During this time, you have an opportunity to work with a therapist and sort out who you are, what kind of life you want now that you are part of a family with a much wanted son, and whether you can acknowledge the source of your anger and heal from this long period of being a survivor but not a partner in a real relationship.

Please ask your gynecologist to draw blood for vitamin D, calcium and parathyroid hormones. I suspect that you have very low levels of vitamin D, which coupled with no estrogen produces a toxic environment in the genital tissue. Ask your doctor to prescribe vitamin D in much higher levels than have been considered necessary in the past.

I begin with vitamin D3 — 5,000 IU every other night for six weeks, and check the urine and blood to make sure that the vitamin D does not increase either blood or urine levels of calcium after a month. Avoid all pressure to the genital tissue during this time of healing — even spinning classes or horseback riding. In six weeks, your doctor may want you to decrease the vitamin D3 to 2,000 IU a day.

In three months, the genital tissue is very likely to be much improved. The physical changes that you included in your question should be gone. The burning and itching should disappear. At this point, with no mucosal injuries to the tissue, you should be able to begin vaginal estrogen without discomfort. I suggest that patients start with Vagifem, a small tablet of low-dose bio-identical Estradiol that is inserted into the vagina at bedtime every other night for two weeks, while continuing the vitamin D. Vagifem is then generally used three times a week.

One month after the vaginal estrogen therapy, ask your doctor to re-evaluate the tissue. It should be pink, moist, well-vascularized and elastic. Begin a course of meditation with breathing exercises every night, followed by gentle local stretching of the vaginal opening using a lubricant like Astroglide or mineral oil. When you feel that the vaginal opening will comfortably allow intercourse, then you should be physically ready to resume your sex life.

I hope that you will be ready at this point to become your old sexy self, only better.

* * * * *
Dr. Patricia Yarberry Allen,
director of the New York Menopause Center, is a gynecologist affiliated
with New York-Presbyterian Hospital and a board certified fellow of the
American College of Obstetrics and Gynecology.
Have a question about sex, women’s health or the menopausal transition? Write to askdrpat@womensvoicesforchange.org.

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