WVFC recently invited Dr. Patricia Yarberry Allen—our own Dr. Pat—and WVFC Medical Advisory Board member Dr. Hilda Hutcherson, both practicing gynecologists, for a wide-ranging, freewheeling conversation about women, sex, and sensuality over 40. Here’s the first installment of that conversation, covering everything from vaginal lubrication to erectile issues, with a few cupcakes on the side.

Dr. Pat: Some patients who are in the menopausal transition and beyond will tell me that they have genital awareness during or after intercourse—maybe it burns when they urinate after they’ve had sex. Or they’ll say that there’s a little stretching feeling when the penis enters the vagina, and they don’t feel as lubricated, even though they feel turned on.

And many of my patients are ashamed about this. They don’t want their partner to know that they’re not lubricated. So I get lots of questions about “What can I put in there before I have intercourse so he won’t know that I’m not lubricated?”

By the way, I find this a great opportunity to say to patients, “Honey, he is going to have some erectile function issues. You can just count on it. And this is the time to begin the conversation [with your partner] about it. “Now that we are entering a different phase of our lives and want to have frequent, comfortable intercourse, there are things that you need to know about me. And there are things that you are going to want me to know about you—that I already know about, because I’ve done my homework.”

There are lots of drugs that have an impact on vaginal health: drugs for breast cancer prevention or breast cancer recurrence, like tamoxifen, the aromatase inhibitors, proton pump inhibitors like Aciphex, Nexium, Prevacid. Those drugs inhibit the absorption of calcium and vitamin D, and are often toxic to the vaginal mucosa. Even SSRIs—antidepressants—have an impact on vaginal dryness. There are many drugs that may have an impact on genital health, and that’s an important thing to know.

Dr. Hilda: Even birth control pills.

Dr. Pat:
Low-dose birth control pills often cause vaginal dryness, because they have levels of estrogen that are much lower than a woman might have in her late menopause—when she’s having a lot of estrogen, anyway. So if a woman is on the birth control pill and she’s in her 40s, one of the things we can do is get her off the pill and find another form of contraception. If she’s on the low-dose birth control and wants to continue with it, I sometimes suggest vaginal estrogen, like Vagifem, that acts to increase estrogen impact on the vaginal mucosa.

Dr. Hilda: I wanted to add [something] to when we talked about medications and things that can cause vaginal dryness. Besides the loss of estrogen, obviously, when you’re becoming peri-menopausal, I’ve found a lot of women in their 30s who are saying, “You know, it’s just not getting there. It’s not getting moist the way it used to. What’s going on?” And sometimes I attribute that to just the beginning of peri-menopausal period when estrogen is starting to go down.

One of the other things that I find fascinating is that we often will immediately say it’s hormones, or it’s medications, or it’s one of those physical causes. I find that a lot of women, as they get older—in their 40s, for instance—will start to have problems with their relationships. There’s something about being a woman in your 40s, when you finally realize that you’re very deserving of some things.

Dr. Pat: Yes!  [Laughs]

Dr. Hilda: You’re deserving of respect, and you’re deserving of love, and you’re deserving of good treatment.

Dr. Pat: And sexual attention in bed. With somebody who knows what he’s doing.

Dr. Hilda:
Exactly! So it’s often only when you get in your 40s that you start to wake up and say, “Hm!  Something’s missing here.”

Dr. Pat: I mean, some lucky girls get it earlier, but —

Dr. Hilda: Well, yeah.

Dr. Pat:
But a lot of us don’t.

Dr. Hilda: But a lot of us don’t. And I find that in the 40s, many, many women start waking up, and they start to realize that “This isn’t as good as I would like for it to be.  You know? And I need more out of this relationship sexually and otherwise than I’m getting right now.” And so there’s this tension that develops in the relationship. And of course, relationship issues will cause you to lubricate less. You have problems lubricating, problems becoming aroused because there’s some anger and resentment that’s coming forth in the relationship. So another reason why someone will be dry and not lubricating may be because the relationship isn’t what they might want it to be.

Dr. Pat: What do you prescribe? Do you prescribe a vaginal moisturizer when a woman is not ready for estrogen, because she’s still having periods and just complains of—less lubrication?

Dr. Hilda: For women who don’t have this relationship issue—which of course, you need a marital therapist for, because you need some help to get that relationship resolved and you need communication skills to communicate with your partner—but for women who have physical reasons for dryness, if we’re not going to go the estrogen replacement route because it’s not time yet, because they’re producing estrogen or they just don’t want to use estrogen creams, there are suppositories or rings.

There are so many great lubricants. Years ago, when I first started my practice, how many years ago was that? A lot. [Laughs]  Like 25 years ago. When I started my practice there was KY.  KY jelly.

Dr. Pat: That was it.

Dr. Hilda: That was it!

Dr. Pat: The same thing we use to examine patients.

Dr. Hilda: Exactly!  

Dr. Pat:
Dries quickly.

Dr. Hilda
— which dries out and gets sticky, and it’s just not very pleasant. Or some people try the Vaseline, which isn’t good for our vaginas, and some tried various oils, cooking oils —

Dr. Pat: Ew!

Dr. Hilda: — which hang around for a little bit.

Dr. Pat: I once had a patient who was unmarried and had an unexpected one-night stand and chose to use a flavored olive oil that had pepper in it. That didn’t turn out well for either one.  [Laughter]

Dr. Hilda: For either one!

Dr. Pat: It was a hot time in the old town that night!

In the next Sex Talk–Getting down to business. Dr. Pat and Dr. Hilda on their favorite lubricants and vaginal moisturizers, how to save those expensive bed linens, and why they know that men enjoy performing oral sex on women.

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  • Tammi August 16, 2012 at 1:34 pm

    Thanks for sharing your thoughts on patricia yarberry allen.

  • b. elliott February 24, 2011 at 3:44 pm

    Looking forward to that next installment!