Private health

Expert answers to your most intimate health questions

Help for ‘down there’ dryness

Q: I’ve had vaginal dryness since menopause. We use lubricants and I’ve tried vaginal moisturizers, but sex is still uncomfortable. Breast cancer runs in my family, so I don’t want to take oral estrogen. Is it safe for me to use a topical estrogen?

A: Absolutely, yes! A low-dose vaginal estrogen cream, suppository, tablet or ring can relieve dryness and reinvigorate vaginal tissues—without the estrogen being absorbed throughout your body, the way it would be if you used traditional hormone therapy. It’s even been found to be safe for breast cancer survivors.

You actually have many options for treating this problem, which is quite common: More than half of postmenopausal women suffer from vaginal dryness, discomfort and pain during sexual intercourse, but most don’t seek treatment for it. Getting relief for this unpleasant symptom is important, not only for intimacy in your relationship, but also for your sexual health, since regular sexual activity helps maintain healthy vaginal tissues after menopause.

In addition to estrogen, you can consider trying a vaginal suppository that contains the hormone DHEA (dehydroepiandrosterone), which the female body converts to estrogen and testosterone in the vagina. Used nightly, it can combat dryness and painful sex in menopausal women. Or, if you’d prefer to use a nonhormonal product, talk to your doctor about Osphena, a once-a-day pill that helps plump up and lubricate the vagina. It contains a selective estrogen receptor modulator—meaning it targets certain tissues without affecting others. My patients find that it’s very effective for improving vaginal dryness, and one study found that it makes a substantial difference within four weeks.

Can menopause make my heart race?

Q: Lately I’ve noticed that my heart sometimes races as I’m getting a hot flash. Could this be due to perimenopause (I’m 49), or should I be worried about a heart arrhythmia?

A: This is tricky since it could be due to either. I tell women to see their doctor for any heart-related symptoms, since palpitations can be linked to more serious issues, especially if they’re accompanied by trouble breathing, dizziness, weakness or chest pressure.

That said, it’s not unusual to get heart palpitations during perimenopause. As estrogen levels decline, the sympathetic nervous system becomes more active, causing heart rate and blood pressure to spike in response to stress, including an oncoming hot flash. And while these palpitations can be anxiety-provoking, they’re usually nothing to worry about. When they strike, try calming yourself with slow, deep breathing or by visualizing a relaxing scene such as a tranquil beach. Also, be sure to drink plenty of water to prevent an electrolyte imbalance, which can also cause palpitations.

Q At the gym, I overheard two women talking about undergoing vaginal steaming at a spa. Could this eliminate my vaginal odor?

A Often described as a “facial” for the vagina, vaginal steaming involves sitting over a bowl of hot water infused with herbs such as rosemary, basil or wormwood for 20 to 45 minutes. Some claim the centuriesold practice cleanses reproductive organs, eliminates odor and relieves menstrual pain, but scientific evidence is scant. And there are risks, like the possibility of burning vaginal tissue as well as infection if the equipment isn’t kept super clean.

Besides, the vagina is a selfcleaning organ, which is why steaming (and douching) is unnecessary. In fact, efforts to freshen the vagina can disrupt the balance of bacteria and may actually result in infections. If the odor is foul or fishy and you suspect an infection, see your doctor. Otherwise, I advise cleansing the exterior vulval skin with warm water and a mild soap.