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Dear Dr. Roach: I am 65, and my lady friend is 60. We are still sexually active. However, intercourse is uncomfortable and painful for her. I’ve found a website that talks about a laser procedure that is supposed to be the “holy grail” to make intercourse enjoyable again. I would like some unbiased comments on the procedure as to what actually happens during the treatment. Is it safe, what is the efficacy of the treatment? I might add that we have tried different lubricants and non-hormonal creams. — D.S.

I’m not (yet) a believer in laser vaginal regeneration techniques. The Food and Drug Administration has recently issued a warning about these devices: “These products have serious risks and don’t have adequate evidence to support their use” for sexual function.

There are also reports of adverse effects, including pain and bleeding. On the other hand, I have read reports from a gynecologist who has had good results from the procedure. I still can’t recommend laser treatment until I see published data on its effectiveness.

Painful intercourse in women is a complicated subject. One common cause is atrophic vaginitis. Vaginal estrogen is an effective treatment for this, and it might be appropriate for your lady friend. I would definitely recommend she find an expert on pelvic pain in women.

If she does use vaginal estrogen, you should avoid intercourse of any kind immediately after she applies the cream. Estrogen can be absorbed by men through the skin. Only a small amount of vaginal estrogen is absorbed into the body: The rest will remain in the vagina for some period of time. Since most women will use vaginal estrogen one to three times weekly, not having oral or penetrative intercourse on the day of vaginal estrogen use would be safest.