Photo: Ralph Rabago

Why is my wife dry down there?

Low estrogen and vaginal dryness can happen at other times. Estrogen levels can fall after childbirth, with breastfeeding, during cancer treatment, or with anti-estrogen drugs. Then there are non-hormonal factors. Cold and allergy medications and some antidepressants can dry out vaginal tissue.

acog.org - Experiencing Vaginal Dryness? Here's What You Need to Know.

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Vaginal dryness can cause irritation, burning, and pain with intercourse. It’s common after menopause, and it also can happen in the years leading up to menopause. Often, my patients notice symptoms when they haven’t been sexually active for a long time. Then they are intimate with a partner and find that sex is painful.

Here’s how I talk with my patients about vaginal dryness.

The cause is often low hormone levels related to menopause.

After and around the time of menopause, your body makes less estrogen. Estrogen is a hormone that helps maintain the vagina’s lubrication, elasticity, and thickness. Low levels of estrogen can cause thinning, drying, and inflammation of vaginal walls. This is called vaginal atrophy.

But there are other causes too.

There may be symptoms besides vaginal irritation or painful sex.

Dryness isn’t always just inside the vaginal canal. Less estrogen means less natural vaginal moisture. This can dry and irritate the vulva, the external female genital area. Women with vulvar dryness often notice irritation when they’re putting on their underwear. Some women also have increased urinary frequency or repeated urinary tract infections (UTIs) along with vaginal dryness. When this group of symptoms happens during menopause, ob-gyns call it genitourinary syndrome of menopause.

Moisturizers and lubricants often help.

For vaginal dryness by itself, I recommend trying over-the-counter moisturizers and lubricants.

Vaginal moisturizers add moisture around and inside the vagina. There are two types. Internal moisturizers are inserted into the vagina, where they help build up vaginal tissue. External moisturizers are made for the vulva. Lubricants decrease discomfort during intercourse. Sexually active women should use lubricants in addition to a vaginal moisturizer. I prefer water-based lubricants, though they don’t last as long as silicone-based products. Skip oil-based lubricants. They can cause irritation and make condoms less effective. See your ob-gyn if irritation and pain during sex don’t improve after 2 months of use, or if you have other symptoms.

Hormonal treatments also may be an option.

I often talk with patients about hormonal treatments when vaginal dryness comes along with urinary symptoms or menopausal symptoms, such as hot flashes. Estrogen creams and tablets are inserted a few times a week into the vagina. Creams must be measured and can get messy. Tablets are a good alternative. Vaginal rings are placed in the vagina by the patient. They release a low dose of estrogen over 90 days. These treatments deliver less estrogen than typical hormone therapy and have fewer risks. Talk with your ob-gyn about the pros and cons of different hormonal options.

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What does it mean when a woman creams?

In the middle of your cycle, during ovulation, your discharge may feel slippery or thinner. Then during the second part of the menstrual cycle, after ovulation, you may notice creamy, white discharge. Healthy vaginal discharge during this time is typically white, creamy, milky, or cloudy and is sometimes thick.

flo.health - White Discharge During Sex: What Is It? And Why Does It Happen?

As mentioned above, healthy vaginal discharge can be slightly different in look, texture, and color from person to person. Before we get into what it looks like, let’s go over what it does. Well, the vagina (or the internal part of your genitals) is actually self-cleaning, thanks to discharge. Fluid is released from glands within your cervix and vagina to flush out any bacteria and old cells that might lead to infections. Think of discharge as the body’s own shower gel, which means you don’t need to clean it with anything other than water. It’s normal to start producing discharge in the months before your first period. And the production of discharge slows as you transition into menopause. There’s no such thing as “normal” discharge because everyone is different. However, the National Health Service (NHS) in the U.K. says that healthy vaginal discharge is white or clear and doesn’t have a strong or unpleasant smell. Similarly, if your discharge is thick or sticky, it’s nothing to worry about. Discharge can also be more slippery and stretchy, kind of like egg whites — this signals that ovulation is about to happen, which is when an ovary releases an egg. Don’t panic if your discharge leaves a slight yellow or white stain in your underwear or sheets — this is perfectly normal, and lots of us experience this (even if we aren’t talking about it).

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