Vaginal Dryness Is Ruining My Sex Life

I’ve talked to a lot of 50-plus women who are worried about using estrogen to treat their vaginal dryness. The result for some of them: an unnecessary, self-inflicted sex drought.

In this week’s column, our sexual health physicians offer their take on why you might rethink estrogen — even if you have a history of breast cancer, as our questioner does.

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Our experts also weigh in on how diet affects your sex drive. Prepare yourself to decide between good sex and that Royal Farms fried chicken and fries you’ve been craving.

Vaginal dryness has made sex very uncomfortable for me, but I’m afraid to take hormone replacement therapy or use any vaginal estrogen cream due to my breast cancer history. Thoughts?

For the majority of women with a history of breast cancer, vaginal estrogen is very likely to be safe, according to Anita Mikkilineni, an ob-gyn focused on sexual health at George Washington University Medical Center in Washington, D.C.

In the Mood

For AARP’s In the Mood column, writer Ellen Uzelac will ask experts your most pressing 50+ sex and relationship questions. Uzelac is the former West Coast bureau chief for The Baltimore Sun. She writes frequently on sex, relationships, travel and lifestyle issues.

Do you have a question? Email us at sexafter50@aarp.org

Unlike hormone replacement therapy, which is systemic and treats the entire body, topical estrogen has one job to do: Improve the health and vitality of the vagina. Out of an abundance of caution, Mikkilineni suggests that your gynecologist consult your oncologist about the path forward. “In my experience, most oncologists agree it’s safe and, in fact, encourage it as part of your recovery,” she says.

When older women are diagnosed with breast cancer, Mikkilineni says, there’s little discussion about the “elephant in the room” — sexual function. 

“We need to do a better job of adding this really important aspect of how patients relate sexually to their partner and themselves,” she says. Not doing so, she says, can result in feelings of body dysmorphia, depression, anxiety and a changed relationship with your partner.

Other options to consider:

Nonhormonal vaginal moisturizers. Designed to make the outer layer of vaginal tissue slippery and soft, moisturizers can help decrease painful sex, according to certified sexual health counselor Maureen Slattery, an ob-gyn with Rochester Regional Health in New York.

Moisturizers are purchased over the counter and are usually used twice a week. Among the brands Slattery recommends are Lubrigyn, Revaree and Good Clean Love. Look for the ingredient hyaluronic acid, which creates the moisture.

Dilators. Consider consulting a pelvic floor physical therapist or sexual health physician about using dilators, which stretch the vaginal tissue and can get you more comfortable when you have sex, Slattery says.

Dilators, made of silicone or hard plastic, are inserted in the vagina for five- to 10-minute intervals. “Put it in, and go read a book,” Slattery says. They come in graduated sizes, starting small and getting larger in diameter. Dilators can be purchased through Amazon or a medical supply company.

Sex therapy. Mikkilineni strongly suggests checking in with a sex therapist about your “sexual sense of self” after breast cancer treatment. “Reestablishing a healthy relationship with one’s own body and genitalia that may look or work differently is of utmost importance,” she says, and a therapist can help navigate that terrain.