WOMENS-HEALTH Messages for May, 2000: Re: wife is in great pain.

Re: wife is in great pain.

From: Lynn D. Montgomery, MD (anonymous@obgyn.net)
Wed, 31 May 2000 10:10:12 -0500 (CDT)

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In reply to: hopn: "wife is in great pain."

At Tue, 30 May 2000, hopn wrote: >
>My wife and I have not had sex in about 5yrs. yes years. She is 50 and
>I am 41. She has gone through menopause and is afraid to have sex
>because of the pain. She did'nt have a sex drive during menopause.She
>is wanting to start having sex, but she has little lubrication so we use
>a jelly. When I insert one finger she says that it painful. and when I
>try two fingers she is in GREAT pain. She just thinks that its because
>we have'nt had intercourse for long, and that her mussles are more
>tender. I think its more than that. Thank-you

The first thing I would do is to make sure there is not any other pathology in the vagina causing her the problem. Second, I am wondering about the 5 year thing. It is really not normal for there to be no sexual activity in a relationship for 5 years. Is there any underlying reason for the lack of sex drive (i.e. depression, past psychological trauma, etc.). The reason I mention this is because there is a problem called vaginismus that results in pain similar to that you describe and likely has some basis is psychology. Finally, taken at face value, there is a possible explanation for the symptoms. The fact that your partner has not been sexually active for 5 years, combined with the fact that she has gone throught the menopause, could result in a degree of vaginal stenosis or narrowing of the vaginal entrance and canal. Estrogen given as replacement can help this, but often it isn't enough. First, I would recommend that the oral or patch estrogen be supplemented with vaginal estrogen cream. This will make the vaginal tissue more elastic and thicker. Once this has had a chance to have an effect, I would begin with some very gentle dilation. This can be done via a variety of techniques all the way from patented vaginal dilators to fingers to very gentle intercourse. I often give my patients the sheaths that syringes come packaged in. They range in size from a very small sheath for a 5 cc syringe, to a very large one for a 60 cc syringe. There are also commercially available "dildos" that can be ordered in a variety of sizes from very small to very large (try company on the web by the name of Good Vibrations) By using something that gradually introduces a larger caliber into the vagina, it will begin to stretch, eventually eliminating the discomfort. Bear in mind that this is very gradual process, usually taking several weeks of dilegent stretching. Also, it should not be forced or be accompanied by unbearable pain. There may be a little discomfort and maybe even a little spotting, but nothing extreme. The estrogen cream should be continued through this process and once comfort is achieved, she may be able to wean down from the vaginal therapy and rely on the oral or patch estrogen... Lynn

--
Lynn D. Montgomery, MD
Director, Maternal-Fetal Medicine
Rocky Mountain Perinatal Center
Missoula, Montana

**Note:  Opinions expressed here are for educational purposes only and, as such, do not constitute a physician-patient relationship.  This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.

**Private e-mails cannot be entertained due to time constraints, consequently no private e-mails will receive a response.

**Thank you for your understanding ;-)

Next message: Wendy: "Laparoscopy left me with shoulder pain too!"
Previous message: Lynn D. Montgomery, MD: "Re: side effects of estrostep"
In reply to: hopn: "wife is in great pain."

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