As women age and hormone levels naturally decline, sexual problems can occur. The most common sexual problems among women aged 50+ are: decreased libido, inadequate vaginal lubrication, and difficulty with climax. Vaginal dryness, or the more severe vaginal atrophy, can be a debilitating symptom and a major contributor to low libido. Instead of avoiding the pain and therefore intimacy, many women are seeking treatment from their physicians.
While lubricants can make sexual intercourse more comfortable and/or pleasurable, it is important to remember that lubricants are palliative, not preventative. The bio-identical hormone estradiol (E2) effectively treats the dryness and atrophic changes at low doses when applied vaginally. Commercial products such as Estring Vaginal ring, Estrace Vaginal cream and Vagifem tablets contain estradiol. Other bio-identical hormones such as Estriol (E3), Testosterone and DHEA (dehydroepiandrostenediol) have also been used clinically alone or in combination in low vaginal doses to treat this issue. These hormones had to be compounded since there was not an FDA approved product on the market.
In November 2016, the FDA released a press announcement about the approval of Intrarosa (prasterone) to treat women experiencing moderate to severe pain during intercourse. Prasterone may be better known by the name dehydroepiandrosterone (DHEA). For those uncomfortable with or unable to use Estradiol, this gives us an alternative FDA approved product. One caveat to remember would be that DHEA or prasterone is actually a precursor in the body to both estrogens and testosterone. So, if you have been told to avoid estrogen, this may not be your best choice.
If pain is causing unwanted choices limiting intimacy, talk to your physician about treatment options.