Dear Doc | The sex was dry

Q Dear Doc, I am a middle-age woman. I recently started dating a man and we finally had sex, but it was just dry! We had to stop during sex because he said his penis was getting sore. We did not use a condom and we did not have any lubricant. I am concerned, though, because this never happened before. I have never had this problem with another man. Will I always have to use lubricant now? Is it because I am older? Is there anything I can do to make my wetness return?

A This can be quite uncomfortable as well as distressing to your sexual relationship. However, there are quite a few reasons why this occurred, and the fix is dependent on the cause.

Normally, the vaginal walls stay lubricated with a thin layer of clear fluid. The hormone oestrogen is responsible for helping to maintain that fluid as well as keeping the lining of your vagina healthy, thick, and elastic.

A drop in your oestrogen level will reduce the amount of moisture available, and it can occur at any age from a number of different causes.

Vaginal dryness is a very common symptom of menopause, with approximately one out of every three menopausal women having this issue. Menopause also causes the vaginal lining to be thinner and less elastic. This is called vaginal atrophy. All of this is as a result of the fall in oestrogen levels.

Oestrogen levels can also drop because of:

Childbirth and breastfeeding.

Radiation or chemotherapy treatment for cancer.

Surgical removal of the ovaries.

Anti-oestrogen medications that are used to treat fibroids or endometriosis.

Other causes of vaginal dryness include:

Allergy and cold medications.

Certain antidepressant medications.

Some forms of birth control

Douching.

Not enough foreplay before intercourse.

No matter what the cause may be, vaginal dryness can be extremely uncomfortable. It can lead to vaginal itching, vaginal burning and painful intercourse.

Seeing your gynaecologist will allow for the cause of your vaginal dryness to be determined, and for the best treatment option to be administered.

The most common treatment for vaginal dryness due to low oestrogen levels is topical oestrogen therapy. This replaces some of the hormone that your body is no longer making. It helps relieve vaginal symptoms without causing a significant increase of the oestrogen levels in your bloodstream, unlike the hormone therapy you take in pills.

There are three ways in which vaginal oestrogen is given:

Ring: This soft, flexible ring is inserted into your vagina by either yourself or your doctor, where it releases a steady stream of oestrogen directly to the tissues. The ring is replaced every three months.

Tablet: Similar to treatments you may have received for a yeast infection; you use a disposable applicator to put a tablet into your vagina once a day for the first two weeks of treatment. Then you do it twice a week until you no longer need it.

Cream: You use an applicator to get the cream into your vagina. You will initially apply the cream daily for one to two weeks, then cut back to one to three times a week, as directed by your doctor.

Any oestrogen product can have side effects, such as vaginal bleeding, and breast pain. This treatment option is not be recommended if you:

Have breast cancer.

Have a history of endometrial cancer.

Have abnormal vaginal bleeding.

Are pregnant and breastfeeding.

Other Products

You can buy a vaginal moisturiser, such as Replens, without prescription at any pharmacy.

An oral medication taken once a day, called Ospemifene, makes vaginal tissue thicker and less fragile, resulting in less pain for women during sex.

Ensure adequate foreplay and take your time before having sex, to make sure that you are fully relaxed and aroused. You can apply a water-based lubricant such as K-Y jelly to help enjoy intercourse more.

Avoid using douches, bubble baths, scented soaps and lotions around the sensitive vaginal area. These products can worsen dryness.

But, most important, remember to use a condom, as it is the only form of contraception that protects agains sexually transmitted infections. Condoms are also lubricated, which can help with any dryness that may occur.

Visit your gynaecologist and discuss which treatment option will be best for you.

deardoc@gleanerjm.com