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[Nancy]

Hi,
I'm a newbie but not a newbie to menopause. I'm post meno about 6 years with a very rocky menopause journey with all sorts of symptoms I had no help with . It was all so gradual I just muddled through  .
I need help - I must say this forum is a jewel. I have learnt more here than I have on multiple GP, clinic and meno specialist visits. I suffer from health anxiety (another symptom, made worse by covid), so I worry about all the issues but it is such a relief to hear my issues are similar to others.
My main problem is intimacy is too painful - it's rolling on 5 years since it has been possible and it has suddenly made me really sad that it is no longer possible. There are lots of comments and experiences with VA and it's a relief to know that is what it is (I've had checks but of course it hasn;t stopped me worrying that something has been missed!). It is sore at the entrance and at the cervix (gp did an examination and it was really painful).  I have been using vagifem for 2-3 years, but it's still impossible. Yes lubricant was recommended but not how I should use it, and I have bought, but haven't used dilators. What I am hoping for is some advice on what I should do next to give myself the best chance of reversing, or improving this so my every patient dh and I can feel that intimacy again....of course, we try other things but it's not the same. Advice welcomed with open arms. Thank you xx

[Joaniepat]

Hello Nancy, welcome to the Forum.
I wonder if you are getting enough oestrogen to the genital area. You don't say how many Vagifem a week you are using so there may be scope for an increase there. Also, many women find they need the addition of an oestrogen cream such as Ovestin to apply to the labia, as Vagifem does not always help there. Are you taking any systemic HRT, as that might help. You can also apply whatever Yes product you have to the vulva, or an emollient such as Epaderm or Hydromol to ease soreness.
I'm sure you will get plenty of advice from others here, but another good resource, where you can pose the same query, is the private Vaginal Atrophy Facebook support group. There are many women there with the same issues and excellent advice and written resources are available
Best wishes,
JP x

[CLKD]

I would suggest that you use the 'vagifem' every night for at least 4-5 weeks, every night for ever if necessary.  The 'yes' moisturiser can be wiped gently on the outer vaginal areas, it is important to keep the whole area as moist as possible which prevents the itchy feelings.  When I get the need2P I take 2 Nurofen 3 times a day to ease the nip as the spincter shuts off the urine flow.

I use 'ovestin' both internally and externally.  Or KY jelly on the outer labia to stop the dryness.  It's what works for you, it is important to find a regime and stick to it.  Many 'experts' think that using more than twice a week is OTT however; VA treatment is a low dose of oestrogen so in most cases, is quite safe to use regularly.  It's about Quality of Life.

Some find that using bath products aggravates the condition. 

Let us know how you get on.

[Nancy]

Thank you both for the very useful information.  I use vagifem 2-3 times a week.... Dryness doesn't seem to be an issue which is odd as the pain is as if it is. I think it has just all contracted during a 'quiet' period for medical reasons years ago and it was never the same after that. Assume there's no risk with upping the amount of vagifem? I'll try and get a routine going with the yes lubricant and maybe start using the dilators. Any advice as to how often would be great. I'm determined to give it my best effort ... The advice on the forums has really eased my anxiety around this but can be overwhelming. Now I just need a plan. X

[CLKD]

See above - initially use 'vagifem'. nightly.  I wasn't dry as such but VA was like razor blades  up there.  'ovestin' regularly eased symptoms.

'Yes' is a moisturiser so won't replace any oestrogen.  Dilators, used gently, can ease the lips apart to enable a deeper application of 'vagifem'.

[Joaniepat]

You are right about the vagina shrinking and/or shortening in menopause. Although I have used dilators it was a long time ago so can't remember much about it. A separate post with 'dilators' in the heading would probably elicit a few responses. Have you considered seeing a women's pelvic health physiotherapist? Might be a good idea to get your pelvic floor assessed for hypertonicity, get professional guidance on correct breathing to relax the PF, and using the dilators.
As to the Vagifem, there is no risk in increasing usage, it is such a tiny dose with no systemic absorption.
JP x

[Diamonds and pearls 53]

Nancy, there is no risk in upping the amount of Vagifem. Many women use this in conjunction with systemic HRT. As mentioned you can use it nightly if that improves things. It might also be worth trying Ovestin instead  of Vagifem to see if that works better for you. You don't have to use the applicator if it's too sore, you can just administer gently yourself using your finger. That's what l do as l find it easier. And definitely use it externally on the labia as well. Re lube just use liberally whenever you feel you need to, it won't do any harm.

[Nancy]

Thanks ladies. I did start with high dose vagifem and reduced down though I might up it for two weeks before doing the deed ... It attempting to.

I haven't any issue with administering vagifem, thankfully it's small but I know that doesn't matter. It's the dtd is the issue...just too painful.

Thanks again for advice. It's great to be able to offload everything here and not just piecemeal to the one or two people and then medical who will listen to me as needed when issues arise! It would be nice to be on top of this.... So to speak 😉