Menopause Matters Forum
Menopause Discussion => Personal Experiences => Topic started by: Elizabethrose on November 12, 2016, 02:23:11 PM
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Hello everyone,
I would be grateful for some advice please as I feel I need to visit my GP to discuss vaginal HRT. I'm 57, late stage peri, for the past year have had 4 bleeds, all anovulatory, continue to have massive oestrogen surges and plummets BUT for the past 2 months I've been on an oestrogen low with flushes etc and am feeling slightly uncomfortably dry. I've never experienced this before. I would say the discomfort is internal, from the outside all looks normal and still ‘plumped up' etc. I have absolutely no discharge or mucus, all is totally dry.
I had a very violent first labour, with deep second and third degree tears, ripped cervix, fractured coccyx so have lots of scar tissue. My cervix bled throughout my second pregnancy and the high vaginal area was exceptionally uncomfortable (imagine a thermos flask being inserted constantly). I was admitted antenatally a number of times but the docs could not find out what was causing it, there was no sign of any infection but all was red raw! All cleared up immediately after the c section. A recent hysteroscopy had to be done under GA as it was impossible to get through the cervix without one, they tried! None of this scarred area is sore though.
I've only had thrush once in my life as a result of an antibiotic disagreeing with me. The GPs found it very difficult to treat: a number of things were tried which my vagina seriously and painfully reacted to. Premarin was tried but stopped after I reacted to that too; stomach cramps, spotting, constant headache. I should say at this point that I'm enormously reactive to hormone change, have been treated by various well-considered specialists over the years. HRT proved a disaster for me, as the side effects were impossible to live with. I swore that I would never go near HRT again and indeed it was recommended that I didn't. However, given my own hormones seem to have calmed I thought it may be time to try a local oestrogen again.
Dancing Girl recommended Sylk, which I have used once a day on and off for the past couple of weeks, I have also used Yes. Neither product seems to make me react but I am allergic/reactive to a lot. I can only use pure vegetable oil soap, nothing else near my vaginal area. Never was able to use spermicides, but could use KY without a problem.
Sorry for the ramble, I'm trying to give as much info as may be necessary for someone to advise me. I have no knowledge of vaginal oestrogen and wonder what you ladies would advise given the info I have provided.
Many thanks I would be so grateful for your help x
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My goodness you've been through the mill bless you
These are what I have used for dryness
Replens : after my hysterectomy when I was much younger = worked well and kept me moist
Vagifem (ongoing) : cleared my UTIs and plumped me up but I haven't noticed moistness
Sylk: prescribed recently for vaginal dryness and splitting during intercourse, solved lubrication problem only
Testosterone: produced lubrication, no tearing/splitting during intercourse
Just to add I've been on oestrogen hrt since I was 32(now 50)
X
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I started with Ovestin, still use a little blob externally a few times a week, but moved onto Vagifem which I prefer.
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Oh Annie, thanks for your response. Whoa, it sounds like you've been through the mill too! Poor you, I can well imagine the pain of splitting, how awful for you.
May I ask, how long have you been using Vagifem, is it expected that it will increase lubrication? Is it that it may well take a while to have an effect dependent on how bad the VA was? I'm glad to hear the testosterone is proving beneficial, is that a recent addition?
My ovaries have proved very productive for many years(!) so I don't know what the state of play is re my testosterone production. This is all very sudden really. I had a three month oestrogen low at the beginning of the year but didn't experience this sort of discomfort then. Normally everything is a roller coaster ride with me with copious cerv mucus.
Thank you Annie, I hope all continues to improve for you. x
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Hi Tinkerbell,
Thank you for your response. What is the difference between the products and why do you prefer Vagifem?
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I found that for me Vagifem worked better and as it is a disposable applicator for each use it is just easier...although I guess not so good for the environment!
Ovestin is a cream that you need to fill into the washable applicator each time.
Vagifem is a tiny pessary that is prefilled into a very skinny applicator.
For both you need to use it every night for two weeks and then go into a maintenance dose that suits you. Both manufacturers say 2/3 times a week but I have never found that enough, so use it every night at the moment.
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Thanks for your detailed response Tinkerbell. Do both products feel as comfortable, did you experience any irritation with either?
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As these products have to be inserted, how would that affect your current problems ? :-\ ?
Initially I had pessaries which were withdrawn. My GP gave me Ovesting1mg 1+ years ago. A specific amount is drawn up via a stiff plastic applicator and inserted as high into the vagina as possible, push the plunger to deliver the amount, withdraw applicator. Wash applicator. Used nightly for 2 weeks then every 4 and 6/7 night or more if necessary.
I think the only way you will find out is to try …….. as well as using KY as often during the day as you feel necessary. I find with tearing of skin in other areas that packing the area with appropriate cream - Savlon - but probably not 'down there' ;); helps the skin to 'knit'. Vaseline - Granny swore by Zinc and Castor oil.
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Hi CLKD, thanks for your response.
I don't think I'd have a problem inserting an applicator, it's dry but not tearing or anything. Today I have an awareness of my vagina (high up), if you can understand what I mean. It feels dry, like it's rubbing or something. It feels a bit scarily like how it kicked off in my 2nd pregnancy. I don't know whether it is a touch of thrush, I've only had that once before and it didn't manifest itself like this. It isn't at all sore on the outside just very dry! x
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Thrush ITCHES! ::) high up. Dryness is probably the initial cause. This causes any damaged or thinning skin to stick together = awareness of the area affected. Bugga ………. :-\
For me VA was like razor blades up there ……. :o which was eased with medication. Have you tried coating a tampon liberally with KY - which you are unlikely to react to - and inserting gently as high up as possible? Several times a day?
My go-to of course if LIVE yoghurt, again as high up as possible. Several times a day. Every day ;-).
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Thanks CLKD, I'll watch it and get off to GP Monday if nec. It may be thrush starting, I'm saline washing the outside area just in case and using Sylk to moisturise. I may not use the veg soap tomorrow, it could of course be that. Here's hoping!
I'd be interested to get feed back on these products though as it may help my choice. x
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Hi Elizabethrose
I use Vagifem I have just finished a 14 day reload I find it quick and easy to use, mostly it's pain free to use - sometimes I can feel it a bit tight to insert butfor the most part it's good. I think I will upgrade my twice weekly to three times - I use mine at night after my evening shower
I use Ovestin cream on my outer bits currently twice weekly
I also use Hydromol liberally when ever I feel the need / also E45 if I feel a bit scratchy
💚💚Ss
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I also had very rough births , cut up to the cervix and down to anus and tore three inches into my butt muscle that was pregnancy no one , other two scars as well.
I saw mr Nick Panay last week , and he says as we age the scars tighten with the atrophy and can cause lots of trouble , I have been told to massage the scars with a dilator regularly with a blob of ovestin on the end to soften the scars.
I use vagifem / ovestin and systemic HRT all for my vagina. I dip the vagifem into some YES and insert 7 days a week.
When examined ( baring in mind all the oestrogen I use ) I am moderately estrongised, but there is still clearly signs of atrophy and thinning of the skin on the scars.
I have had women's physio , and they can feel all the " hard" internal scars , but the massaging isn't the nicest thing to do when it is all so sore.
Also YES have bought out a new " vaginal moisturiser " VM that you use every three days , I used my first one this am.
Our poor vaginas , 3 9lb babies in under four years , I was only a size 8/10 now a days I would of had C-sections. My eldest is 30 this Christmas.
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:o :-X
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Oh Annie, thanks for your response. Whoa, it sounds like you've been through the mill too! Poor you, I can well imagine the pain of splitting, how awful for you.
May I ask, how long have you been using Vagifem, is it expected that it will increase lubrication? Is it that it may well take a while to have an effect dependent on how bad the VA was? I'm glad to hear the testosterone is proving beneficial, is that a recent addition?
My ovaries have proved very productive for many years(!) so I don't know what the state of play is re my testosterone production. This is all very sudden really. I had a three month oestrogen low at the beginning of the year but didn't experience this sort of discomfort then. Normally everything is a roller coaster ride with me with copious cerv mucus.
Thank you Annie, I hope all continues to improve for you. x
I started vagifem 2015 when I joined this forum, I wrote about constant UTIs and members recommended it, it stopped them almost immediately and plumped out the new sagginess I'd noticed
I started testosterone only last month so early days but we noticed I don't need the lube so far plus I've not split , I'm only talking paper cut type tearing but as we all know, even the slightest nick is painful
X
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I have never used Ovestin but I have Vagifem and estriol cream (used to be Gynest but now generic). Vagifem contains estradiol (the main oestrogen in our bodies), whereas the other two are estriol - with the Ovestin being 10x the strength of the estriol meaning you use less.
In my opinion (which is immaterial now) the best vaginal oestrogen treatment was (?were) the discontinued Orthogynest pessaries which CLKD referred to. This was because the estriol was contained within a hard waxy pessary - easy to insert and gently oozed out providing less messy lubrication as well as plumping. As you can see from here some of us use Vagifem for plumping up the tissues internally and the cream for the outer areas and vaginal entrance. Unless you have very bad VA if you go down this route (ie two products) I would say the estriol cream is better (than Ovestin for the external bits) as can be used much more liberally - being weaker.
As I've written elsewhere the two types of oestrogen target different receptors in the bladder/vagina. Estradiol binds to both oestrogen receptors but estriol only weakly to the alpha receptor and mainly to the beta receptor.
Unfortunately the paper I used to refer to about all of this no longer works at my link so is no longer freely available so this is all from memory.
Some people say that Vagifem is stronger than the estriol creams but from what I've read, although estriol only binds weakly to the alpha receptors, the doses have been calculated so that they are each equally effective (approximately) in treating vaginal atrophy.
If you are going to use just one product, I would say therefore it's a matter of preference - the messier creams with the applicator that has to be washed each time, or the easy to insert tiny tablet (Vagifem). I would actually ask for both - the generic estriol (for outer areas) and the Vagifem - and then you have the option of trying the cream internally as well.
When I was in late peri-menopause like yourself I was prescribed the estriol pessaries for a few months until I eventually went on to HRT and stopped the pessaries, and then later re-started these too until discontinued when I swapped to Vagifem ( personally couldn't be doing with washing and loading an applicator!).
The amount of systemic absorption is minimal and if you still have high oestrogen you really should not notice any side effects, unless you are very sensitive to the fillers.
Hurdity x
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I use Ovestin, mainly because by the time I was diagnosed, it was too painful to insert an applicator and with the cream, I could start off applying it outside and gradually apply it further in as the pain eased. Something to bear in mind if you do find an applicator too uncomfortable when you try it. I don't find the applicator difficult to wash but never having tried Vagifem, I've nothing to compare it with.
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That's the preparation Hurdity and really sorted my 'razor blade' feelings. Ovestin1mg works well too.
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Hi ladies, so sorry for my late response, nightmare mig today!.
Thank you all so much for your responses and for taking the time to post. Ironically today all feels calmer: interestingly I had used Yes for the past 3 days and I don't know whether I reacted to it. Used a blob of Sylk this morning instead. Whatever the case I'm going to educate myself, taking on board all of your help and advice and go see a GP. The stories of VA on here should not be ignored and with my ridiculous reactivity to hormone change who knows what I have in store next! I am not producing any vaginal mucus at the moment so that in itself needs to be considered.
Sweetscarlett Thank you for your comment, I shall consider the use of both, I hadn't realised that was a possibility. I've never heard of Hydromol so will look in to that too x
CLKD Thanks CLKD, all these little tips are invaluable! x
Maryjane Oh Maryjane, your experience sounds just like mine, what a bloody nightmare. I didn't have big babies but my first was stuck in my pelvis and they didn't realise even after a 3.5 day labour. They had to rip him out as he was in trouble but thankfully managed to revive him after about 12 mins. All nightmarish but we were very very lucky that he survived. It rather took my mind off of my savaged body! What you must be going through, I'm so very sorry for you. Thank you for the comprehensive detail and advice, I hope your body continues to mend x
Annie Thank you for the further detail, the more info I can acquire the better informed I shall be. Good luck to you, it's seems like you've had a real battle. x
Hurdity Thank you for your very detailed advice: you've rather blinded me with science and the brain is addled today so I'm trying to take it onboard. As I understand it, the estriol cream is weaker than the Ovestin, which I suspect may better suit me as I don't yet appear to have a problem externally aside from sudden dryness. I will consider combining this with the Vagifem. I am very sensitive but of course won't know whether I will react until these things are tried.
Your comment about the oestrogen receptors is very interesting: I am going to look into this further. You say your link no longer works but if you have posted this info previously I may find it with a MM forum search, I'll give it a try.
For the past few years some of my oestrogen surges have been through the roof, these cause immense problems for me. However, it appears that they are becoming less frequent and less intense, and I've been on a low for the past 2 months. Unfortunately even minute doses of added hormones have affected me in the past but hopefully this will be less likely with my own hormones removed from the equation. I can but try. x
Dorothy Thank you Dorothy, I'm sorry things weren't sorted out early enough to prevent you from experiencing the pain. I shall consider your advice re the applicator with Vagifem. x
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Can I suggest the Estring if you think you might react badly to the fillers in Ovestin or Vagifem?
It's a silicon ring impregnated with enough oestrogen for three months, when you replace it. It sits happily in place and you cannot feel it.
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Hi ancient runner
Thank you for your suggestion. I know nothing about this so will google and check out the MM links. How high does it sit, can you feel it? After my first labour, tampons were never comfortable again. I tried and tried but in the end had to just use pads. Before I flood you with questions I'll research it and return to you if I may? x
Have any of you other ladies used the Estring?
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Have a 'search' - it rings a bell.
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Hello again ER
I can't feel it but looking back I might have been conscious of it to start with, when I was probably sore anyway. That phase didn't last long. I think there are quite a few on here who use it - there have certainly been discussions about it.
Good luck with the doc.
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I don't think this was the reference I was thinking of (it was a few years ago now) but it does explain about estriol and beta receptors and I see i referred to it in 2013:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003469/
I really doubt whether you would be affected by the very small amount of oestrogen (estradiol) from Vagifem - mostly any initial effects from systemic absoprtion would be more likely in women who had very low oestrogen, and in any case after the first two weeks systemic sborption is minimal. I think you mentioned Premarin in your original post - well that is totally different and as you know a mix of very strong horse oestrogens taken orally. There is no comparison between what any woman would feel taking this (orally) in early peri, and vagifem (vaginally) in late peri! That's not to say you won't, but less likely and the effects would settle unless you are extremely sensitive to any exogenous hormones (introduced from outside the body).
Hurdity x
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Thanks for searching that out Hurdity, I will read later.
The Premarin I was prescribed many years ago, was a cream used vaginally. I almost immediately developed abdominal cramps, spotting, constant headache, nausea, bloating, painful breasts and excessive, desperately excessive underarm sweating. It was stopped after 3 weeks and all symptoms disappeared. Nick Panay and Anne MacGregor did not seem at all surprised by this. I had the same reaction and more, to the contraceptive pills tried in my twenties and indeed the HRT tried to treat the migraine.
I can't know until I try what reaction, if any, I would have now to exogenous hormones.
Thanks for your response x
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Thank you all for your advice: I went to my GP today and I'm going to start with the Vagifem. I'm very lucky in that she is one of Nick Panay's team so is terribly switched on. Given my disastrous previous experience with HRT, it was felt one product should be started and then adjusted or other things added as is necessary. I'm going to either call in a repeat script in 3 months or see her at any stage if nec.
Thanks again for your help ladies x
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Well done. Let us know?
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Thanks CLKD, will do! x
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Heavens re the Premarin cream - I didn't even know that this was ever available in this country - I think it still is used in US. Have just looked it up and it was only discontinued in UK in 2010 - I'm glad I was never offered it - wouldn't want to be putting horse oestrogens on my bits ::)
Hope the vagifem does the job.
Hurdity x
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Thanks Hurdity. It was prescribed by a dinosaur GP about 20 years ago when all else was failing at treating thrush caused by ABs. My reaction was a violent one. Another GP had a hissy fit when she found out!
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Well ladies, I'm a little baffled! I used the first Vagifem last night, no negative reactions so far which is a good thing for me, BUT I've had considerable mucus all day today. I am still most definitely on an oestrogen low, flushes fairly constant day and night so I know it's not my usual reaction to an oestrogen hike and I have none of my other usual symptoms.
GP did say that given my sensitivity to hormone change I may see some fast reaction but could this really stimulate this quickly whatever has been completely dormant for the past two months? ??? I'm not complaining because today has been a lot more comfortable and I didn't need to use the Sylk this morning.
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I saw mr Nick Panay last week , and he says as we age the scars tighten with the atrophy and can cause lots of trouble , I have been told to massage the scars with a dilator regularly with a blob of ovestin on the end to soften the scars.
This comment is very useful as last weekend my skin split next to my episiotomy scar. I could only think that scar tissue does not stretch like unscarred tissue and the skin is terribly thin in that area due to VA.
I find it much easier to accept and deal with something if I know there might me a logical cause for it so thank you for the comment Maryjane
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Oh babyjane, that sounds so painful. Thank goodness for this forum, I didn't even know that VA existed till I came on here. My nether regions look like a map of the London underground. After Maryjane's comment I'm going to be keeping a very close eye on my scars, especially the Northern Line going south!! x
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Thank goodness for this forum, I didn't even know that VA existed till I came on here.
Same here, I learned so much when I first joined. I am sure I would have been at the doctors a lot more if I hadn't joined this forum :)
After Maryjane's comment I'm going to be keeping a very close eye on my scars, especially the Northern Line going south!! x
:)
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Well ladies, I'm a little baffled! I used the first Vagifem last night, no negative reactions so far which is a good thing for me, BUT I've had considerable mucus all day today. I am still most definitely on an oestrogen low, flushes fairly constant day and night so I know it's not my usual reaction to an oestrogen hike and I have none of my other usual symptoms.
GP did say that given my sensitivity to hormone change I may see some fast reaction but could this really stimulate this quickly whatever has been completely dormant for the past two months? ??? I'm not complaining because today has been a lot more comfortable and I didn't need to use the Sylk this morning.
It's a few months back for me, but I remember it working fairly quickly.
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Thanks Dorothy, I'm just pretty amazed, though to be honest with my history I don't know why I am!. Let's hope it continues! x
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Vagifem seems to be doing a great job so far with no irritation thank goodness, BUT I've used Yes WB again and it really does make me react. Has anyone else reacted to this? We set off out on Saturday morning for a full day of activities and I thought I'd use a blob of Yes on the outside: ooh I squirmed until I could find myself a loo in order to try to remove the pesky stuff.
DG had recommended Sylk to me which seems fine, though I haven't tried it since reacting to Yes on Saturday, bit scared to!
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I find I react to all of them to some extent including the Yes, I have to say, for me, Sylk is the worse!
I keep getting annoyed as my doctor keeps adding it to my repeats without me asking for it :(
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Thanks for your response Tinkerbell. I suppose we are all very different. Maryjane had posted a paper that Nick Panay had co-authored on Vaginal moisturisers and lubricants and Yes seemed to come top for PH analysis etc. I suppose all it takes is one ingredient that an individual may be sensitive to. I'm allergic and reactive to a lot so I'm really pleased that I haven't reacted to the Vagifem so far. Think I might give it a few days and try the Sylk again. x
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Try organic coconut oil and don't take my word for it, do a search on the forum. I learned about it here :)
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Oh thanks babyjane, I have a pot of Tiana, which is organic, raw extra virgin coconut oil which somebody gave me and I haven't opened. (Don't think they had thought I might consider it on my ailing bits!) Do you use it just for a daily lubricant? x
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Or you could ask for Estriol cream ( the generic 0.01%, not Ovestin) as well as the Vagifem, and depending on the ingredients - just to rub around the external area if that's how you are using the moisturisers. I've never used them myself but use Estriol with no problems whatsoever..
Hurdity x
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You could try the YES Shea butter ?
Theybwill send a free sample first , they have also just bought out a new YES product called VM vaginal moisturiser, along the lines of replens without the nasties , again ask for a free sample.
I used the coconut oil once and 😳 we are all so different. I have never moisturised my face ever , or wear makeup but my " nether regions " Dear Lord it's crazy.
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Thanks Hurdity, I did have this conversation with my GP. Given my ridiculous sensitivity to added hormones she wanted to try one at a time to see how I reacted. I'm not completely sure I actually need anything externally as the Vagifem is doing a brilliant job so far, used the Yes Saturday as I had a heavy walking day. I won't be using it again!
I'm going to give the Sylk another try but also try the coconut oil suggested by babyjane.
Thanks ladies x
Just seen your post Maryjane - why only once, did you react to it? (Need to change my specs, your emogi is too small for me to see!!) I'll check out the Yes website. x
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Yes I reacted to it really burnt.
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Oooh err! Oh it's all trial and error!! x
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Hi Elizabethrose, I used the coconut oil recently after my vaginal skin split. I found it very soothing. I also read on this forum it can be helpful for constipation. I have been adding a half teaspoonful to my porridge every morning and it really works :)
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Thanks babyjane
I'm going to give my bits a chance to get over Saturdays nasty reaction and then try the Sylk which had been fine previously but I'll also give the coconut oil a go. It's a case of trying everything, it would seem we are clearly all completely different. One thing's for sure though, I'll try each product in my own home so I can wash it away very quickly if necessary! :o x
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Try one thing at a time so you know what irritates and what doesn't. I know what you mean about washing things off quickly! :-X
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I love drinking coconut milk when we are making curry …… maybe bathing in it ??? cheaper than asses' milk ;-).