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Dear Dr. Myrtle,
I have been experiencing lots of dryness and some pain with intercourse that I think is related to menopause. What exactly can I do to remedy this, other than use hormones?
 We have put together a vaginal renewal program for women who are currently sexually active with vaginal penetration, and are experiencing dryness and discomfort or pain during intercourse that is either diffused throughout the vagina or burning or tearing at the vaginal opening.
Here are the steps that you can follow:
1. Daily vulvar and vaginal moisturizing with Liquid silk. If you are experiencing severe discomfort and dryness, you can use an applicator (like the ones that come with Monistat – an unused one) to insert some deeper into the vagina. To massage this into the vulva, press gently into the skin and move the fingers in a circular motion, don’t slide the fingers along the skin. Press in, circle, then release. Be sure to massage into the inner lips and outer lips, to keep them conditioned.
2. Use a vibrator for internal vaginal massage – coat with Liquid Silk, insert, turn on, and let run for 5-10 minutes a day for 2 weeks, then 5-10 minutes every other day for 2 weeks, then every 3 days indefinitely. Choose a vibrator that is not going to be painful to insert – small is fine. Go by how many fingers can be comfortably inserted into when you are NOT aroused.
After a month of internal vaginal massage, consider a slightly larger vibrator, if possible. The goal is to be able to use one that is 2-3 fingers’ wide on an ongoing basis.
3. No intercourse for at least 4 weeks. Other sex play and intimate touch and contact is encouraged, but not intercourse until the vaginal skin is softer and more conditioned, and you can tolerate 2 fingers or more comfortably penetrating you.
4. Enjoy at least one orgasm a week – by yourself, or with someone else. This encourages healthy blood flow and improves sensation and nerve response. More than one a week is fine, if it’s comfortable and you have the time and energy for them.
5. Kegels – it is important remember to do both the “squeeze” and the release/relaxation part of the exercise. This keeps the pelvic floor flexible so penetration is more comfortable. See the AWT Kegel brochure for a description of this method.
6. When you are ready for intercourse, you should consider using a silicone-based lubricant to lubricate your partner before penetration, and Liquid Silk to lubricate and moisturize your skin. You and your partner should begin with vulvar and vaginal massage and make sure that both of you are well-lubricated and that you are quite aroused before penetration. If pain still happens, try to identify where the pain is and and then call us or talk with a health care provider.
7. We encourage the use of a vibrator before, after, or during intercourse if you have difficulty getting enough arousal and stimulation to have an orgasm.
For women who are not currently sexually active with vaginal penetration, steps 1, 2, 4, 5 & 7 all apply. This will help you have comfortable pelvic exams, and if you wish to enjoy penetration in the future (with someone or by yourself) it will be more pleasurable.
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