Dallin
On Menopause, Dryness, and Getting Your Spark Back
Every issue, Dr. Lauren Briscoll opens the mailbag and answers a reader's question honestly, plainly, and without the fifteen-minute-appointment rush. Have a question of your own? Write the editor and it might run in a future column.
Dear Dr. Briscoll,
I don't really know how to start this, so I'll just say it. My wife and I have been together for almost twenty years, and things have changed since I went through menopause. It's not that I don't love her. I do, more than ever. But I'm dry all the time now, sex barely crosses my mind anymore, and when we do try, it can hurt so bad I want to cry. I feel like I'm failing her, and I'm too embarrassed to bring it up with my regular doctor. Is this just what happens now? Is there anything that actually helps?
Missing Myself in Dallin
Dr. Briscoll responds:
First, thank you for writing this in. You are nowhere close to alone. I hear a version of this letter in my office more weeks than not, and every bit of it is normal. None of it means you're failing anybody.
Estrogen keeps vaginal tissue thick, elastic, and well-lubricated. When it drops off during menopause, that tissue can get thin and dry. Doctors call it genitourinary syndrome of menopause, GSM for short, and that's usually behind both the dryness and the pain you're describing. Low desire is its own separate thing, tangled up with hormones, sleep, stress, and just plain how you're feeling about your body these days. It's common for both to show up at once and feel like one big problem instead of two.
The good news: there's a lot that helps.
For the dryness and the pain, start simple: a good water-based lubricant during sex, and a vaginal moisturizer used a few times a week whether or not you're being intimate, which rebuilds moisture over time instead of just adding it in the moment. If you'd rather skip hormones altogether, there are real options: hyaluronic acid vaginal suppositories work like a deeper, longer-lasting moisturizer, and ospemifene is a daily pill that treats the pain directly without being estrogen itself. If low-dose vaginal estrogen is more your speed instead, that's safe for the vast majority of women too, and works right where you need it without reaching much of the rest of your body.
Kegels are worth adding in either way. They keep blood flow and muscle tone up in that whole area, which helps healing along. Just know pain and tightness aren't always about weakness; sometimes those muscles are gripping too hard, not too little, and squeezing harder makes that worse, not better. If Kegels don't seem to help, or the pain doesn't ease up, a pelvic floor physical therapist can figure out which one you're actually dealing with.
For desire, there's no single fix, but it's worth looking at the whole picture: sleep, stress, how connected you're feeling to your wife outside the bedroom, whether the pain itself has you flinching before anything even starts. Sometimes treating the physical piece is what brings desire back on its own, once sex isn't something you're bracing for.
Come see me. This isn't something you have to just live with, and you shouldn't have to be brave to ask about it. That's what I'm here for.
Dr. Lauren Briscoll
Coming Up Next
Next issue, back in the mailbag: a letter from a reader who couldn't bring herself to ask in the exam room, answered here instead.
And in the Chronicle's Valentine's Day special edition, Dr. Briscoll steps out from behind the mailbag for something different: an interview with K. A. Moll, an author who frequents the area and has a particular soft spot for writing lesbian doctors in love. "My stories explore love as a healing force, messy, complicated, and human," Moll says of her work. Dr. Briscoll's already read one of her novels, Blue Ice Landing, which is getting a new audio production this November, and she's got questions.