Menopause and sexual comfort in Henderson, NV

What’s happening in your body

Estrogen keeps vaginal and vulvar tissue thick, moist and elastic, and it supports your bladder and urethra too. When estrogen falls, that tissue gets thinner and drier, and it can burn, tear or hurt with sex. Urinary urgency and more frequent infections can come with it. Doctors call this genitourinary syndrome of menopause, or GSM. Unlike hot flashes, it usually doesn’t fade on its own. Without treatment, it tends to get worse.

Desire is a separate question, though the two often travel together. Pain, poor sleep, medications like some antidepressants, stress, your relationship and your overall health can all turn desire down. A hormone level can’t capture all of that, which is why I ask about all of it.

What you’re probably feeling

My patients laugh when I call it “no boom-boom in the bedroom.” It’s not funny when you’re living it. One woman told me, “I love my husband, but I’m not into sex with him.” Another said, “I’m losing the feeling of being a woman.”

• Dryness, burning or itching that doesn’t go away
• Pain with penetration, or bleeding afterward
• Needing to urinate more often, or more urinary infections
• Desire that’s gone quiet
• Avoiding intimacy because you know it’s going to hurt

There’s no required level of sexual activity here. If you don’t have a partner, or you’re not having sex, comfort still matters, and it’s still worth treating.

How I treat it

Through the 4D Method. We start with your history, and an exam when you need one, because infection, skin conditions and pelvic floor problems can look just like GSM and need different treatment.

For dryness and pain, the options include lubricants for sex, vaginal moisturizers you use regularly, low-dose vaginal estrogen, vaginal DHEA and an oral option called ospemifene. Each has its own considerations, and we’ll pick based on your symptoms and history. When pain has other causes, pelvic floor physical therapy can make a real difference. If you’ve had breast cancer or another hormone-sensitive condition, I’ll work with your oncology team on any medication decision. You don’t have to put up with painful sex while we figure this out.

For low desire that bothers you after menopause, testosterone has solid evidence once other causes have been looked at. It’s the use with the strongest evidence. In my practice I also see it help with motivation, brain fog, bone strength and muscle, and I’ll tell you plainly that part is my clinical experience, not settled research. In the U.S. it’s prescribed off-label for women, so we’ll go over what that means, the side effects to watch for and how we’ll monitor it. It’s not a magic switch, and I won’t pretend it is.

What the research says

The Menopause Society’s position statement on genitourinary syndrome of menopause supports low-dose vaginal estrogen as effective treatment, with very little of it reaching the rest of the body. The 2019 Global Consensus Position Statement on testosterone therapy for women, endorsed by the major menopause and endocrine societies, supports testosterone for postmenopausal women with distressing low desire after a full assessment.

You can start with a few words

Bring your medication list and a rough idea of when things changed. If it’s hard to say out loud, start with one of these. I’ll take it from there.

• “I have dryness or irritation that’s affecting my comfort.”
• “Sex has become painful, and I want to understand why.”
• “My desire has changed, and it bothers me.”
• “I want to know which options fit my medical history.”

Serving Henderson and Las Vegas

I see women from Seven Hills, Anthem, MacDonald Highlands, Green Valley, Summerlin and Lake Las Vegas at my Henderson office, and patients anywhere in Nevada by telehealth.

Hormone Therapy Institute · 2850 W Horizon Ridge Parkway, Suite 200, Henderson, NV 89052 · (702) 568-6108