Dr. Judith Reichman 'Today' show contributor • Profile • E-mail

Q: I'm 50 years old and all of my girlfriends are talking about how dry they are down there so that sex is painful. Is this an inevitable part of aging? What can I do to prevent it?

A: The vaginal lining is very estrogen sensitive. Even years before actual menopause, when estrogens fluctuate during the cycle and reach a “low” just after your period, you may sense that you become less lubricated during intercourse. (This can also happen when you are breast-feeding and don’t ovulate or produce normal quantities of estrogen). With menopause, lack of estrogen causes a decrease in blood supply, muscle tone and elasticity of the tissue, a diminution of fluid and lubrication with arousal, a change in pH and eventually, thinning of the vaginal lining. Eventually, the vaginal opening may shrink so that penetration becomes difficult. All these rather horrific symptoms are encompassed by the medical term atrophic vaginitis).

There are many things you can do to prevent this, though. The adage use it or lose it does apply when it comes to vaginal health. Women who have frequent intercourse and are sexually active are less likely to undergo atrophy. And it helps to use a lubricant at the time of intercourse. Two popular brands are Astroglide and KY Jelly. There's no need to embarrass yourself by asking some 16-year-old clerk for the lubricants — just go to the condom shelf in the drugstore and you'll find vaginal lubricants there.

Another product that helps moisturize the vaginal mucosa is available over the counter. It’s called Replens. This will not repair the lining, nor does it act as a lubricant, but many women feel that regular use helps maintain some degree of “internal fluidity”.

If that doesn't suffice, or you want more help with your vaginal integrity, talk to your doctor about the various forms of local estrogen that can nourish and maintain the vaginal mucosa. (Unless you decide to go with general hormone replacement therapy, in which case that might suffice). Vaginal estrogens include:

• Vaginal tablets (Vagifem). These are very small tablets that come on inserters. Use it two times a week for maintenance.
• Vaginal estrogen creams (Premarin, Estrace, and generic brands). These are inserted with an applicator that is filled with a doctor-directed dose of the cream. You usually use it two times a week. The cream may be messy, but it can also be soothing.
• Estrogen intra-vaginal ring (Estring). This looks like a hollow diaphragm ring; it very slowly exudes small amounts of estrogen over a three-month period of time. So once you insert it you can forget about it for three months; neither you nor your partner should feel that it’s there.

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These forms of estrogen are considered “ local” and their absorption though the vaginal mucosa is usually not detectible (unless used in excess or with initial use in cases of extreme atrophy). They don't require any addition of progestational agents to protect the lining of the uterus. Many oncologists now allow women who've had breast cancer to use these local forms of estrogens to allay symptoms that prevent them from having intercourse. These products do, however require a prescription.

Dr. Reichman’s Bottom Line: If you're dry down there and intercourse hurts, don't feel that you are powerless to do something about it. There are over-the-counter products you can try, and if they don’t work, talk to your doctor about getting local estrogen help.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.

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