Reclaiming the Joy of Sex
Oct 01, 2018 Cedars-Sinai Staff
This 60-year-old woman and her husband gave up sex for nearly a decade because it was too physically painful for her. It's one of many common women's health issues—and most women never seek help. A Cedars-Sinai urogynecologist changed this couple's life. She's part of an all-female medical team urging women to give up their shame and silence.
The passion in Jessica's marriage was still strong when sex became so painful she couldn't bear it anymore. She and her husband, Bill, virtually gave up on intercourse for nearly a decade.
"Most women are not comfortable talking about this with their doctor, and many doctors don't address it."
Jessica wants other women to hear her story so they too can find help, but she doesn't want her real name to be used. Like many women who suffer from a postmenopausal condition called vaginal atrophy, she hasn't confided in friends and even struggled to bring up the subject with doctors.
"At my lowest point, I had no sex drive whatsoever," Jessica says. "Bill and I have always had great chemistry. He kept saying there has to be a way to fix this. We did a lot of arguing and crying and trying to figure it out before we finally found a doctor who put the lovemaking back in our marriage."
That doctor was Karyn S. Eilber, MD, a Cedars-Sinai urogynecologist who specializes in pelvic medicine and reconstructive surgery. She reassured Jessica that she was not alone. As estrogen takes a nosedive, nearly half of postmenopausal women experience symptoms such as thinning and dryness in the vaginal wall that can cause pain during intercourse.
"Most women are not comfortable talking about this with their doctor, and many doctors don't address it," Eilber says. "If you're a cancer survivor, you're a hero and you can talk about it publicly, but discussing vaginal atrophy means admitting how old you are. In our culture, we make fun of the dried-up old lady, and we don't want to be that. This is a condition of silence and shame. Change is happening, but it's very slow."
Eilber has good news for women who struggle with vaginal atrophy: "You don't have to accept pain with intercourse as a way of life. It can be easily fixed, and women are entitled to having pain-free, enjoyable sexual activity."
Searching for a Solution
Jessica first experienced the shift from pleasure to pain during sex after she had a hysterectomy 10 years ago at 50. With breast cancer in her family, she didn't want to take on the risks of hormone replacement therapy.
She found it difficult to bring up the subject of vaginal pain with her male gynecologist. "I didn't think it was something that could be fixed, and I was embarrassed to talk about it," she says.
She switched to a female gynecologist, but the recommendation that she use low-dose estrogen cream several times a week for about a month didn't work. Jessica was also struggling with a chronic inflammatory skin condition that can affect the genital skin and also can cause pain during intercourse. This led her to a dermatologist who got this problem under control and referred her to Eilber.
The Way Back
By the time Jessica and Bill walked into Eilber's office for the first time, they were feeling more like best friends than lovers. Both had retired, and having more time together made it even more important to them to reclaim the joy of sex.
Eilber explained the importance of getting on a long-term regimen of localized, low-dose estrogen (either a cream or a ring or a tablet inserted into the vagina) rather than just trying this kind of treatment for a short time as other doctors had suggested. And she noted that laser therapy is an option for women who are not comfortable even with low doses of estrogen.
Jessica chose to apply a vaginal prescription cream twice a week, indefinitely. She also used dilators—smooth plastic, rubber or glass cylinders that come in graduated sizes and weights—to help expand the vagina and increase elasticity of the tissues. Eilber noted that dilators are helpful after a long period of abstinence for the same reason doctors recommend stretching before exercise. (A physical therapist at Cedars-Sinai taught Jessica how to use the dilators.)
After about eight months, she was able to have pain-free intercourse, and her sex drive returned as the pain subsided.
Last Valentine's Day, Bill accompanied Jessica to Eilber's office. Jessica was doing so well that this would be her last regular checkup. Bill greeted the doctor with a big smile and a bouquet of flowers.
That evening, Jessica and Bill had a romantic dinner at home, then made love—celebrating not just Valentine's Day but also the fact that this important part of their life together had been restored and their 24-year marriage is stronger than ever.