Q: My husband and I have both recently retired and we’re trying to get our sex life going again, but I am terribly sensitive and dry “down there.” I’ve tried some lubricants but it still hurts. There’s a history of breast cancer in my family so I want to be careful about hormones and was wondering if estriol is safe. Do you have any suggestions?

A: The good news when it comes to a menopausal woman’s genitals, is that the best way to restore their function is to use them, very carefully at first. You might begin with some gentle manual stimulation on your own or with your husband, with lubrication. Explore other areas of the body too, to create arousal. As your body starts receiving desire and arousal signals again, over time it will respond with its own lubrication and hormones.

Choosing the right lubricant is a matter of personal preference but remember, if it’s going onto your skin it’s going into your body, so try to find one that is free of chemicals. If you have questions or doubts about a particular ingredient, look it up on the Environmental Working Group’s Skin Deep Cosmetic Safety database.

Unfortunately, most vaginal lubricants contain a lot of glycerin, which is ultimately drying. You can find some good organic lubricants online at Good Clean Love. Zestra is a natural lubricant made from a blend of non-irritating plant extracts and oils designed to increase sensation.

Some women find that plain aloe vera gel works well and others like coconut oil.

If you’re still experiencing pain after a few months, you may want to consider a small amount of vaginal estriol, which is the safest estrogen relative to breast cancer. For most women, just 0.5 to 2.0 mg every three or four days works wonders within a matter of weeks. Your doctor can order vaginal estriol cream or suppositories from your local compounding pharmacy. Although estriol isn’t commonly used in conventional medicine in the U.S., it’s been used in Europe for more than 30 years and its safety and efficacy, at the low doses mentioned above, are well established.

Use the estriol cream at a time of day when your husband won’t come into contact with it. He doesn’t need estrogens. It should be well absorbed within eight hours.

You’ll find many more details and strategies for rebooting your libido in my new book, co-authored with Jennifer Landa, M.D., The Sex Drive Solution for Women.

  estriol, vaginal dryness, vaginal lubrication