Pain with Sex, age 70- The Female Patient

I saw a patient today that is 72 and CANNOT have intercourse with her husband of over 40 years. They have had an active and satisfying sex life but things have reached a point where she hurts too much to enjoy it, cannot achieve orgasm and he is upset about not being able to enjoy a connection they once had. She had a female genital tract cancer over 20 years ago and was told she could not take hormones. She was given some cream a couple of times a week by her family doctor and no counseling, teaching or encouragement. It didn’t help but she wasn’t sure what to do. They have tried lubricants, the medicine didn’t work and she finally said, ‘go find it somewhere else’ it just hurts too much. She came to my office to see what could be done. I was so sorry to hear that it had gone on so long. Our medical system needs to allow the time not to trivialize patient’s quality of life and allow providers to ‘talk’ about issues that patients are brave enough to bring up. They will often only bring it up once, especially embarrassing topics that are difficult to discuss. We need time to listen to patients and address their concerns in real , solution oriented ways. This patient, after so many years can use vaginal estrogen cream. Even if she could not, there are options with dilators and anesthetic topical agents to allow the increase in the caliber of the vagina. With estrogen cream, this will allow a more accommodating vaginal canal more quickly. I am starting a treatment plan that assesses her theraputic response and supports her along the way. We have ordered some dilators for her and plan to help her and her husband learn how to use them. There is a physical therapist I work with that can help them if necessary. I want to help her re-kindle her physical connection with her husband, and I believe this is entirely possible. I hope providers would help patients with sexuality concerns in real, practical ways or refer if they are not comfortable treating these disorders. This patient left with hope and feeling heard. She was grateful. Female sexual response can continue into your 70’s if you want it to. The anatomy and neurons will allow it with some help. The physical connection can continue. Dr N

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