Vaginal atrophy, dryness, and lack of flexibility


Dear Sex Counselor,

I am postmenopausal - I have vaginal penetration issues that are severe, tearing and extreme dryness as well as progressive desensitization. I am looking for ways to renew vaginal tissue and increase elasticity.
Where do I begin...massage vibrator? moisturizer? kegel exerciser? estriol creams?

You want to begin with reading through the Vaginal Renewal program that we have put together.

For women with severe dryness, we recommend daily moisturizing usinga hybrid lubricant such as Sliquid Organics Silk, Erosense Sync, or Oasis Silk.. If you find that none of these work for you (some women are sensitive to this product), then we recommend trying the  Sutil Luxe or Slippery Stuff lubricants as a good second choices.

You will also want to do daily internal vaginal massage with a vibrator. Choose the size of the vibrator by deciding how many well-lubricated fingers you can comfortably insert into your vagina when you are not aroused. Then measure that width - this is the width of the vibrator you want. Many women who experience severe dryness and inelasticity have to start with the Massage Wand Size 1, which is the slimmest vibrator of its kind available. As your skin becomes more flexible and develops more of a cushion, you can increase the width of the vibrator you are using until you work up to the widest size listed next to the article. If your partner is wider than that, we can help you choose the next one.

In addition to following the Vaginal Renewal program, you will want to do Kegel exercises daily, following the instructions in our Pelvic Floor Health for Women brochure.

You don’t have to use a tool, but if you have trouble locating your pelvic floor muscles, a tool helps you find them and be sure that you are exercising the correct muscles correctly.

These exercises will help to increase the flexibility of your pelvic floor muscle, and learning how to do the full, deep relaxation of that muscle at the end of each exercise will help you relax the pelvic floor when you are ready to enjoy penetration again.

You also want to try to have one orgasm a week, either on your own, or with the help of a partner (but no intercourse for the first month - so partner play should be focused on oral or manual stimulation). If you are having trouble with sensitivity, using a vibrator for external stimulation can be helpful. This will also increase blood flow to the tissues, encourage regular firing of the nerves that respond to sexual stimulation, and exercise your pelvic floor. If the vibrator you have for vaginal massage isn’t strong enough, get one that is stronger.

Estrogen cream can speed up the recovery of your skin, but is not necessary. If you want to use it, then go ahead and get a prescription from your doctor. You can stop using it later if you wish. If you are a cancer survivor, then talk with your oncologist before using any estrogen product.

As for change in sensitivity...the massage, orgasms, and pelvic floor exercise will help. The other things that will help are to exercise your body every day for at least 30 minutes, vigorously enough to sweat, and follow a "good sex diet" that increases blood flow and sensitivity.

Here are our guidelines for the AWT Good Sex Diet:

  • Eat 1 - 2 oz. of dark chocolate (70% or higher) a day
  • Drink green tea if you can, or Rooibos (Red) tea if you don’t like green tea or want something without caffeine. As much as you enjoy.
  • For protein choose beans, chicken, turkey, fish (ocean fish, not whitefish) that is wild caught, and only grass-fed beef.
  • Eat lots of differently colored vegetables. 3 - 5 servings (or more) a day, including broccoli, leafy greens, carrots, etc. Only eat yellow or blue or sweet potatoes, not white. Eat corn only occasionally, and only fresh sweet corn, not creamed or otherwise processed.
  • Eat lots of fruit, especially apples and berries, 2-3 servings per day.
  • Eat at least 1 oz. of nuts, walnuts or almonds are good, per day. Eat nuts as a snack when you are hungry to satisfy your hunger and stabilize your blood sugar.
  • Cook with healthy oils like Canola and Olive Oil. Avoid trans fats completely, and use butter sparingly.
  • Avoid white flour and white sugar. Use whole wheat flour and honey or fruit sweetener or agave syrup when making sweet desserts, whenever possible. If you really must eat a piece of cake or have some ice cream, eat a hand full of nuts along with it to balance out your blood sugar.
  • Drink lots of water. Filtered tap water is fine.
  • Supplement your diet with 1000-2000 mg of Fish Oil, a basic multi-vitamin (Theragran M is a good choice), 2000 iu of Vitamin D3 and 250-500 mg. of Calcium Citrate (no other form) for maximum protection against cancer and maximum help for your cell membranes.
  • Did I mention chocolate?

A good couple of books to help you with this diet:

  • Eat, Drink & Weigh Less by Walter Willett MD and Mollie Katzen 
  • Great Food, Great Sex by Robert Fried and Lynn Edlen-Nezin 
  • The Hardness Factor (not a cookbook, but still an excellent book overall) by Steven Lamm MD 

All of this should help get you to a place where penetration is more comfortable and orgasms and arousal happen more easily.

If you have questions on any parts of this program, drop us a note or give us a call.

Thanks for the question!
The Sex Counselor