Dear Dr. Roach: I am 65, and my lady friend is 60. We are still sexually active. However, intercourse is uncomfortable and painful for her. Ive found a website that talks about a laser procedure that is supposed to be the holy grail to make intercourse enjoyable again. I would like some unbiased comments on the procedure as to what actually happens during the treatment. Is it safe, what is the efficacy of the treatment? Ive done the usual internet research but am not sure what to believe. I might add that we have tried different lubricants and non-hormonal creams (such as Replens) with little success. Im aware that there are hormonal-based treatments and would like comments on them if there is time. With this treatment, I am concerned about estrogen during sexual activity. D.S.
Answer: Im not (yet) a believer in laser vaginal regeneration techniques. The Food and Drug Administration has recently issued a warning about these devices: These products have serious risks and dont have adequate evidence to support their use for sexual function.
There are also reports of adverse effects, including pain and bleeding. On the other hand, I have read reports from a gynecologist who has had good results from the procedure. I still cant recommend laser treatment until I see published data on its effectiveness. At least one study has been completed but is not yet published.
Painful intercourse in women is a complicated subject. One common cause is atrophic vaginitis. Vaginal estrogen is an effective treatment for this, and it might be appropriate for your lady friend. I would definitely recommend she find an expert on pelvic pain in women, someone who can provide guidance on the best treatment after a thorough evaluation.
If she does use vaginal estrogen, you should avoid intercourse of any kind immediately after she applies the cream. Estrogen can be absorbed by men through the skin, and although the blood levels are low in male partners of women using vaginal estrogen, there may be effects that werent seen in a short study on the subject. Only a small amount of vaginal estrogen is absorbed into the body: The rest will remain in the vagina for some period of time, which I cannot find precisely defined in published literature. Since most women will use vaginal estrogen one to three times weekly (after initial daily use for one to two weeks), not having oral or penetrative intercourse on the day of vaginal estrogen use would be safest.
