Ask Dr. Hilda

Question: I am a 44 year-old newlywed for the first time!! Unfortunately, I am going through the change and I am experiencing vaginal dryness so bad that my husband cannot continue to perform. He is feeling inadequate of pleasing me and I am feeling very depressed about it. I have spoken to my gyn but she does not really pay much attention to my issue and I think I need to find someone who can talk to me. I have lubricants but this is not satisfactory to my mate or to me because it is not natural.† Can you give me any ideas of what I can orally take that can perhaps lubricate me from within? I take vitamin E pills and take showers in organic coconut oil to lubricate my skin but that is not working I am not ready to get on another hormone pill from the doctor because I just got off of the Angeliq pill for hot flashes at night.† I used that product for about 4 or 5 months, but could not handle the side effects I was having.

Dr. Hilda, please help me, I am so worried about the changes I am going through as a woman but also canít make my husband understand it is not him, it is what is going on inside of me.

Answer: Congratulations on your marriage! Vaginal dryness is the most common complaint of women as they enter menopause, and is due to the loss of estrogen hormone. We can replace estrogen either systemically with pills, patches and creams, or locally. I recommend local estrogen therapy with either a Estring, a ring that stays in your vagina for 3 months before being replaced, or the Vagifem suppositories that are placed twice a week. Estring and Vagifem release small amounts of estrogen daily that is absorbed into the tissues of your vagina, making it moist. It can take 4-6 weeks before you see a significant difference, so be patient.

In addition, you should use a vaginal lubricant every time that you have sex. Lubes may not be ďnaturalĒ but neither is painful sex! My favorites are KY Intrigue (especially good for menopausal women because it lasts a long time,) and KY Silk. Astroglide is another popular lube. All can be purchased at your local pharmacy. You can make lubes feel more ďnaturalĒ by adding them to your foreplay. You rub on him, and he rubs on you. That way, you have two slippery surfaces rubbing against each other!

And remember, women need a lot more time devoted to foreplay as we age. Let your man in on that little secret! --Dr. Hilda




Question: I was reading your q&a's and I noticed that the question about the whole masturbation and orgasm answer which helped me, but I have a question. When my boyfriend and I are having sex, I've noticed that when he performs oral sex the intensity of the orgasm is way smaller than when I masturbate and as well, I noticed that during intercourse, I get to the high but I don't feel the same release as when I masturbate and I just feel partially satisfied afterwards. Is this normal?

Answer: Yes, it is for many women. The reason you have your strongest orgasms during masturbation is because you are able to focus solely, and intensely, on your own pleasure. There is no one else there to distract you or demand your attention. You donít have to worry about whether he is enjoying himself or will come too soon. You know where your trigger spots are, and how to stroke them, in a way that no one else does. You can fantasize freely, without distractions, and that increases your arousal. You can slow down, rest, start again, and tease yourself until you are ready to blow. See what I mean? No man can duplicate that! But oral sex and intercourse have other benefits, like connecting with a person that you care about and providing some variety in your sex life. It might help to show your partner exactly what works for you by letting him observe you masturbate. He might just turn out to be a fast learner! --Dr. Hilda




Question: Dr. Hilda I've tried many times but I've never been successful at pleasuring myself. My fiance' has no problem pleasuring himself yet I feel a tinge of jealously because he can do it but I can't. Its as if I absolutely need him to get off yet he doesn't need me. Btw I'm a 40 year-old woman and I'm not sure which way to go with this. Have you ever encountered women that are unable to masturbate? Any suggestions?

Answer: Yes, I have encountered many women that are unable to find pleasure in masturbation. The female body is covered with sensitive nerve endings that are capable of providing supreme pleasure. The clitoris, the female center of pleasure for most women, is covered with 8000 nerve endingsómore than the head of the penis! And the only purpose of the clitoris is pleasure. Yet many women are consumed with guilt and shame when they even think of masturbation. Some women are able to indulge, but then feel shame after experiencing orgasm. So if you received negative messages about masturbation while growing up, it may be difficult for you to relax and enjoy the pleasure.

In my opinion, masturbation is not only natural, it is the best way for women to learn about their bodies, how to experience orgasm, and how to have the best sex life possible. I recommend that you change any negative messages that you may have about self-pleasuring into positive ones. Then take the time to explore your body and find your most sensitive spots. Sometimes adding a small vibrator makes the introduction to masturbation easier. So get busy exploring at least once a week. Doctorís orders! --Dr. Hilda




Question: Hello Dr. Hilda, I am 29 years old and I have grey vaginal hair. I normally just shave it and keep it moving, until now. Its beginning to trip me out at how much more grows back! My mother has it and has always from her early 20's as well. My other sisters don't suffer with this! What does this come from, and do you have any suggestions on how to get rid of this?

Answer: It always amazes me how having gray hair down there is so much worse than having it on our heads. Rest assured that having gray pubic hair does not mean that your genitals are aging prematurely. And if he gets that close to your vulva he is not worrying about the gray hair. But if it really bothers you, continue to shave. That is better than applying harsh dyes. How will you ever explain your gray roots? --Dr. Hilda




Question: I have cysts on both of my ovaries and I have had them in the past and have had them surgically removed. I want to know outside of surgery for the second time, what are some options for getting rid of the ones I have and/or keep more from returning? They are not cancerous. My doctor has asked me if I wanted to have another surgery and she also asked me if I wanted to have a hysterectomy. I am only 40 and I refuse to have a hysterectomy. My Dr. suggested that I try the birth control shot called Lupron. She says that's one way of keeping me from having a cycle which may keep the cysts from returning. But she says that's not even 100 percent. I've contacted you, hoping to get some other options or at the very least some helpful feedback.

Answer: Benign simple cysts are common. If they are small, simple, are not growing and not causing pain, you might just watch them and do nothing unless they begin to change. Taking birth control pills often decreases the size of simple cysts and decreases the chance that they will return. You should not take birth control pills if you have a history of blood clots, breast cancer, hypertension, or you smoke. Speak to your doctor about whether pills are right for you. Lupron causes a ďmenopause-like stateĒ and should not be used for more than a few months without additional hormones. --Dr. Hilda




Question: I am 34yo mother of 5 (last 2 were twins). Since their delivery and a tubal, 4y ago I have had cramps that feel like labor pains. I take motrin like candy during that time. If not I feel like I'm dying. I use pads and tampons and I change every 2 hours just about and still soil my clothes. I was told I have fibroids and I need to have them removed. My husband and I doesn't want anymore kids. I have been leaning toward a partial hysterectomy. I have heard different reasons on why I should and shouldn't do this. My concerns are what are the chances of them returning. I do not have a strong sex drive anymore since the first kid. We have been together for 18y and so I don't want to make a major leap and will regret it in the future. What do you think?

Answer: It depends. If your fibroids are small, I would suggest that you have a myomectomy, or the removal of the fibroids alone. If your fibroids are large, or you have many fibroids, I would suggest that you have a supra-cervical hysterectomy. In this procedure, the top of the uterus is removed. The cervix and ovaries are not removed, so you will not go through surgical menopause and your vagina is not affected. When you have lots of fibroids, there is a greater chance that the fibroids will return years after a myomectomy. Removing the top of the uterus means that you will not be bothered with fibroids again. But before any surgery, discuss non-surgical options like hormones and uterine artery embolization with your doctor.

Bleeding and pain can kill your desire for sex. You may have an increase in your desire once you have had surgery and are feeling better. --Dr. Hilda




Question: It is always a pleasure to listen to you on the Michael Baisden show. My daughter is 12 years old and started her menstrual cycle when she was 11. She has complained about cramps, so finally I took her to the doctor and they gave her mefenamic acid. She has been on this medicine for 2 months and she still has severe cramps and the doctor said to keep giving her the medication for another 1-2 months. She also throws-up at least 5 times during the first day of her cycle. Her cramps last at least 2 days and she often misses school or other activities. Will this medication (I believe it is an anti-inflamatory) help her and is there anything else I can do for my daughter.

Answer: Mefenamic acid is an anti-inflammatory. It is similar to Ibuprofen that makes up Motrin and Advil. Anti-inflammatory medications are commonly used for menstrual cramps. They work by decreasing the production of prostaglandin hormones that cause cramps in most women. The key is to start taking the medication before you begin your period and take them 3-4 times a day until the period is over. The problem is that you may not be able to predict the period in advance in a 12 year old. If that is the case, you should begin the pills as soon as you have the first sign that the period is beginning. Take the medication with food because it can upset the stomach and cause abdominal pain, nausea and vomiting. Severe cramps can be treated with birth control pills but I would not recommend them in a 12 year old. The good news is that she will probably out-grow the cramps, or they will become much more manageable when she gets older. --Dr. Hilda


Question: I need your advice on how to heal myself. I am 36 years old. I was raped when I was 12 years old. I met my husband when I was 15 and we are now separated and in the process of getting divorced. He was physically and emotionally abusive towards me for the past 8 years. He demanded sex at times right after he was physically abusive with me. I want and need to heal my sexual self because of the negative feelings and emotion I have about sex. I am currently in couseling - dealing with the emotional scars of the relationship. Is there a sex therapist that I should also see?

Answer: I am sorry to hear about your experience. Sexual abuse can have a lasting, lifelong affect on women. You are right to seek counseling. At this point, I would say to continue with individual counseling. Your counselor will let you know when it is time to seek the help of a sex therapist. Certainly, when you begin a new relationship, a sex therapist might be helpful.

Sexual abuse is common. You are not alone. I wish you the best in your quest for sexual and emotional healing. --Dr. Hilda


Question: I have two daughters, 16 and 14 and both of them are very attractive all the way around and I know that the boys are gunning for them. (LOL) I am terrified of them being overly influenced by peer pressure and our overly sexed society to start having sex at a young age. I try to have an open mind and Iím very realistic with the ways of a teenager because I havenít forgotten that I was once one myself. I am a 42 year old man and the biggest thing that I worried about back then was herpes and pregnancy. I can only thank God that Iíve never had an STD and didnít start having children until my mid 20ís. I was listening to you on the Michael Basdin show yesterday and Iím very afraid of my girls making the mistake to have sex early and become pregnant or worst, getting aids or any type of STD. What can I do as a man to keep the doors of communication open and not be too father like to my girls so that they donít make the same mistakes that I did by having sex at a young age. I donít want them to shut down on me and I donít want to be too strict as to put them in the mind set that makes them think that they have to sneak around. My mother was 13 years old and pregnant with me and Iím horrified of the same thing happening to my daughters. Please, please, pleaseÖ.Any advice will be appreciated.

Answer: My advice is to be open and honest with your daughters about sex. Give them the facts, and nothing but the facts. Talk to them about your values but donít try to scare them or make them feel guilt or shame. Educate them about STDs and how to protect themselves, as well as the emotional side of sex. Tell them about the beauty of sex in a healthy adult relationship and give them all of the reasons why young girls should wait to have sex. Let them know that you are available any time that they want to talk.

Children receive hundreds of sexual messages every day from the radio, TV and their friends. You must talk to your children often. Just knowing that you care and are available to them will make all the difference. --Dr. Hilda


Question: I am extremely frustrated while writing this letter. My 5 year niece was recently diagnosed with Genital Herpes. My sister in law has had herpes since she was in her early 20ís and apparently my niece has had some type of contact with either her wash cloth or the toilet seat according to the doctor. The doctor did confirm that she has not been violated but, people need to understand the impact of STDís. How do we explain this to a 5 year old? When she does become old enough to have sexóhow does she explain to her first that she has an STD? Please help me understand this.

Answer: You donít explain it to a 5 year old. She doesnít need to know anything until she is much, much older. For most people, the longer you have the virus, the fewer outbreaks you have. So by the time she becomes sexually active, she may be having very few, if any, outbreaks. The conversation will be easier than you think. But you donít need to worry about that now. --Dr. Hilda


Question: I have a 16 year old daughter and was wondering about the HPV vaccine. Is it safe? In your opinion is necessary?

Answer: The HPV vaccine is safe. It has been shown to dramatically reduce infection with the types of HPV that causes 70% of cervical cancers, and most genital warts. It consists of 3 shots over a 6 month period of time. The vaccine should ideally be given before you become sexually active, but is also effective after a woman becomes sexually active. I do recommend it for a 16 year old. --Dr. Hilda


Question: I'm experiencing vaginal dryness at it's worst, and yes I am going through menopause. Recently, I had sexual intercourse and it was very uncomfortable. As a breast cancer survivor I realize my options are limited as to what I can use. I asked my gynecologist if there was anything else he could recommend besides "Astroglide", he replied no. What do you recommend?

Answer: My first suggestion would be to use Replens vaginal moisturizer twice a week to keep your vagina moist. You can add massages with vitamin E oil if you still find yourself somewhat dry. For sex, I would use a silicone-based lubricant like Eros or Wet. You can buy them on the internet at sites like: www.babeland.com. For some women, none of the lubricants work and a small amount of estrogen is absolutely necessary. For these breast cancer survivors, I recommend Vagifem estrogen suppositories once or twice a week, or an estrogen ring, Estring, that is changed every 3 months. Both release only a small amount of estrogen that does not seem, according to research, to increase systemic estrogen levels. Both are considered to be safe, according to researchers, in women with breast cancer. Speak to your doctor about your risks and these medications. Sex boosts your immune system, so finding a way to continue to have pleasurable sex is important. --Dr. Hilda


Previous Q&As on Sexual Satisfaction

Previous Q&As on Reproductive Health



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