Question: Does the clitoris dry out after menopause? I inadvertently dried out my clitoris following a treatment prescribed by a gynecologist to get rid of a small cyst-like pimple that had developed from an infection in the area. As I am 60 my doctors want to give me estrogen to get rid of the dryness. They assume that the problem was aggravated by my age. How does the clitoris become lubricated? Would reduced levels of estrogen affect the level of lubrication? Is there any thing else I could do to restore the normal level of lubrication in the area? It hurts to walk, sit, and have sex.

Answer: The hormone estrogen is responsible for genital lubrication and sensation. When estrogen production increases during puberty the oil and sweat glands in the area become more active, and the vagina and cervix start producing fluids as well. This acts to keep the vulva moist. The glands around the clitoris also produce sebum that lubricates it; when it collects it is called smegma. When menopause occurs estrogen levels decrease, if not before menopause, and vaginal dryness and painful intercourse can occur.

You will likely need to take estrogen in two different forms, orally and topically. They each affect the body in different ways. The estrogen cream will help with your decreased lubrication and possibly increase your sensitivity to sexual stimulation. You may also want to be prescribed testosterone to help increase your desire for sex and improve your sensitivity to sexual stimulation. Testosterone is available in pill and cream forms and each affects the body in different ways. Estrogen replacement therapy suppresses your natural testosterone level, which is likely already decreased because of menopause.

A word of advice, request that your doctor prescribe a human estrogen, not Premarin, a horse estrogen.

A good source of information on hormones can be found at the link given below. The women in this discussion group are very familiar with hormone replacement.

http://groups.yahoo.com/group/VulvarDisorders

Two books to consider reading are "For Women Only" by Jennifer Berman M.D. and Laura Berman Ph.D. and "Screaming to be Heard" by Elizabeth Lee Vliet, MD. The first book is about female sexual dissatisfaction and discusses hormone replacement therapy and the second hormones.

Her Follow-up E-mail #1:

I dried out my clitoris by following a treatment a gynecologist prescribed to get rid of a cyst-like pimple that had developed in the clitoris from an infection/inflammation. The treatment: every night I applied betadine solution directly on the clitoris, took a 15 minute sitz bath in non-oilated Aveeno, and then blow dry it with a hair dryer. Unfortunately he had me doing this for nine weeks - I finally went to my gp [general practice] in excruciating pain who discovered the dryness. Because I am 61 (went through menopause five years ago) - she had me apply Premarin cream (and cortisone) directly on the clitoris - every day - for three weeks, then every three days for a month and a half. This reduced some of the dryness but left me with a "burning" clitoris especially when I walk. The Premarin cream really burned at times - and puffed up the labia.

My dermatologist has me using Premarin only in the mouth of the vagina (10 days on and 10 days off) as she feels I have over treated the clitoris. There has been improvement but it is slow as my walking and urinating irritates it.

Unfortunately I cannot take estrogen orally as it affects my circulation. Fortunately (or unfortunately given the state of my clitoris!) I have a very healthily sex drive. My husband and I were having sex three times a week until this happened. I am sure this will return once the discomfort in the clitoris is dealt with.

I had my estrogen level tested in Germany last October and the doctor said it was high for a woman my age.

I am going to a gynecologist who is a specialist in sex medicine on Tuesday so your information is very timely. I am also going to see another gynecologist on the same day that believes in alternative medicine so I will have some options on how to treat this.

Her Follow-up E-mail #2:

I have a diagnosis of my problem. It seems that I have a small sore on the left "leg" of my clitoris that has not been able to heal - or is healing very, very slowly. This probably developed when the area was very dry - and may have been aggravated by my walking and use of Premarin cream in the area. Both gynecologists I saw yesterday agreed on the diagnosis (I can actually see the spot with some stretching of my head) - and the treatment.

Because the clitoris is a male organ they are giving me a small amount of testosterone to apply to the sore to help the skin heal. I am also to apply some ozonated olive oil over the testosterone to keep the area lubricated. I am to do this once a day. Estrogen cream would be of no use in this instance. (The testosterone is being sent to my house tomorrow. I have already used the ozonated olive oil twice and it has helped. The purpose of the ozone - to bring oxygen to the area to help it heal faster.)

The Premarin cream that I was using in the mouth of my vagina has left me with skin irritation there and in the vulva area around it. I have been given some Estradiol (#?) [17b] to apply to that area to help clear up the irritation. Both the estrogen and the testosterone are being mixed especially for me in a hypoallergenic base. The doctors do not like Premarin cream because it contains so much "garbage" to preserve it so that it has a longer shelf life. In particular the alcohol in the cream causes real irritation. "The only thing you should do with alcohol," the one gynecologist said, "is drink it." The interesting thing in this - I mentioned the alcohol to my dermatologist - and she said that that was a preservative and not "that kind of alcohol" and should not cause any problems. The gynecologist's answer to this was: alcohol is alcohol.

At least I know a) I have a real reason for my discomfort and b) I was right to say that the creams that I had been applying were making matters worse. If you are interested, I shall let you know how the treatment works and how long it takes.....

Her Follow-up E-mail #3:

Finally I can repy with some good news.

The treatment worked! It took about seven weeks for the "ulcerated area" to heal. After three weeks of treatment the open sore was gone to be replaced by a small "blister". I started walking longer distances (2-3 miles at a stretch) after three weeks, climbing mountains, swimming after five weeks. I was able to use my clitoris (gently!) after about five weeks of treatment. However, the testosterone made my clitoris very sensitive so, for example, it would ache when I was in an highly air conditioned space (particularly near the frozen food sections of grocery stores!). I was also feeling more discomfort than I normally would because of the effect of the testosterone.

I saw the doctor the last week in August - and as I said - the area had healed completely. I did have some minor skin irritation inside the clitorial hood which was caused by some estrodial cream that had worked its way in. I also had some minor vulvitis which was probably also a reaction to the estrodial cream. Both the testosterone and estrodial creams were "hpyoallergenic" - using a lecithin gel base and generally gave me no serious problems.

I have been off all creams now for the past three weeks and the vuvlvitis, skin irritation are completely gone and the clitoris is much less sensitive - I would say it is almost completely normal. I still have some minor burning in the area which occurs when I sit or move in a certain way. This is getting less and less. This is probably the healed skin stretching. I would assume there is some scar tissue there. I will see the doctor the end of November - but as I say, all looks well. The doctor will be writing an article about this for some medical journal. He even took pictures! Before and after.

The hardest thing to cope with now is my mental state. Because this has gone on for so long (14 months) and involved a number of different problems - each one healing only to be superceded by a new problem caused by the treatment for the old problem - I won't believe it is over, until it is over.

In the end, I have found four wonderful doctors, made some new friends - and have no problem talking about my clitoris to all and sundry. And, I even know where it it! Thanks again for the website and the info - it was a godsend.

My Reply to Her:

There are pre/post menopausal women who always need to use a little Estrodial or estrogen cream to keep their vulvar tissue healthy. If you should notice any dryness, irritation, etc. that has no apparent cause, you may have developed Atrophic Vaginitis. You can read about this on the Health page.

The emotional distress associated with any chronic illness can be hard to over come. Many people do not understand how such a "little" problem "down there" can have such a major and negative effect on a woman's life. Many of the women on the Vulvar Disorders discussion forum have had the same experience, or are currently experiencing the same. You may want to seek or provide emotional support there.

Her Follow-up E-mail #4:

I should add that the Dr. did give me some Estrodial for the tissue around the opening of the vagina in case I needed it. I am also using a progesterone (natural) in a gel base which I apply twice a day to different spots on my body. Studies have shown that the progesterone level in post menopausal drops to zero, whereas the estrogen level is at 40- 60% of what it was before menopause. A number of gynecologists - mine included - argue that it is better to restore the balance between progesterone and estrogen (and testosterone) in the body than to focus on increasing the estrogen levels. Besides, there are less side effects from progesterone than estrogen. The progesterone should help with any dryiness in the vagina (something I have not experienced yet). I have only been on this treatment for two months - and aside from the "odd accident" to my clitoris - I really had had no problems with menopause.


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