Ask the Nurse

I'm having painful intercourse despite using vaginal lubricants and hormone therapy. I'm a BRCA2 carrier with a history of ER/PR positive breast cancer. My main problem is pain with increasing vaginal dilation during intercourse. I don't have pain with initial penile insertion or with insertion of a vaginal probe during a pelvic ultrasound. Will pelvic floor stimulation or perhaps the Mona Lisa Touch treatment help painful intercourse?

Painful intercourse (dyspareunia) is not just due to vaginal atrophy, which is also known as Genitourinary Syndrome of Menopause (GSM) but also vaginismus or muscle spasm of the vagina and pelvic floor.

GSM is best treated with very low dose, local vaginal estrogen therapy like the lowest dose 4mcg of vaginal estradiol inserts that are effective and usually safe to use in breast cancer survivors. In addition to estrogen therapy, lubricants and vaginal moisturizers can be used as needed in conjunction with your breast oncologist and women’s health physician.

If you want to avoid local vaginal estrogen and/or it is not effective, then talk with your physician about using local vaginal DHEA. It contains no estrogen and does not carry a boxed warning and allows the cells in the vagina to make the right levels of hormones on their own without affecting the uterus or breast.

It sounds like you may have underlying pelvic floor dysfunction or muscle spasm especially when this only occurs when the vagina is stretched. You will need to schedule a visit with your women's health physician to be evaluated with a pelvic musculoskeletal examination. In majority of cases, female pelvic floor physical therapy is beneficial to work on pelvic floor exercises to help relax, stretch, and strengthen the muscles of the lower pelvis.

In regareds to using the relatively expensive laser therapies by treating the vaginal mucosa with the CO2 laser Mona Lisa Touch, the FDA has recently issued warnings about these laser therapies.

All my best,
Speaking of Women's Health Nurse

January 22, 2019 at 11:05am