Q. It's been about 10 years since I went through menopause. I recently started using an estrogen patch, but am experiencing a problem with vaginal dryness. Sometimes it's bad enough that it feels like the opening to the vagina is closing. Needless to say, this makes intercourse painful, if not impossible. Will the patch eventually help, or should I try something else?
A. Vaginal dryness is a common problem after menopause. In many women, estrogen helps relieve this condition, but there are a couple of things you can try if the patch isn't working.
After menopause, when the level of estrogen in your body declines, the tissues in the vagina can become thin and dry. Doctors call this condition atrophic vaginitis. It can be severe enough that the tissues will bleed at the slightest irritation. The walls of the vagina can adhere to each other, and separating them can be painful.
If the patch isn't working, ask your doctor about using an estrogen cream in the vagina. It will put the estrogen where you want it to work, and in most cases this will work better for you.
In addition to estrogen, you can use various nonprescription lubricants, such as petroleum jelly, K-Y jelly, Astroglide gel, Maxilube jelly, Replens pre-filled applicators and Lubrin vaginal inserts. (Don't use petroleum jelly with condoms, though, because it can make them more likely to break.)
These over-the-counter lubricants contain slightly different ingredients or mixtures. If you don't like one, try another. However, if your condition is severe, lubricants alone probably won't be enough; you'll need estrogen to help heal the lining of the vagina.
In any event, do not start self-treatment before checking with your doctor. You need to make sure that your vaginal irritation is due to not having enough lubrication rather than a vaginal infection or any of a number of skin conditions.
More on Body Piercing
Q. I was interested in your discussion about the risk of piercing various parts of the body. As a practicing dentist, I would like to emphasize the possible dental risks involved with tongue piercing.
One major risk stems from the large blood supply to the tongue, in contrast to many other parts of the body. Accidental puncture of a blood vessel can cause significant swelling, so much so that it may even make it difficult to breathe. Another problem is accidentally swallowing the jewelry or studs used.
A more common problem is chipping the front teeth. Many people with a pierced tongue "click" the barbell against their teeth, which can crack the enamel--even break a tooth. Occasionally, this can lead to a dead tooth and require a root canal treatment.
Another problem is damage to the gums. The continual rubbing of the jewelry against the gums can strip away the gum tissue. In some cases, this may require periodontal grafting to restore proper gum tissue to support the teeth.
In my experience, many people who pierce their tongue are unaware of the possible complications involved.
A. I received this letter from Eugene Giannini, a Washington area dentist and chairman of the public relations committee of the D.C. Dental Society. As he notes, tongue piercing can pose problems unlike those associated with piercings of other parts of the body.
Besides the complications he mentions, tongue piercing can lead--in rare cases--to serious infections in the mouth. These can spread to other parts of the body. I certainly don't recommend tongue piercing, but if you must do it, it's important to take proper precautions, watch out for any of the complications mentioned above, and see your doctor or dentist if you develop any problems.
Jay Siwek, chairman of the department of family medicine at Georgetown University Medical Center, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.
Consultation is a health education column and is not a substitute for medical advice from your physician. Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, DC 20071. Questions cannot be answered personally.