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Dear Aunt Vadge,
Married 30 years to the same partner. Years ago I had two Bartholin’s gland cysts, and a 1996 emergency operation with dirty instruments left me with herpes. Now I’ve suddenly developed pain with sex, and might have Epstein-Barr virus. I’m very dry.
My doctor gave me a hormone cream for extreme dryness, and I use coconut oil, but sex is too painful. There may be mould in the house (I’ll get it tested). Nobody knows how to help me. I get glutathione shots from a naturopath, have acupuncture, eat organic, and don’t drink or smoke.
Help!
Blessings,
N.
Age 71, California
Dear N,
You’re clearly a brilliant carer of yourself, so it’s maddening to be stuck – so here’s a clearer lead than ‘nobody knows’. At 71, with extreme dryness and newly painful sex, the overwhelming likely driver is genitourinary syndrome of menopause (atrophic vaginitis). Without oestrogen, the vaginal tissue thins, dries and loses its stretch, so it tears and stings the moment anything touches it.
EBV or an old herpes history can add a layer, but they’re not what makes a vagina this dry – the atrophy is the main event, and it’s very workable.
First, make the oestrogen cream actually work. Local oestrogen really does rebuild atrophic tissue, but only if it’s used consistently as maintenance (typically a loading phase, then two to three times a week, ongoing), not dabbed on just before sex – and it takes several weeks to plump the tissue back up.
If you’ve been using it sporadically, that alone could be why it ‘isn’t working’, so ask your doctor to confirm your schedule.
This is also where your naturopathic leanings can really help, alongside the cream. There’s real research behind sea buckthorn oil for vaginal dryness, used both orally and locally – a lovely science-meets-nature option to discuss with your naturopath – and phyto-oestrogens from food and herbal medicine add a gentle, weak oestrogenic nudge on top.
A regular vaginal moisturiser used a few times a week (different from lube at the moment of sex) makes a real difference too, with even a study on olive oil plus gentle vaginal exercise behind it. Just choose carefully, since many over-the-counter moisturisers contain contact allergens. And for stubborn atrophy, laser or radiofrequency treatments stimulate the tissue to make its own moisture and can be worth exploring.
Whatever you do, please don’t push through the pain.
Give the tissue real time to heal before trying sex again, because repeatedly having painful sex teaches your body to brace and fear it, building a pain-and-tension cycle on top of the dryness as the pelvic floor starts guarding. When you do return to it, go slow, warm up for a long time, and use generous lube plus your maintenance moisturiser.
On the EBV and old herpes threads, if you’re getting actual ulcers or recurring sores (not just dryness), that’s a separate, treatable antiviral conversation, and our EBV-and-the-vagina article will help you tell whether it fits.
Your picture is complex and individual, so take this to your naturopath and doctor and push them on the atrophy specifically – but please know it’s a well-trodden, fixable problem, not a dead end. You’re doing so much right.
Blessings back to you,
Aunt Vadge
This is general information based on current research and our clinical experience, not a substitute for personalised medical advice.
