Q: After too many urinary tract infections I was finally diagnosed with neurogenic bladder through specialized tests. For three years I was on a medication to encourage emptying of the bladder, which cut out the infections My main issue (now) is dryness in the vaginal/urethra area. The doctor jokingly said I needed a dermatologist. She gave me an estrogen cream, which burned so badly I gave it up in three days; also, my mother had cervical cancer from hormone therapy during her menopause. I've been trying various creams to ease the burning and dryness and am now trying pure glycerin. I also have used Monistat's itch-relief cream, which has 1 percent hydrocortisone. My question is: are these OK to use daily in that area? Should I see a dermatologist? My urologist has no answers for me, other than hormones, which I flatly refuse to use. She did recommend Aveeno's Oatmeal Bath & Bodywash. Many older women with this problem may not want to use hormones. There must be a holistic, natural way. Thank you for any ideas you can share. — Lori

A: This is a very important issue for many women, and I am glad that you have brought it up. When your vagina isn't properly lubricated, it can feel itchy and irritated. Vaginal dryness may make some daily activities uncomfortable, and it can make sexual intercourse less pleasurable. In fact, during menopause, vaginal dryness is a common cause of discomfort or pain during sex (dyspareunia). Vaginal dryness is a common

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condition. It can affect women of all ages. An estimated 10 percent to 40 percent of women who have reached menopause have signs and symptoms related to vaginal dryness. Aside from dryness, some of the signs and symptoms include itching, burning, feeling of pressure, pain or light bleeding with sex and urinary frequency or urgency. Reduced estrogen (female hormone) levels are the main cause of vaginal dryness. Estrogen levels can fall for a number of reasons: menopause, childbirth, breast-feeding, cancer therapy, and surgical removal of ovaries, immune disorders and cigarette smoking. Medications for allergy and cold and some antidepressants, as well as certain diseases, may also be responsible. Douching disrupts the normal chemical balance in the vagina and can cause inflammation, so it is not recommended. A pelvic exam is one way your doctor evaluates and diagnoses vaginal dryness. He or she may take a sample of cervical cells or vaginal secretions for examination under the microscope or to send to the laboratory for other testing. If one is uncomfortable from vaginal dryness, just like you have been, self-care measures can help. Water-based lubricants (Astroglide, K-Y) lubricate your vagina for several hours. Vaginal moisturizers (Replens, Lubrin) help moisturize your vagina and last longer than lubricants do; they may decrease dryness for up to three days with a single application.

Occasional vaginal dryness during intercourse may mean that a person is not sufficiently aroused. Though you may be willing to try just about anything to relieve your discomfort, avoid using the following products to treat vaginal dryness, because they may irritate your vagina: vinegar, yogurt or other douches, hand lotions, soaps, bubble baths. Using Monistat, which is an antifungal cream and hydrocortisone, an anti-inflammatory cream, will only help if indeed you have a fungal infection or documented inflammation. I would NOT recommend using these products without a doctor's supervision.

If vaginal dryness is not corrected by self-care measures, vaginal estrogen therapy may be helpful. I know that you have had a bad experience with it, but vaginal estrogen therapy comes in several forms: estrogen cream, estrogen ring and estrogen tablet. I would encourage you to explore using some of these options again, since they will be the most helpful. I agree with you that it is scary to think about estrogen pills. You may choose, after discussion with your doctor, to use them only for a short time. Research shows that with this approach the risk of cancer as a side effect is very small. Finally, some alternative therapies that have been suggested for treating vaginal dryness include isoflavones, black cohosh and wild yam. However, there's no convincing evidence that any of these therapies are effective. More research is necessary to determine the safety and effectiveness of these approaches for treating vaginal dryness. Because of the lack of evidence I am rather skeptical about trying them. Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or geriatricmd@aol.com.