Summertime is high season for gardening.  Pregnant gardeners need to take extra precautions to avoid chloasma and melasma (dark blotches) on the face and neck, protect backs, knees and pelvic support, and avoid gardening aids that may be toxic if inhaled or coming in contact with skin.  For the full scoop on healthy gardening while pregnant read this piece from www.sheknows.com, including content from Dr. R:

Gardening during pregancy – your skin, your joints, your pelvis, your baby!

(c) Amy Wentz

I

For the latest on vaginal dryness in your 40’s and beyond,  enjoy this guest-blogger entry written for Sweet Talk on the Spot. I’m talking user-friendly vaginal estrogens, over-the-counter lubricants, kitchen myths and the latest from Europe.

WD-40

Dr. Romanzi Talks Lubrication After 40Wednesday, April 21, 2010 by SweetTalk on the Spot

Our resident Vaginal Phitness expert, Dr. Lauri Romanzi, educates the SweetTalk community with answers to your most pressing, personal questions.

Q: Dear Dr. Romanzi, Why do women experience pronounced vaginal dryness after 40, and what lubricants do you recommend for women over 40?

A: Aaaah, the Magic of Estrogen.

First, a little background: Before puberty, estrogen levels in girls circulate at a tiny fraction of normal adult levels. At puberty, the ovaries start cranking out estrogen to full – range, grown woman levels, and stay that way til about age 35, when the slippery slope toward menopause goes gently into first gear.

By age 40-45, fertility, skin integrity, bone density, cardiovascular resilience and even memory can be affected as the reduction in estrogen production accelerates into third gear.  For many women this “Change before the Change” is confusing, because they continue to menstruate, and may even become pregnant, as these menopausal symptoms cavort erratically around the edges of their lives. One month is “normal”, the next nutty with late menses, heavy flow or light spotting, hot flashes, night sweats, aches and pains, insomnia and mood swings in a rollercoaster of unpredictability that heralds the life cycle book-end mate to the process of puberty. My New York City colleague, Dr. Laura Corio, coined this phrase, “The Change Before The Change”, and used it as the title of her book on health in the decade before menopause.

Regarding vaginal dryness and lubrication: The vulva, vagina, clitoris and lower urinary tract skin surfaces contain a high density of estrogen receptors, and as these receptors undergo peri-menopausal deprivation in the early to mid-40’s, many women report uro-genital symptoms.  In the vagina, these may include dryness, poor spontaneous sexual lubrication, reduced clitoral sensitivity, difficulty achieving orgasm, and muted orgasm intensity. And here’s the ironic truth – overweight women tend to fare better because body fat makes its own estrogen, called estrone, that, when present in high levels, minimizes the impact of reduced ovarian estrogen production, called estradiol. Skinny women make very little estrone, overweight women make a lot of estrone. Both skinny and overweight women’s ovaries run out of estradiol between age 35-ish and menopause.

A woman who is sensitive to reduced estrogen production in the 40’s and beyond, sex may be plagued by painful dryness that is often frustrating and confusing, both for her and her sexual partner. With reduced estrogen production, the exquisitely estrogen- sensitive skin of the vulva, vagina, and clitoris literally becomes thin, dry, and brittle. As a doctor, I’ve taken care of many women over the years in stable, happy, sexually active relationships who come in to the office utterly mystified by these symptoms, with partners convinced that the women don’t love them any more or accuse them of having an affair. so abrupt and intense can be the sexual impact of estrogen deprivation.

My favorite treatment option for hormone-related vaginal dryness is … hormones: Recoil not, as this does not mean total-body-dose (a.k.a. systemic) hormones. You can use ultra-low-dose vaginal estrogen therapy that rejuvenates the vaginal skin to youthful elasticity, sensitivity, and lubrication. It does this by making those poor, deprived estrogen receptors in the vagina, vulva and clitoris happy.  There is not enough estrogen in these local estrogen treatments to increase estrogen blood levels, and there is no evidence that they increase cancer risks, as some total-body hormone regimens might. Ultra-low-dose vaginal estrogen therapies come in cream (fingertip application), suppository (vaginal insertion) and ring (vaginal insertion 4 times per year) form.  I shared this low dose vaginal estrogen information on the Dr. Oz show a few weeks ago.

Lubricants help with dryness, but will not improve elasticity or sensitivity. The best lubricants are water soluble and paraben free. Glycerin-free lubricants are best for women who cannot tolerate this additive, and silicone based lubricants require less re-application. Lubricants contain no hormones.

Oils and herbs are purported to reduce vaginal dryness, however clinical trials thus far fail to demonstrate efficacy, and oils may throw off vaginal pH or turn rancid, ultimately causing vaginal irritation and possible increased risk of vaginitis.

Several of my European patients are using hyaluronic acid vaginal suppositories, which are not available in the U.S.  These novel vaginal ovules help maintain cellular hydration, and are marketed both for post-operation healing and menopausal dryness.  Given that these ovules contain no hormones, it is likely that this product will not improve sensitivity, but would restore lubrication and thereby improve elasticity.  Catch the red-eye to Paris and let us know if it works for you!

Back to lubricants before I finish: The shop shelves buckle under the voluminous assortment of 21^st century sexy lubricants with additives designed to improve blood flow, enhance sensitivity and super-charge orgasm intensity.  Marketing trials are not the same as scientific, clinical trials published in peer-reviewed medical journals, and it is not clear that the robust marketing claims are born out in the bedroom. That said, if these pumped-up lubricants rock your world, are paraben free and water soluble, have at it!

Plumbing and Renovations was written to demystify prolapse and incontinence. For starters, if you have prolapse, you do NOT need a hysterectomy, even if your uterus (take the kids out of the room) is hitting your knees.
A few reviews from readers:
1 of 1 people found the following review helpful:
5.0 out of 5 stars Informative and a surprisingly easy read!, December 26, 2008
By L. Y (New York, NY) -
This review is from: Plumbing & Renovations (Paperback)
This book truly saved me! After 2 opinions that I should get a hysterectomy, I found an alternative and am now working on my second child! After having my first, I needed help getting my pelvis back in shape. An incontinence issue acquired during my pregnancy also needed addressing. This book spelled it all out for me and with its amazing illustrations and information, I have seen a real improvement all of the way around.
I am hoping to see more of these “Beauty Call” books from this author, as I think they touch on subjects rarely addressed, in a thorough, concise and amusing way. Kudos! <

5.0 out of 5 stars Finally! An intelligent (and hilarious) surgeon, April 7, 2009
By EG “never_enough_books” (Athens, Greece) -

This review is from: Plumbing & Renovations (Paperback)
Ladies, if you have a dropped uterus (you’d be surprised how many women do) read this book first! You probably don’t need a hysterectomy. You also want to read this book if you suffer from a dropped bladder, your vagina is loose, or you want to know what treatments are available to, among other things, improve your sex life. Eminently readable, informative and wise, this book should be issued as a textbook for sex education classes, so thoroughly does it cover the subject of the female anatomy. Dr. Romanzi, I Kegel as I write this. Thanks!

5.0 out of 5 stars A hilarious entree into what your mom forgot to tell you – or never knew, December 30, 2008
By A G (New York) -
This review is from: Plumbing & Renovations (Paperback)
A friend gave me this book and I was SHOCKED by what no one – not your mom, not your doctors tell you. I learned more about my body from this book than I ever could have imagined. Plus, its a riot. It should be recommended reading for women.

(c) Lauri Romanzi 2009

Stress urinary incontinence affects millions of women worldwide. Stress incontinence occurs when the sphincter of the urethra is weak, due to age, childbearing or trauma, and urine leaks out with physical exertion, commonly with sneezing and coughing.  This is “exert and squirt” leakage, and not associated with the sensation of urgency. Leaking with cough, sneeze, lifting, carrying, exercise and dancing are common symptoms for women with this condition.

 A minimally invasive sling may be your best option if these symptoms sound familiar. Learn more here from this Eyewitness News clip:
http://www.urogynics.com/pages/pops/fox.html

More Magazine is in the right place at the right time with the right idea – it’s never too late to live your dream, change your ways and jump-start a new way of being. With their series of day-long seminars on reinvention, the premiere series finishes up with the MORE Reinvention Convention in Chicago on May 15, 2010. If you’re in town, sign up! From finances to business start ups to fitness to health, there’s something for everyone. Dr R will be speaking on the sex and health panel with renowned colleagues Dr Gail Saltz and Dr Madeline Fernstrom. What better time to re-define your life than now? See you there! http://www.moremusthaves.com/2010/reinventionConvention/rc_chicago_speakers.html