A number of my female patients are indigent and smoke. What can be used to treat vaginal dryness and decreased libido in these women? — MaryLou Potts, ARNP, Ocala, Fla.

For women with vaginal dryness, topical lubricants can afford relief. There are numerous low-cost OTC lubricants to choose from, but a woman who uses condoms or a diaphragm should be steered towards water-based lubricants only, as oil-based products may break down latex and thus decrease the efficacy of her birth control or STD-prevention method.

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If the patient is not using one of these latex-barrier methods, olive oil or 100% pure coconut oil can be used for lubrication. For peri- or postmenopausal women who are experiencing vaginal dryness from vaginal atrophy, topical low-dose estrogen in the form of a ring, a cream, or a pill can also be used. Smoking is not a contraindication for such products.

For virtually all women, I consider the complaint of a decreased libido a symptom rather than a disease. A thorough history and examination needs to be obtained to assess for the underlying cause of decreased libido. Such causes include dyspareunia (caused by vaginal dryness, vaginal infection, uterine fibroids), depression, certain medications (e.g., selective serotonin reuptake inhibitors, antipsychotics, antiepileptics) relationship issues, substance abuse, stress, fatigue, body issues, and lack of privacy.

In addition to treating any underlying issue that is causing or contributing to a woman’s decreased libido, I recommend that providers discuss how sexual desire varies from woman to woman. Libido can also vary tremendously within one woman’s life span, depending on external circumstances. All of this is quite normal. Listening to the patient’s story and normalizing her experience (if no pathology is found) will likely be more therapeutic than experimenting with one of the many unproven pharmaceutical agents now available. — Mary Newberry, CNM, MSN (181-2)