Can anything be done for bleeding, painful sex at site of very old episiotomy site?

[highlandheart1961]

I am 51 year old woman and had a hysterectomy in 1991. I only have 1/2 of one ovary left. Blood tests have shown that I am post menopausal. I have been married to the same man for 36 years and we have 2 grown children. He is 55. We are both still very much in love and would love to express that by having intercourse. I am having severe pain during intercourse and began to bleed every single time we made love. Pretty soon, I was turning my husband away and I don't want to do that because I love him and I USED to enjoy sex with him and would like to again. My family doctor, who also does my pap smears has examined me and as soon as she inserted the speculum, the thin skin around the vaginal opening (basically where my very old episiotomies were done)  tore and began to bleed. Very painful as well. She placed me on a low dose of hormone cream based on some kind of mathematical formula based on the results of my hormone blood work, hoping that it would thicken the skin that was tearing. I'm not crazy about taking hormones due to the cancer risks. I don't smoke but I am overweight. I took the hormone cream for 1 month and there was absolutely no changes in pain or the tearing or bleeding. The area continues to tear, bleed and cause severe pain with intercourse. so naturally, it has now been months since I've been able to have sex with my husband. I'm really becoming depressed over this, as is my husband. Can you PLEASE make any recommendations? I feel so very sad and frustrated. I would also like to mention that just recently, within a few months, I began hiking and afterwards, especially the next morning, My lower abdomen where I used to have pain associated with menstrual cramps feels like there is a ton of bricks sitting there and I can barely raise up straight and walk for a few days afterward because of the pain and heaviness. I don't know if that also has something to do with me getting older and the thin vaginal tissue? Thanks so much.

[highlandheart1961]

Thank-you. I appreciate your answer. I'm asking around now, trying to find a good OBGYN. I haven't had one since my hysterectomy in 1991. I've been going to a general practice MD for so long, I just took it for granted that they would be able to take care of this problem. Now, I understand how important it is to see a specialist. Again, Thanks for your advice.

[J. Kyle Mathews, MD, DVM]

Sorry to read of your problem.  Estrogen cream vaginally will usually help this issue but must be used indefinitely.  I usually have my patients use one gram vaginally at night for 2 to 3 weeks and then use it three times a week for maintenance.  Should this not alleviate the problem, I would suggest you see your OBGYN for consideration of other treatments.  Sometimes steroid cream can be helpful.  If all treatments fail.  The area can be surgically revised.  Thank you for your question.  J. Kyle Mathews, MD