Women’s Health

What can I do about vaginal pain during intercourse?

DEAR DOCTOR K: I'm in my late 50s. Lately, I have vaginal pain every time my husband and I have intercourse. I mentioned this to some friends, and it turns out a few of them also experienced vaginal pain, starting around menopause. What is causing this problem? And what can I do?

DEAR READER: If you're in your late 50s, you probably have gone through menopause. At menopause, levels of the hormone estrogen plummet. This causes the vaginal lining to become thin and produce fewer lubricating secretions, resulting in dryness and irritation. The vagina becomes shorter and less elastic, and the vaginal opening narrows. All of these changes can make intercourse uncomfortable, painful or impossible.

Do I need to get a Pap test every year?

DEAR DOCTOR K: I've had a Pap test every year for 20 years, since I was about 25. It's always normal. Do I still need one every year?

DEAR READER: The answer used to be yes. The reason was that doing the test often would help catch cancer of the cervix at its earliest and most curable stage. However, studies showed that less frequent Pap tests for younger women caught just as many early cancers. The studies also showed that many older women with repeatedly normal Pap smears (like you) had an extremely low risk of ever getting cancer of the cervix.

What could be causing my painful urination?

DEAR DOCTOR K: I'm a woman in my 50s, and every so often it is painful for several days when I urinate. The doctor tests me, says I don't have a urinary tract infection, and that there's nothing to do. It's true that it goes away, but I'd like some relief when it hurts. Is there anything I can do?

DEAR READER: Urinary tract infections are a common cause of painful urination, but there are other causes as well. And those other causes can be treated. Here's what you need to know before you talk again to your doctor.

Are there any natural remedies for hot flashes?

DEAR DOCTOR K: I'm afraid to take hormone therapy for my menopausal hot flashes. Are there any natural remedies that work?

DEAR READER: Natural remedies can help for hot flashes, but hormone therapy is helpful more often. For that reason, I'll come back to the pluses and minuses of hormone therapy after answering your question.

Why can’t women drink as much as men?

DEAR DOCTOR K: Can you explain why "moderate" drinking is defined differently for men and women? Is it because men tend to be heavier? Or is there more to it?

DEAR READER: Women are advised to drink less alcohol than men because they are much more vulnerable to alcohol's harmful effects.

What is premenstrual dysmorphic disorder (PMDD)?

DEAR DOCTOR K: I always assumed my premenstrual mood swings were normal. But then I talked to some friends whose emotional symptoms are much less severe than mine. A quick Internet search turned up "PMDD." Can you tell me more about this?

DEAR READER: The physical symptoms of premenstrual dysmorphic disorder (PMDD) and premenstrual syndrome (PMS) are the same. They include fatigue, swollen breasts, backache, headache, food cravings, bloating, constipation and diarrhea. But the emotional symptoms of PMDD, compared to PMS, are much more severe.

Do all cases of DCIS breast cancer need aggressive treatment?

DEAR DOCTOR K: I have been diagnosed with ductal carcinoma in situ. My doctor wants me to have surgery. But recently I read about a study that said not all women with this type of breast cancer even need to be treated. Can you help clear this up?

DEAR READER: Ductal carcinoma in situ (DCIS) is a type of breast cancer. In DCIS, the cancerous cells are contained within the breast's ducts (which carry milk to the nipple) but have not invaded surrounding tissue.

I have pelvic organ prolapse. Are there any exercises I should avoid?

DEAR DOCTOR K: I have pelvic organ prolapse. Are there any exercises I should avoid?

DEAR READER: Pelvic organ prolapse is a condition in which the uterus, bladder, urethra or rectum drop down and press against the walls of the vagina. Normally your pelvic floor -- a sling of muscles and ligaments that stretches from your pubic bone to your tailbone -- holds your pelvic organs in place. Pelvic organ prolapse results from a weakened pelvic floor.

How can I prevent recurrent UTIs?

DEAR DOCTOR K: I'm in my 30s and fairly healthy. However, I keep getting urinary tract infections. My husband and I want to know what I can do to prevent them.

DEAR READER: Many women know well the symptoms of a urinary tract infection (UTI). You might feel a frequent urge to urinate, yet pass little urine when you go. It may hurt when you urinate. Your urine might be cloudy, blood-tinged and strong-smelling. Furthermore, many women have a tendency to get repeated UTIs. UTIs are usually caused by bacteria that live in the gut and are present on the skin around the rectum.