#vaginal atrophy treatment

[religion-is-a-mental-illness]

I am in pain. Everywhere. All of the time.

It's a burning feeling. Because of the overgrowth at the top of my body that the bottom of my body cannot support. I feel like I'm carrying a heavy weight and I'm hugely disproportionate.

My joints all ache all the time.

You know how when you take a deep breath, your ribs expand? Well, when I do that, my ribs stay open, and I have to put my hands at either of my sides and like, close them back in, or they just stay like that and it hurts. And I believe that's due to binding.

My vocal cords hurt. My original voice was very, very high pitched. And my singing voice is gone. Were I to be in danger, there's no way for me to scream. And even just talking for long periods hurts.

I was told that I would have vaginal atrophy, but I didn't know what that meant. Vaginal atrophy involves the shrinking, thinning and pretty much disintegration of the vagina. Mine is so small that I can no longer use tampons.

I did not know that this was going to happen to my body when I gave "informed consent."

==

This is what "gender affirming care" looks like.

[drvidushimehta]

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[parintha]

Vulvitis Treatment Vaginal Atrophy

Vulvitis treatment focuses on relieving inflammation and discomfort in the external genital area. It typically involves identifying and addressing the underlying cause, such as infections, irritants, or allergies. Common approaches include topical creams, soothing baths, proper hygiene practices, and avoiding triggers. In some cases, medications like antifungals, antibiotics, or corticosteroids may be prescribed to manage symptoms and promote healing. Consulting a healthcare professional is essential for accurate diagnosis and tailored treatment. Read fulll information on Parintha.com about white discharge kyu hota hai?

[nothorses]

hi sorry to bother u about this, i searched around transmasc subreddits for an answer to this and while i saw a few people joking about getting dry cramps, nobody seems to know what this is. and i vaguely remember seeing a post by you mentioning "mystery cramps" in a post also about vaginal atrophy, but I didnt pay attention to the post much at the time bc at that point i wasnt experiencing atrophy or mystery cramps.

but now I'm a bit over a year on T, (my periods stopped only about 4 months ago though, because i was on a much lower dose than most for a lot longer time than most. that ~4 months ago time frame lines up with upping my dose from 0.2 to 0.3ml. i'm on 0.4ml tho now as of about 3 weeks ago) and suddenly i'm getting "mystery cramps" sometimes, it seems to happen especially the night before my T-shot day, (but i cant say that with certainty—i know i'm having them right now and my shot day is tomorrow morning, and i think thats been the case, but i dont know for sure) and they feel exactly like period cramps. to the point where i feel super paranoid that maybe i've been injecting improperly and the testosterone isnt absorbing right and my period is actually coming back. (something i often have nightmares about)

i searched your blog again for that post and did find it, (the one about estradiol cream treating it) but the wording of it is a little unclear and i wanted to just clarify that this is the same thing youre talking about? or if what im experiencing is different than the "mystery cramps" you meant and i should see a doctor

I am for sure not a doctor, and I think you should see one either way!

My personal understanding of the "mystery cramps" is that it's a part of "vaginal atrophy" that some, but not all trans folks who go on T experience, and it usually doesn't start until a couple of years on T ( which is also, to my knowledge, based on more standard doses as opposed to "low-dose" T).

Mine started about two years in, and was happening occasionally at first- always at night, and often the day before my T shot- then progressed to several nights a week over time. Nowadays I tend to experience cramping almost every time I so much as miss one dose of estradiol. Ibuprofen and Midol are the only OTC pain relievers that seem to do the trick, and the cramping will keep me up through the entire night untreated. It also tends to come in fairly predictable waves (spaced maybe 15-30 minutes apart) and right before I started estradiol, I remember getting some light spotting as well.

iirc, I talked to my PCP when it was just starting up, and their response was along the lines of "that's weird, let's keep an eye on it". I moved and didn't have a PCP for a while, so when the spotting started, I went to a walk-in urgent care clinic and talked to them. They gave me a referral for an ultrasound, and encouraged me to go to a "women's health" clinic that had long history of specializing in trans care as well. When I talked to the folks at that clinic, they encouraged me to go through with the ultrasound (I didn't), and prescribed estradiol cream because I asked them to and they didn't see a reason not to try it.

If you think it's possible this is what's going on with you, I would really encourage you to talk to a doctor, specifically bring up research around this issue and estradiol cream as a treatment option, and ask them if there's a reason not to try it just to see if it does anything for you. If nothing else, estradiol cream also treats vaginal dryness, tightness, and inflammation (other symptoms of "vaginal atrophy"), so it might be worth a shot for those reasons anyway!

And don't do what I did; if they want you to do an ultrasound or whatever else, go with it, and rule out other possibilities. Listen to medical advice from medical professionals who know your medical history and who you trust are listening to you & know what they're talking about.

[batmanisagatewaydrug]

Hi sex witch!

I’m FtM, and I don’t have penetrative sex at all. It’s unpleasant and not at all enjoyable to me in any form. With that in mind, I’m on hormones, and am worried I might get vaginal atrophy and not notice since I don’t use that area of me at all. How do I tell if I’m starting to atrophy without that sort of experience?

Also, I heard that you only have to start getting pap smears and stuff once you start having penetrative sex, but I’ve never engaged with a partner in that way, just a toy I bought to experiment with (waste of money rip). Should I still go at some point?

hi anon,

topical estrogen treatments are generally used to help treat vaginal atrophy; this doesn't interfere with or counteract your HRT in anyway, just helps keep your vagina strong and healthy. signs that it may be time to pursue this options include persistent genital discomfort such as dryness, itching, burning, and painful or frequent urination, although of course it's best to consult with a healthcare provider if you're worried.

it's recommend that you start getting pap smears at age 21 even if you've never had partnered sex. I would personally say it is worth it, since pap smears are important preventative care that can serve as an early warning for cervical cancer. while the odds of developing cervical cancer without ever having partnered sex are low, it's also not a chance that I'd personally recommend taking.

[scientia-rex]

I got home from work today sneezing my head off with a right eye that won’t stop watering, took a hot shower, climbed into bed, and I haven’t climbed out since. I’m grumpy and I have a headache and if I’m not testing positive for COVID or debilitated by symptoms tomorrow I’ll still need to go to work because that’s twenty patient visits that would need to be rescheduled, usually with someone else, and that’s twenty people I’m letting down. Today I did one of my patented 45-second Pap smears (if it takes longer than that, your doctor needs to get better!) for someone with vaginal atrophy from menopause (it is both very common and very treatable) and she was in disbelief. (This time it was more like 30 seconds.) I saw a suicidally depressed patient who’s clinging to life with both hands and I changed their meds last week and I am not making them wait to see me. I cleaned a wound no one else gave a shit about and I saw a bitter pissy Republican Party bigwig who has terrible anxiety and depression she doesn’t tell anyone about, who’s alienated everyone but who I can still convince to try treatment.

I do my job on hard mode on purpose. I like being important—who doesn’t? I like being legendary, I like that when people move to town and ask for doctor recommendations on Facebook so many people mention me that other patients feel compelled to tell me about it. I got nominated for best doctor in our local region last year. (I didn’t win, out of 5 nominees.) But when I’m sick, when I’m the kind of sick that can be hidden easily, the kind of sick I was always expected to go to school and rotations and residency with, it’s so hard. I hate exposing patients, even to a cold, but the benefits of receiving care are probably enough to outweigh the chance of transmission. I wrestle with myself: if I call in, it starts a ripple effect. Can they get a per diem from their “pool” (of three) to come in? Can they reschedule my patients with me? I don’t have any open spots for five weeks. Can they open same days? None available for three weeks. Can they open blocked spots? That’s going to make my life hell when I come back from being sick. That’s clinic staff calling twenty patients, trying to reach them. That’s twenty patients who feel abandoned. They can know intellectually that doctors get sick too, but they don’t believe it. They take it personally. I have seen this over and over again, until I had to believe it.

It is so EASY for people who don’t do this job to tell me how I’m doing it wrong. “Just stay home!” Oh, okay, you want to tell the person whose chronic opioids I’m supposed to write for that I can’t? You want to put the nurses through getting the on-call to write a bridge prescription? I write more ADHD meds than most of my peers—usually a lot more. You want to tell my colleagues to write meds they’re uncomfortable with? How about tell my suicidal patients (which is a lot of them!) that the provider they know and trust after months or years will be replaced today by a 70-year-old white man who still thinks they should pull themselves up by their bootstraps? Tell my queer patients that they have to wait until I’m better and back to get their hormones and their STI screenings, reschedule a Pap someone was dreading. Every day is a kaleidoscope of opportunities to make a real connection with “difficult” patients. I’m good at it. I may be the best at it at my clinic.

I don’t hate calling in sick just because the clinic manager is a judgy bitch, though that doesn’t help. I hate it because of what it does to my patients. And it’s not simple. Pretending it is does all of us a disservice. I am not a widget. I am not easily replaceable. You can’t plug any of our per diems (all men, 2/3 white, 2/3 old, 1/3 a Bitcoin bro) into my place and call it an equivalent, and my schedule is already so packed that if I call in sick, patients will be guilt-tripping me about it for months. I’m not kidding. That happens every single time.

Christ alive, I wish it was true that doctors never got sick.

[johannestevans]

Hate living in a cesspool of a country where I've been experiencing the signs of vaginal atrophy for a while, recognised them, know what the treatments are and how simple they are, and yet have been procrastinating treatment bc of concerns getting it addressed will endanger me

because i obviously don't want a politically motivated doctor to use this as an excuse to meddle with my HRT or force me to detransition

[womenshealthclinic]

Vaginal tightening and vaginal atrophy treatment are essential procedures for improving women's comfort and overall well-being. Vaginal atrophy, often caused by menopause or hormonal changes, can lead to discomfort, dryness, and irritation. Women's Health Clinic, a leading provider of these treatments, offers advanced, non-invasive solutions designed to restore vaginal health and elasticity. Their specialized treatments enhance comfort, improve hydration, and promote overall vaginal rejuvenation. By providing expert care in a supportive environment, Women's Health Clinic ensures patients receive the best in women's health services, empowering them to feel confident and comfortable in their bodies again.

[lastoneout]

Things that can go in/pass through the vagina just fine:

penis (and/or semen)

sex toys made of body-safe materials

condoms (male and female)

lube

infants you are actively giving birth to

all that other shit that comes outta there during childbirth

period blood

mucus your body naturally produces so long as it doesn't smell or look weird

tongue

fingers

tampons and menstrual cups

IUD or other insertable birth control methods

ovulation tests

medical devices used during pap smears and pelvic exams or IVF treatments

dilators for those who've had bottom surgery

medications as directed by your doctor(like estrogen cream to prevent vaginal atrophy when on testosterone)

Things that should not go in there!!!

soap, oh my god do not put soap in there holy shit

food

flavored condoms/lube

douching fluids

crystals/special rocks

blood that isn't yours

pregnancy tests(you're supposed to pee on them)

sex toys made out of non-body safe materials unless you put a condom on them

stuff that isn't sterile or hasn't been cleaned properly

no fr like if you are doing anal you NEED to clean your penis/sex toy or at least swap to a new condom before putting it in the vagina holy fucking infections batman

anything you're allergic to(this includes everything on the safe list, if you're allergic to it it's not safe)

the body parts/bodily fluids of someone who has an STI unless you guys have protection(condoms, dental dams, latex gloves, you're taking PrEP/medications to keep your HIV viral load low enough that you can't pass it on, ect.)

Not a comprehensive list ofc but like since it does seem we occasionally need the reminder here ya go. If you're unsure about anything planned parenthood has a lot of sex education material up on their website, def check it out!!

[butchpeace]

Pelvic Floor Health for Detrans Women

A disclaimer before we start: I am not a doctor, a PT, or an expert of any kind, I just noticed there was a lack of information about pelvic floor health in the detrans (and trans) communities and I wanted to compile the information that I’ve gained. If there are any issues or you have any wisdom to share, please DM me! I plan to add to this post and edit it over time as I learn more.

95% of females who have been on testosterone report pelvic health issues, which can include urinary leakage or retention, bladder pain, difficulty emptying the bladder, general pelvic pain, pain with sex, vaginal dryness, vaginal atrophy, vaginismus, anal issues, and more. (Source)

Here’s a discussion with a pelvic floor expert on the issues faced by females who have been on testosterone.

If you’ve experienced any of these problems, you’re not alone, and there are things you can do!

Vaginal Atrophy

The vast majority of detransitioning women (and females who are transitioning) have vaginal atrophy, which is a thinning and weakening of the tissues that line the vaginal wall. Atrophy can lead to pain during sex, or with regular movement, bleeding due to small tears in the vaginal lining, narrowing of the vaginal canal, urinary issues, and more.

Because testosterone affects our ovaries, we can think of this issue as something similar to GSM (Genitourinary Syndrome of Menopause). Many of our symptoms mirror what happens to women as they age and their estrogen production decreases.

Treatments for Atrophy

1. Vaginal estrogen comes in the form of creams, suppositories, and insertable rings.

2. Vitamin E suppositories have been found to be as effective as vaginal estrogen in some studies. (Source)

3. Sea Buckthorn oil capsules have been shown to be effective in vaginal health. (Source)

4. Regular sexual activity can help by filling the vaginal wall tissues with blood, which can help to revitalize those tissues.

There are also many options for dryness, including vaginal moisturizers, aloe, coconut oil, and more. Sometimes the simplest natural options can be the most effective! Always talk to your gynecologist and do your own research on products you’re considering buying and make sure the ingredients are safe. Some people may experience yeast infections and other issues when using certain products.

Vaginal atrophy itself is to blame in many cases for the urinary symptoms that many of us report, and treating the atrophy may be all that’s needed in order to improve the urinary symptoms.

In other cases, we also need to look at overall pelvic floor health. I would argue that taking care of your pelvic floor is essential for any woman at any stage of life, since it can help with so many things!

Pelvic Floor Muscle Issues

Pelvic floor health issues can be divided into 2 types - Hypotonicity and Hypertonicity. Both types can lead to bladder issues, among other things.

Hypotonicity is the classic type many women experience after having children or during menopause. It’s also described as having a weak pelvic floor, and kegels are often the best treatment. The YouTube playlist at the end of this post includes videos for beginner and advanced kegel exercise methods and yoga.

Hypertonicity is the opposite type, where the pelvic muscles are chronically tight. For this, the treatment is to use muscle release methods to relax the pelvic floor. Remember - Relaxed muscles are the best at doing their job.

Anxiety can also be a factor in hypertonicity! If you’re often anxious, get used to checking how that feels in your pelvic floor. Many young women experience bladder leakage or discomfort, feeling like you have to go when you don’t, or pain with sexual activity, due to anxiety which causes overly tight muscles.

You wouldn’t think at first that Hypertonicity could lead to urinary symptoms like leakage, but when your muscles are overly tight, they just don’t work the way they should.

Sitting a lot and generally not getting much exercise also causes muscles in the pelvic floor, hips, and hamstrings to tighten and become shorter, so stretching these areas is very helpful.

And when you have a urinary issue, or you’re dealing with the aftermath of childbirth, surgery, or any other medical trauma to the pelvic floor, there can be a tendency to reflexively tighten your muscles all the time, for fear of what might happen if you don’t. Some people with hypertonicity also experience their symptoms getting worse if they do a lot of kegel exercise. In these situations, kegels can become counterintuitive.

That said, using methods to address both types can be the best option for some people. As long as you listen to your body, keep track of how each method makes you feel, and talk with a doctor or pelvic floor PT if you have serious concerns or don’t understand how to do something, you should be able to figure out something that will help!

Vaginismus is also a very common condition that’s connected to hypertonicity and potential mental causes. You’ll know you have Vaginismus if you’ve always had trouble inserting things into your vagina, or if your partner has had trouble with it. Many women describe it as a sensation of the vagina closing up when faced with something trying to get in. You may find that at certain times or with certain objects, you have no problem, and at other times or with other objects, you do. Stretches and massages for hypertonicity can often help with Vaginismus.

Prolapse is a relatively common issue in women who have had kids and older women in menopause. This can also cause urinary symptoms. The incidence of pelvic floor prolapse in females on testosterone is not known, but due to atrophy weakening the walls of the vagina, it’s possible that testosterone will increase your risk. It’s also more common in people who have had a hysterectomy.

Tools

1. Vaginal dilators can be helpful for people who have trouble with Vaginismus or feel like their vagina is small. These are also helpful for people who have difficulty inserting fingers

2. A pelvic wand or vibrator can help you with massage to loosen muscles, if needed

4. Kegel trainers come in various types and can help you perform kegels more effectively if you know that your issue is hypotoniticy

5. Pessaries can help in cases where atrophy has led to pelvic floor prolapse. Make sure you get diagnosed before using one!

6. Your hands! Don’t underestimate the power of using your hands for external or internal massage

The biggest thing to take away from this post is this - Don’t be afraid of your vagina or pelvic floor! Don’t be afraid to try things that may help you improve whatever issues you’re having.

Your vagina is a normal part of your body, and especially when you’re experiencing issues, that’s when it’s time to really learn about it and understand what’s going on. If you’re anything like me, you’ve gone your whole life being too afraid or too uninformed to do certain things or explore your body in certain ways. We need to reduce the fear, stigma, and awkwardness of vaginal and pelvic floor issues, and the first step is to get to know your body. 💪

Exercises

I’ve put together a playlist of YouTube videos that have helped me in this process, which I will continue to add to. I hope they help you too!

And again, please DM me with any information you think is helpful or stories about what worked for you.

And if you’re a medical professional, I would love for you to review this post and suggest edits or additions.

Please share this with all your friends! My intention is for this to be a community resource we can use to spread awareness✌🏼

[drvidushimehta]

Stress Urinary Incontinence Laser Treatment in Indore | Dr Vidushi Mehta

For those dealing with urinary incontinence, Stress Urinary Incontinence Laser Treatment in Indore offers a state-of-the-art approach. This treatment uses precise laser technology to strengthen pelvic tissues and improve bladder control, ensuring a comfortable and effective solution.

[homunculus-argument]

Okay, I've been talking about HRT a lot recently, but I wanted to clarify something: Testosterone treatment doesn't automatically mean becoming more aggressive. Being more irritable while your hormone levels rebalance themselves is normal, but if you find yourself getting actually angry more than reasonable, more often than reasonable, you might need help of a therapist. Testosterone does, however, cause

increased appetite (you need the fuel to build more muscle)

more body hair (yeah including places you may not prefer it)

fat redistribution (that belly hair has to go somewhere, after all)

vaginal dryness/atrophy (fortunately the locally applied estrogen this can be treated with doesn't impact HRT treatments)

male pattern baldness (if it happens to men in your family, it'll happen to you - fortunately hair loss treatments that work on cis men will work on you as well)

unironically enjoying the music of Sabaton (this, apparently, is irreversible, untreatable, and incurable)

[nothorses]

Wait do most guys on t not 'get soaking wet'? I mean I've always 'overlubed' a bit, but but I've been on t a little while now and I feel like I get wetter now than I used to, which is saying a lot. Am I that abnormal?

I'd say it's abnormal in the sense that it's not the common experience, but I don't think that means you need to be concerned about it.

"Vaginal atrophy" means a lot of things, but essentially, it's the same thing that happens during menopause (which also means that resources for people experiencing menopause are often helpful to people with vaginas on testosterone HRT). The hormones that keep that tissue healthy are no longer present in the way they used to be, so the tissue is atrophying over time.

My personal experience has been that while my libido went up & I experience arousal more frequently/intensely, my body's physical response to arousal- lubrication & relaxation of pelvic muscles for easier penetration- is pretty significantly reduced, and takes a lot longer to happen to the degree that I need it to in order for penetration to be comfortable. i.e., I am dryer and tighter. I also have found that I'm dryer overall, and sometimes feel itchy because of that; a little lube helped me go about my day when it first started happening, now I don't really notice it.

During my last pap smear, my doctor noted minor redness, inflammation, and irritation, which she said was typical of folks on testosterone HRT & wasn't anything to worry about. The skin is more delicate and easier to irritate, and that's about all.

You might be experiencing some but not all of the symptoms of vaginal atrophy, or you might be experiencing them more mildly, or you might be early enough in the process that it hasn't been noticeable yet. If you feel like you're actually lubricating more than you used to before HRT, I would also wonder if maybe your libido is just higher? But I'm not a doctor, let alone your doctor, and I have no way of making a worthwhile guess here.

If you're getting the changes you went on T for, like... "vaginal atrophy" is not typically one of the desirable changes anyway, and unless you actively want that, you probably don't need to worry about it. You can and should talk to a doctor if you're feeling concerned about any of this at all, though- I'm just sharing my own personal experiences.

Also, for everyone reading this:

"Vaginal atrophy" can sound scary, but

It's normal and natural, and it happens to everyone with a vagina who gets old enough for menopause to start,

It's entirely- and easily!- treatable, and

It's a reversible effect of testosterone HRT, and things will return to normal given a little time should you ever choose to stop.

You might consider asking your doctor about topical estrogen cream if you want to reverse the effects of vaginal atrophy without interfering with your T. This is also a common treatment for folks who go through menopause.

There are lubes out there specifically for folks experiencing vaginal atrophy as well; they're designed not to irritate fragile skin, and they can be helpful if you're experiencing a stinging sensation during penetration with normal lube (though again, talk to your doctor!! Please!!)

And as a side note: some people who go on T experience cramping (a lot like menstrual cramps) after a few years, and you can also often treat this with topical estrogen cream. I had some pretty severe recurring cramping that went away after a few weeks using topical estrogen cream. If a doctor tries to tell you that the only way to stop this cramping is by getting a hysterectomy, I would consider researching topical estrogen cream and getting a second opinion.

And lastly:

Talk to you doctor!!

[antiterf]

i keep hearing anti-trans people citing studies claiming that trans men who take testosterone always get pelvic floor dysfunction and now i'm afraid to take testosterone

TW: This post has a lot of talk specifically of genitalia and reproductive healthcare, with specific focus on cis women since that's where the research is. It's important to know but I want to give a fair warning for dysphoria.

It's weird that you sent this legitimately when I was looking for stats on that. This is oddly convenient. That never happens.

Pelvic floor dysfunction is incredibly common and while it can get to a point of being severe (prolapse) it's usually constipation, straining, bladder control and regarding mostly AFAB people, pain during vaginal sex.

From what research there is, it does seem that pelvic pain is incredibly common with trans men on testosterone. There's also not a pre and post testosterone question which... should be important. There's also no control group.

There is a recent study that reports that 94.1% of trans men have PFD, but it seems to be lower quality. I'm not saying that to try and completely dismiss it. There's no control group when it would be completely doable for this sort of study. They also don't ask if these symptoms had occurred prior to starting hrt or after.

(Sorry sci hub doesn't have it)

So we can't be positive, but what evidence we do have points to trans men having pelvic pain and PFD while on hrt. Both are honestly really general, and don't inherently mean that prolapse will happen (or "Your vagina will fall out, into the toilet, and you'll flush it down and never get it back. Then you die." Which I'm being partially satirical with that but wouldn't be shocked if some transphobe tried using it).

PFD is treatable with therapy and medication, sometimes surgery, but usually its not needed. There are plenty of trans men and trans mascs who use vaginal estrogen cream to help with dryness and atrophy. PFD is, again, common:

For women of childbearing age, PFD and POP are very common, and 65.8% of women over 40 years report at least one complaint of sexual dysfunction.

And it's likely you'll get it at some point regardless of starting HRT or not.

It's honestly upsetting that such a common, treatable, issue is described as apocalyptic. Like, it's still an important issue to be aware of, and in the studies I link there is mention of participants getting a hysterectomy specifically for pelvic pain. There are a lot of unknowns or barely knowns we have to accept when we start HRT. But don't let people tell you that the worst possible scenario will happen or give you fear mongered healthcare.

If it helps, I fall into the group of PFD and have for my entire life due to IBS. When it comes to intercourse, I do bleed a lot more easily, but often it's just being lubricated. I also take lactobacillus as a probiotic, which is the bacteria that we usually have less of compared to cis women while on hrt. Mainly because it's the best probiotic one for my ibs, but I wouldn't be surprised if it's also helped with vaginal health.

I hope this stuff helps!

[johannestevans]

hi, unless i’m imaging things i think you’ve mentioned having written an article about different treatments for vaginal atrophy. do you have a link?

Hey there, Anon!

I have a big, exhaustive guide to vaginal and vulvar stimulation, and I do discuss the impact of vaginal atrophy and a few options toward treating it, but it doesn't go into specific detail.

Vaginal atrophy is caused by decreased estrogen production, and effectively what happens is that the soft, wet tissue on the inside of your vagina - the parts that are formed of mucous membranes - become thinner and dryer. This can lead to pain during sex, difficulty getting sufficiently loose or lubricated for penetration, and it can make the skin there tear a lot more easily, because when it's thinner it's less flexible and has less support from the surrounding tissues, not to mention the increased friction from lack of lubrication.

It's important to remember that while we're at our wettest during sexual arousal, the inside of the vagina - much like the head of the penis inside the foreskin - should always be a little bit wet. That wetness is really important to the vagina performing its regular activities, keeping itself clean and healthy, and not receiving too much friction just from things like walking around.

Even your rectum has important mucous inside it to keep things running a bit more smoothly and to ensure it's never too dry, and this is why too many enemas in a short period can be bad for your anal and rectal health, and your anus is a lot more closed naturally than your vagina, you know?

While more lube during sex is often the first thing people bring up in response to vaginal dryness, that's actually only one facet of potential issues - for people who are on T, for people going through menopause, for people who for whatever reason have an E deficiency or insufficient E in this area, it can cause other problems too - your vaginal canal might get a bit shorter, muscle weakness in the area (especially of the pelvic floor) can make you need to pee more often and more urgently, you might have some spotting, abdominal pain, uncomfortable or burning sensations when urinating.

In combination with the fact that vaginal atrophy can make you more prone to injury, your bacterial flora can be thrown out of whack by this process too, and these are really really important to maintaining a healthy vagina, producing appropriate amounts of discharge, but also to fighting off infection - vaginal atrophy is also associated with recurrent UTIs and other infections.

So, what can we do?

Firstly, pelvic floor exercises are unbelievably helpful, and everyone should be doing them regularly, regardless of gender or genital make-up.

Here's an NHS guide """for women""" but it mostly doesn't use any gendered language for your actual body parts:

These exercises will help strengthen your pelvic floor, and strengthening these muscles will not only help with stuff like potential urinary incontinence or give you a tighter grip that you can better control during penetration (more control in this area can also help you if you're prone to reflexive tightness under stress, e.g. with vaginismus), but when those muscles are stronger and have more density to them, they provide more support to the surrounding area, which can help blood flow and give more structure to the tissues we're trying to support.

Secondly, as well as good lubricants, there also exist vaginal moisturizers - depending on the extent of your atrophy and how much it's a problem (it might be worse, for example, at some points of the month than others), these might help - you apply them every few days and they help your vagina maintain its lubrication.

If pelvic floor exercises and lube and moisturizer isn't helping, your next step is different forms of estrogen - your medical provider will need to tell you what's available in your area and to you particularly, but there's honestly all sorts.

You can get topical estrogen gels and creams that you smear inside the vagina, you can get suppositories that you insert and are then absorbed, you can get rings that you insert and then stay in place for a few months, slowly releasing E over time.

If you're using testosterone, it's more likely that your medical provider would suggest these latter than taking E orally - the great thing about these topical applications is that the E stays very localised to your pelvic region where you need it, much like when you get an IUS and the progesterone stays relatively localised. Taking E orally, you're introducing estrogen to your whole system, and depending on your current hormone cocktail, it might be harder to figure out dosage and effect, especially over time.

If your medical provider hears you're experiencing vaginal atrophy and, if you say that lube and moisturizer aren't sufficient, they immediately suggest moving to vaginal dilators or pain killers, or if they talk about easing your "discomfort" during sex (especially with a presumed male partner) without talking about pleasure or satisfaction, or especially if you've brought up vaginal atrophy for reasons other than sex and their priority immediately jumps to the imaginary partner they want you to be satisfying, I would recommend getting a new medical provider as soon as possible, and probably telling that one to shut the fuck up.

Many doctors, as we know, are scumbags, but some particularly cunty ones' automatic focus for someone with a vagina is that you're providing sex to your (cishet male) partner - they automatically focus less on your pleasure or satisfaction, let alone your health, and more on the idea of reducing pain you're experiencing enough that you'll let that partner fuck you as much as they desire to.

This is not a medical provider that has your best interests at heart, and if they don't afford you humanity in this area, I would have doubts as to others.

If you're having difficulty with a medical provider, I would always, always advise:

Bringing a chaperone with you. You're entitled to a chaperone, you can always bring one, a lot of the time they'll want to say a chaperone can stay out of the room "for your comfort/privacy" but for your comfort and safety, you can also bring them in with you. A chaperone might be a friend or family member or partner, and they don't even need to say anything a lot of the time - just having a witness there can make a medical provider think twice about bullying a patient. I've served as a medical chaperone for quite a few friends, especially because I'm a thin white man, and even as a faggot, doctors humanise me slightly more than they do friends of mine who are perceived as women, who are POC, who are fat, etc.

Ask your doctor the reasoning behind denying a course of treatment, and ask them to document that they are refusing treatment at this time. Once they write it down, it becomes something that's documented and that they can't deny in court, which tends to make them a bit more flexible.

Don't be afraid to go into the doctor having done a bit of your own research. Doctors will tell you not to google things as many doctors have fragile egos and become nervous at empowered patients - with particularly egotistic doctors, you can always phrase your research in the form of questions to make them feel like you're appropriately aggrandising them. "Are there suppositories for this, or creams? Could my UTIs be related to my vaginal dryness? My mother mentioned vaginal atrophy during her menopause, but I didn't really understand what it was. Could you explain? Could that be me?"

Cisgender women are generally better doctors than cisgender men (statistically, despite being underpaid and underrepresented), but obviously cisgender people are often... very cisgender, and cisgender women can be even more painfully cisgender than cisgender men. Most providers won't bat an eyelid at you requesting a female doctor over a male one for a gynecological concern, but you can't go around asking for the most clocky doctor they've got in the back.

What you can do if you're having trouble at your GP is look for your local GUM (Genito-Urinary Medicine) clinic, and see if they'd see you and talk to you about vaginal atrophy - I know several trans people who work as nurses and practitioners in the GUM field, and in general, GUM practitioners will be way more chill about this field.

Unlike your GP, there's no chance of them getting flustered, nervous, or religiously conservative about sex or genitalia, and GUM practitioners are often more chill about queer, trans, and intersex patients because they already see us a lot more, whether because queer people are more on-the-ball about STI testing, or just because many of us enter sex work, and they're more likely to see sex workers. The benefit of this, though, is that you're almost certainly not going to be their first or only patient with x or y element of your body or identity, which can mean they humanise you a bit better and are generally less shit.

I hope that helps, Anon!

[certifiedsexed]

transmasc bottoms in the crowd Help. how do y’all deal with vaginal atrophy from t (tis a common side effect). Because of my antidepressants I need a lot of stimulation to get off, and I keep getting too in to it and hurting myself even with lube 😭

Have you tried topical estrogen, Anon? That's a very common treatment for vaginal atrophy, especially when its caused by testosterone. So are general vaginal creams!

It might be a good idea to talk to your doctor about a prescription for topical estrogen or some other med, as well as checking out over-the-counter vaginal creams/moisturizers.

Hope this helps! Let me know if you have any other questions, Anon. <3