Can Vaginal Estrogen Affect Your Sex Partner?

Ask Dr. Jen

I’m a family doctor and really appreciate your books and online content. I recently had a patient bring up concerns about partner exposure to vaginal estrogen during sex. From my reading. There is evidence of partner absorption if a woman has sex immediately after using it, but none really on clinical effects. Anyway, just curious if you have any more information or experience with this. Thanks!

-Via Instagram

This questions comes up frequently, so thank you for asking!

When vaginal estrogen is formulated correctly and used appropriately, it is not absorbed across the vaginal mucosa in any significant amount, meaning for a woman in menopause, estrogen levels may budge slightly for some, but they generally stay in the menopausal range. Of all the products, the cream, is the most likely to be absorbed.

But today this post is not about women, it’s about the men.

Theoretically vaginal mucosa should absorb estrogen better than the skin of the penis, so one would think the penis is at minimal risk. However, intercourse is associated with friction, which can cause microabrasions, so that might impact absorption, and it’s always possible that people could be using more cream than they should, increasing the risk of exposure. For example, about once a year I encounter someone who is also using estrogen vaginal cream as a lubricant. I can understand the thinking…hey, you need lube and have a cream meant for the vagina on hand. However, estrogen cream is not meant to be used that way, and of course, there are far better lubricants.

This is a long way of saying that absorption across the penile skin is biologically possible, so it’s a fair question.

There is very little written on the subject, and in 30 plus years of prescribing these products, I’ve never had an issue where a patient of mine has said, “My partner has developed some issues that started after I began using vaginal estrogen.” Obviously, this doesn’t exclude it, but it does speak against significant absorption being an uncommon occurrence, if it happens at all.

The vaginal tablets, suppositories, and estrogen ring are not likely to be of any concern because the way the estrogen is delivered makes it unlikely that any could be transferred in significant amounts to a penis. There isn’t a way the estrogen could stick (for lack of a better description) to the penis and the amount of estrogen is lower than in the cream. The only potential concern here is be cream, where the estrogen product could coat the penis and theoretically hang around long enough to be absorbed.

So what data do we have?

There is a case report from the New England Journal of Medicine from 1980 detailing the case of a 70-year-old man who developed enlargement of one breast. He had it surgically corrected, and then it happened to his other breast. At this point, he remembered that his wife had been using vaginal estrogen (dienestrol) regularly as directed for eight years, but has started to use it as a lubricant for sex two to three times a week starting one and half months before the breast enlargement was first noticed. The estrogen use was stopped and the enlarged breast tissue went away. While the story is convincing, the estrogen levels never changed, so that does add an asterisk (if the estrogen levels went up and the down after the cream was stopped it would be stronger evidence). It’s also possible that a 70-year-old men many may be more vulnerable to absorbing even a small amount of estrogen due to age-related decreases in testosterone levels.

To look at this issue further, researchers took five male volunteers in their 20s and had them each apply 2 g of Premarin cream to their penis (which has 1.25 mg of Premain, and is a hefty vaginal dose and more than we typically recommend!), and levels of different estrogens and testosterone, as well as several other hormones were evaluated to understand the impact. There was a bump in estrone (a weaker estrogen) with a peak at 3 hours, reverting back to baseline by 24 hours. Estradiol levels (the main estrogen) didn’t change, but Premarin has at least ten estrogens and isn’t converted into estradiol in large amounts. What matters here is that it was clear some estrogen was absorbed and that hormones reverted to baseline by 24 hours. This happening once or twice would not have any significance, but if it happens three times a week, that might be a different story. What this study tells us is that penile skin can absorb estrogen in a cream, so regularly applying large amounts to the penis is likely not advisable. This should also give people pause who are using estrogen face cream. I know there is a mail-order menopause company that pushes an estrogen face cream. These products are inadequately tested, so if you are using one, we have no idea how much you could be absorbing and if you have a uterus, this could raise your risk of cancer. Also, there is no convincing data this is helpful for wrinkles or skin texture.

Okay, back to the men (a phrase I never thought I would write on this blog).

There is one other small study where ten women used 1 g of vaginal estradiol or placebo and then had intercourse 2 hours later, and they and their partners had their estradiol levels checked at 12 hours after application. One week later this was repeated, but people crossed over to the other therapy. While there was a statistically significant difference in estradiol levels between the estrogen vs. placebo application, the actual difference in estradiol levels for the men was tiny. And very importantly, estrogen levels stayed well within the normal range for a man, meaning the significance of this is unknown. Interestingly, intercourse lowered absorption of the estrogen for the women.

So what does this all mean?

While admittedly this is an understudied area, there is very little evidence supporting a concern with vaginal estrogen cream when used appropriately, meaning a dose of 0.5 g - 1 g dose of estradiol or Premarin twice a week. It should not be applied immediately before sex, as in this scenario a small amount of absorption through the penis could happen. Otherwise, if it’s not being applied directly to the penis or as a lubricant, it seems to be of no concern. For those who use the cream, it’s best to apply after sex or use it on a day you think sex is less likely to happen. If there is an oops, hey sometimes arousal hits when we don’t expect it, just have your partner wash off afterwards. If this is a major concern, then the vaginal ring or tablets or even oral ospemifene are an option.

And stay tuned, we’ll address all the products for vaginal use in the guide to the hormone menoverse.

References

DiRaimondo CV, Roach AC, Meador CK. Gynecomastia from Exposure to Vaginal Estrogen Cream. N Engl J Med 1980;302:1089-1090.

Ware MD, Kennedy Thomas E, Notelovitz M. Serum hormone levels in men exposed to vaginal estrogen cream: a preliminary report. Maturitas 1985;7:373-376.

Hurst BS, Jones AI, Elliot M, Marshburn PB, Matthews ML. Absorption of vaginal estrogen cream during sexual intercourse: a prospective, randomized, controlled trial. J Reprod Med. 2008 Jan;53(1):29-32. PMID: 18251358.