I'm Using Vaginal Estrogen, and My Vestibule has No Stretch. Help!

Ask Dr. Jen

“Help needed! I’m using Vagifem twice a week and have added Estradiol cream as well. My vestibule has no stretch! Would you recommend trying Vagifem 3x a week? I tear with penetration and my gynecologist wants to send me to couples therapy! I do NOT need counseling!!! I’m not a candidate for HRT due to past pulmonary embolism. I am only 52 and so very worried that I’ll never be able to have intercourse comfortably again. What do you recommend?

- Via The Vajenda

Short Take

When someone is using adequate vaginal estrogen cream and things still feel tight, it’s typically time to look for other causes. The most likely (based on the limited information available) is pelvic floor muscle spasm, which is also known as vaginismus. And it’s very treatable! But of course, there are other causes as well.

Tell me More

First, let’s identify the vestibule, which is the tissue that surrounds the opening to the vagina. It is between the vagina (inside) and the labia minora (part of the vulva and outside).

What to Look for On Exam

There are several things to consider with symptoms of tearing with penetration and/or feeling tight at the vestibule. 

The doctor or nurse practitioner should do an exam to make sure the labia minora,