Crisco is an effective vaginal lubricant
I’ve been in ObGyn practice since 1976—and have recommended Crisco to my patients as a vaginal lubricant for just about as long. I laughed at the mention of storing Crisco in a crystal jar because it sounded like one of my ideas.
Many of my patients use Crisco prior to exercise and other activities because it tends to protect them from irritation. I also have used Crisco as a base for some sexual lubricants that I have compounded, and it seems to work very well.
Another novel remedy: I often recommend cold milk to relieve vaginal irritations and to boost the effect of topical steroids prior to their use—I even patented the treatment and am in the process of licensing it to a consumer company. I previously had a product on the market for treating diaper rash, sore breasts from nursing, irritation from exercise, and other complaints using the same technology and patent.
I now have my patients wet and then freeze a panty liner, apply skim milk to its surface, and wear it until it is no longer cold. It provides great relief from irritation, hair removal, herpetic attacks, and so on.
Stephen M. Renzin, MD
Larchmont, New York
There are better lubricants than Crisco!
The suggestion of Crisco as a vaginal lubricant was distasteful. There are so many products on the market; even olive oil is a better alternative. Crisco stains, gets hot when placed on the body, and is messy. I doubt our male colleagues would apply it to their bodies.
Lisa Riha, DNP, FNP-BC
Migraine drug relieves vasomotor symptoms
In over 30 years of practice, I have found that the old migraine drug Bellergal‑S (belladonna, ergotamine, and phenobarbital) works very well to relieve vasomotor symptoms and insomnia. It is clearly inappropriate for women with heart disease, and the brand is no longer made, but it can be compounded, as necessary.
Tanja Todd, MD
Dr. Barbieri responds
I appreciate the observations of Dr. Renzin and Dr. Todd regarding the use of cold milk to treat vaginal irritation and a compounded version of Bellergal-S to treat vasomotor symptoms and migraine headache.
In regard to Dr. Riha’s criticism of the use of Crisco as a vaginal lubricant, I agree that there are no large-scale clinical trials comparing the effects of Crisco versus an alternative agent in women. However, many postmenopausal patients with vaginal symptoms report improvement with Crisco.
Outpatient vaginal hysterectomy places undue burden on the family
In her commentary on the study of outpatient vaginal hysterectomy, Dr. Rosanne Kho did not discuss the impact that postoperative care of these patients can have on the family. It is a tremendous challenge for the family to care for a woman who has undergone vaginal hysterectomy. I had two friends, both of whom had excellent support at home, who experienced complications. One had a breakdown of the vaginal cuff and bled. The family transported her to the emergency room (ER), where packing was applied. She was ultimately returned to the operating room and given 2 U of red blood cells, followed by a 3-day hospital stay.
The other friend developed a pulmonary embolus on postoperative day 5, as she had been sedentary due to pain. She was taken to the ER, given heparin, and hospitalized for 3 days. She is now on long-term anticoagulation therapy.
Lisa Riha, DNP, FNP-BC
Two questions on menopause management
I have two questions about Dr. Andrew Kaunitz’s Update on Menopause:
- How should I manage a 70-year-old patient who has been taking hormone therapy (HT) for 20 years (transdermal estradiol plus progesterone) and is doing well with stable health? Can Dr. Kaunitz offer any guidelines on dosing, weaning, or maintaining the status quo until the HT is medically contraindicated?
- Does ospemifene have other benefits, such as breast protection and bone health? The package insert, other articles, and my pharmaceutical rep say nothing about additional sites of action. If the drug offers nothing besides protection against vaginal atrophy, is it worth the risk of venous thromboembolism (VTE)?
Maureen O’Regan, MD
Dr. Kaunitz responds
Dr. O’Regan thoughtfully raises two clinical questions relevant to menopausal practice: management of extended use of HT, and selection of appropriate treatment for symptomatic genital atrophy.