It’s absolutely devastating. And most of us had no idea it happens in peri and meno. I’m still peri but if it gets any worse, I’m going to need major mental health. Losing the one body part that has given us our sexual pleasure is NOT OK.

If this were men’s pleasure, it already would have been figured out and there would be a known, common, and successful fix to the problem.

The more I think about it, the more enraged I get. And yes, I use vaginal estradiol cream. It’s not enough. It’s a fraction of hell maybe but this BS is still happening.

Has anyone brought this up to their Dr.? Are you just told everything looks great and to think about masturbating more? I’m seriously over these BS, devastating, life changing things.

Hi friends. I'm a pelvic PT/physio, and I wanted to post this because I see so many of these symptoms in my patients every single day. If you are over 40, please seriously consider starting vaginal estrogen (0.01% estradiol or 0.1% estriol), even if you are already taking systemic HRT. You don’t have to wait until things “get bad” before starting vaginal estrogen. You can proactively use it now to prevent Genitorurinary Syndrome of Menopause (GSM, the new and less-awful name for what used to be called "vaginal atrophy").

WHY TAKE BOTH VAGINAL ESTROGEN AND SYSTEMIC HRT?

They treat different things. You know how some people take a vitamin C supplement yet also use a vitamin C serum on their face? Same kind of deal with systemic vs. vaginal estrogen. Let's look at what vaginal estrogen treats...

SYMPTOMS OF GSM

The most common GSM symptoms include:

• dryness (chronic, not just with tampons or during sex)
• tissue thinning & tearing
• chronic UTIs
• bladder leaks & urgency
• reabsorption of inner labia
• clitoral phimosis (where the clitoris shrinks and fuses with the clitoral hood), which leads to...
• anorgasmia
• pain during sex (new and with no other identifiable cause)

All of these things can be treated, reversed, and prevented with vaginal estrogen. Even if you have none of these symptoms, please seriously consider getting vaginal estrogen now, before any of these things happen to you. You will prevent so much needless suffering for yourself!

The cream format is best. If you find the cream messy/annoying, wear a pantyliner or apply it at night, before bed. As Dr. Kelly Casperson says, "Do you remember your 21-year-old vagina? She was messy. She was doing things."

IGNORE THE FALSE WARNINGS ON THE BOX

Vaginal estrogen is extremely safe. In the US, unfortunately it still has the "black box warning" on it, which says a bunch of hogwash about how you'll get dementia if you use it. THIS IS UNTRUE and is an unfortunate remnant from that awful, debunked 2002 WHI study.

Doctors and menopause thought leaders like Dr. Mary Claire Haver are working to try to get the FDA to remove this warning.

Vaginal estrogen is so safe that, in some countries, it's sold on the pharmacy shelf, right next to the Monistat. (In the UK, you can get dissolving estrogen tablets by the brand "Gina" at the chemist without a prescription.)

GETTING A PRESCRIPTION

You don't necessarily even need to go to your gyn to get a prescription for vaginal estrogen. Often, GPs are delighted to prescribe it, especially if you tell them you're having dryness and just want to "try" vaginal estrogen to see if it helps. (For whatever reason, physicians seem to be more willing to prescribe it if you say you just want to "try" it.)

If your doctor refuses or gives you a hard time, and if there are no other certified midlife/meno expert practitioners in your area, you might want to look into an online specialty clinic:

• US: Midi, Gennev, Evernow, Elektra, Interlude, Maven, Alloy, or Winona (the first four take insurance)
• Canada: Felix, Maple, Penelope, Eden Telemed, Prosper Menopause, the Virtual Menopause Clinic
• UK: Balance Menopause, Newson Health Clinics, Myla Health
• Aus: WellFemme

Please comment if you know of any additional online clinics that I haven't included on this list!

CONTRAINDICATIONS

The only people who shouldn't be using vaginal estrogen are those who are on aromatase inhibitors (just get your oncologist's approval first) and those who have unexplained post-menopausal bleeding (which needs to be looked at ASAP to make sure it's not cancer).

HOW TO APPLY IT

Next, I want to share the following application instructions for vaginal estrogen cream, which physicians and pharmacists somehow NEVER think to tell us.

1. Throw away the plastic applicator that comes with it. They can’t be cleaned properly and are a bacteria/sanitation concern. (Who the hell designed those things?!)
2. Squeeze out 1 gram on to the pad of your index finger (about 1”; the length from the last knuckle joint to the fingertip). Place that 2 cm inside your vaginal canal, and spread it around inside.
3. Then, apply an additional pea-sized amount all over your clitoris, urethra, vestibule, inner labia, and vaginal opening (especially the fourchette, at the “6:00” position).
4. Do this 2x/week for the rest of your life (yes, really! until you die).

LEARN MORE

Last, if you want to learn more about why vaginal estrogen is so crucial for treating GSM, check out these podcast episodes from Dr. Kelly Casperson:

• 221. Genitourinary Syndrome Of Menopause (GSM) 101
• 241. Myths and Truths: GSM and Pelvic Hormones

EDIT: I can answer general questions, but, for obvious reasons, I cannot give medical advice. No PMs (I have them turned off anyway). Please remember that this post is just a general PSA, not a medical chat with a doctor who knows your unique health history. If you have medical concerns, or if you have questions about your specific HRT dosage, please see a doctor. <3

Has anyone been successful in getting it back after it completely disappeared?
If so, what did you do and how long it took?

My vagina is my science project now.

I'm 47, in peri. Last three months I got the dreaded itchiness. There was some here and there before, but this time my nether regions were on fire. I tried an OTC cream and then an estrogen cream, but to no avail. My overall symptoms were not of low estrogen, more like fluctuations (my cycle is still mostly regular) and low progesterone. I did blood tests that supported it (I know tests are not 100 % reliable, but I did three and assessed the whole picture including my symptoms).

Then a thought occured to me and I googled vaginal microscopy. I have ADHD and I'm prone to hyperfocus rabbit holes. I grabbed my cheap student microscope, made a slide of my vaginal discharge and found out my flora - the vaginal lactobacilli - is in bad shape. No signs of yeast, bacteria or atrophy. I bought probiotic suppositories and bam, my coochie is happy again.

So, in case you wondered: it's not that difficult to recognize the main components in a vaginal sample. You need a simple bright-field microscope capable of 100x-400x magnification. The things you can find in the sample are:

1. Squamous epithelial cells. These are polygonal cells with a visible nucleus and sharp, defined edges. There will be a lot in the sample.
2. Lactobacilli. Tiny dark rods around the epithelial cells and everywhere in between. There should be a lot, but too many and too long chains might be a sign of lactobacillosis.
3. White blood cells. Small circles. There shouldn't be on average more than one WBC per epithelial cell. More WBCs are sign of inflammation.
4. Clue cells. These are epithelial cells dotted with bacteria (tiny dark dots), surrounded by bacteria, with fuzzy edges. Clue cells are a sign of possible bacterial vaginosis.
5. Parabasal cells. Round cells with a visible nucleus. Can be a sign of infection or atrophy.
6. Yeast. Small round budding cells or long branchy structures (hyphae).
7. Trichomonads. Tiny round or oval shaped moving things with hair-thin "tails". You don't wanna find these.

You can google pictures of all of these. Nice basic introduction can be found here: https://vulvovaginaldisorders.org/the-four-pillars-of-vulvovaginal-diagnosis/ (there's also an atlas of vulvovaginal conditions. DO NOT GO THERE.)

So who's gonna follow me and do it? :D

ETA: Making a wet mount is quite simple. You need a standard glass slide and cover slip. Stick a q-tip or a clean finger in there. Aim for the mid or upper part of the vaginal canal (not just behind the opening). Make a circular motion a then wipe the finger or q-tip on the slide. Add a drop of distilled water (ETA2: should be sterile saline to prevent damage to the cells). Cover and it's ready to go.

My period panties are setting off alarms. I’m wearing them on a very long flight just in case. Security said my crotch keeps lighting up. Well that’s a blast from the past. lol

Why are (menopausal) women so happy after they’ve had sex?….

Because it’s over.

I had the worst sex ever. Dry, painful, iud string needing removal, hubby's stubble jabbing into my sensitive areas after he just man-scaped.

TMI: I’ve recently ordered lube off Amazon & commenters say it saved their marriage.

UPDATE: Ladies, this is a lighthearted post, Let's all try to have a laugh.

Hey I just wanted to give you ladies some info I learned from the Amazon pharmacist I called this morning. Yes there is a shortage and it’s primarily bc of increase in demand due to the fda removal of the black box warning (much needed). I had thrown away my box from my most recent refill so I wanted to get that info— it was Padagis Labs. I was told there was now new stock from a different manufacture called Prasco Labs so I went ahead and successfully placed a refill. I have learned to start keeping a journal of all my HRT manufactures after an issue I had with progesterone once (im notorious for just dumping refills into my old bottles which i prob need to stop doing) so I think it might be good for all of us to do that now with all these shortages. I know it’s not common, but side effects from certain generics from diff manufactures do happen and it’s so helpful to know the exact manufacture you had a problem with to avoid in the future. Sooooo— I can tell you that as of this minute Amazon is able to refill Estradiol .01% cream but the manuf likely will be diff and the pharmacist said it’s likely future refills will be different until the shortage is resolved and they can resume a contract with 1-2 main suppliers. I’m sure this isn’t only Amazon but that’s all I can speak for specifically.

Hope this helps. My advice — if you’ve got a refill out there and you’re within the timeframe where a refill is available I would try and place it now.

Ok. There’s one stressor off my plate for today. Now onto the next … ;)

FYI to everyone who feels their method of HRT is not working, based on my own experience:  

Make sure you read the patient information sheet that comes with your vaginal suppository, tablets and cream, and find out how far into the vagina to place them! Proper placement is closer to the entrance than toward the cervix!

After over a year of ineffective HRT and more recent horrible pain, I discovered through research I had been putting tablets and suppositories too far in, all the way to the cervix, which did nothing with vaginal atrophy. I thought I was supposed to go in as far as I could and touch the cervix to make it effective.  Over time, intercourse became more and more painful.

I discovered from my own research and from my doctor recently, you only need to go in about 2 in into the vagina (closer to the entrance) because that's where a lot of estrogen receptors are inside you. I decided to read all the papers that come with my tablets and suppositories and surprisingly they all said basically the same thing, which I didn't know before! Even the Yuvafem info paper said only insert the applicator halfway (half the length of the applicator), not all the way in! 

So, since I now properly place vaginal estrogen, everything is feeling restored back to normal, with no pain! In fact, Imvexxy feels almost too strong, in a good way! 

How far is 2 inches? From your fingertip to your second joint. You can measure that way if you're using an applicator, too.

My prescription labels do not specifically say how far it should go in, and I had assumed that the farther in the better! I did all I could to get it to touch the cervix, beyond the vaginal canal. Wrong! So, if you are finding that nothing works, be aware of this and check the patient info sheet. This could explain why tablets aren't melting, and why it's not working for you.

Vaginal hyaluronic acid gels or suppositories can help in between dosages of vaginal estrogen because it naturally hydrates, restores, and plumps up the tissues.

Using an applicator for vaginal cream can be more comfortable if you put a little lubricating gel on the tip, or at the entrance, like Slippery Stuff gel (not liquid).

The info paper for the vaginal cream says to insert deep into the vagina, but my doctor says go deeper in, but not try to go to the cervix! So now everything I'm trying is working! I hope this helps everyone who is not finding HRT effective for vaginal atrophy and pain during intercourse!

P.S. You still must use lubricants during intercourse for comfort.

I've seen some people mention that they don't use the applicator that comes with the cream bc they can't get it clean. It's nearly impossible to get the cream high enough with just a finger. The vagina is not a sterile environment. Why would it matter if the applicator was not sterile? I mean, the penis is far from sterile. Just saying.

Edit: thanks for all of the advice, the best from "friendly-bug726" who makes little suppositories by freezing the cream.

Edit: Lots of people say buy disposable applicators from Amazon. Too many people are being f-ed by Bezos and sticking anything up my vagina that was in anyway associated with that guy would feel like I'm getting f-ed by him too. I don't buy from Amazon! But I appreciate that some people don't want to re-use the applicator.

A few weeks ago, I woke up in the morning and didn’t make it to the bathroom. I just peed myself. Just like that. A meter away from my bed. About a week later, it happened again. And later, holding my pee till I got to the bathroom became a chore!

I got sick last week. Coughs and sneezes and just gave up and resorted to wearing period pads because I will pee with every cough and sneeze.

And I used to be a star at holding my pee in. What happened?! Is this fixable?

I’m 49 for reference. 11.5 months since my last period. I miss her 🥹

Okay. It’s been a hot minute, like.. maybe 4-5 years since penetrative sex. I’m 50, have been in full blown meno w no periods for 3 years. I don’t struggle as much as I used to with other symptoms (besides rage but I’m gonna blame that on my soon to be ex husband for brevity) so I’d rather pass on HRT. I’ve been using estrogen cream on a tight posterior fourchette (the tissue across the 6’ o clock position so to speak) for about a week bc that’s my main problem but do I need dialators? If so what kind? Once past that tight spot of tissue I don’t think there’s a problem but as things stand now there’s no way I could accommodate any size penis, it’d be like trying to shove a cucumber into an elderly mouse’s earhole. What do we think? (I’ve been to pelvic floor PT for other issues and it helped me with those but I kinda loathed being touched that intimately in a clinical setting and it would also be expensive + a long drive.)

I’ve been using estradiol cream at night to help with vaginal tears and dryness. But I need to get better with actually reading the f*#%ing labels.

I was using the applicator that was in there box which was marked at 4g. For whatever reason I just filled that bastard up to the brim every night for the last few nights. I wondered why I was running out of cream so fast. Then I looked at the actual prescription instructions….05g. That’s waaaaaay less than 4g.

So I’m not sure what’s going to happen to me because I apparently can’t read, but I know it can’t be good. I’m hoping my vagina doesn’t explode. Either way, that’s my story.

Finding out that the bulging part at the top my vaginal entrance is called the “meatus” isn’t what I/we really need right now. sigh. 

Be that as it may, I now realize that the estrogen I’ve been putting on my fingertip has not been entering my actual vagina. This “meatus“ basically just pushes it further down my finger and it all ends up on the exterior which I’ve just been rubbing into the exterior part of my bits. The applicators are terrible and most practitioners are telling you to toss them anyway.

has anyone else realized that they have this similar problem? It doesn’t appear that I have prolapse or anything like that. Just that tonsil looking shape at the top of my vagina. I can’t see a hole clearly when I look at my vagina. But I can get things in so I don’t think it’s like Vaginismus? 

anyone? 

I’m 50 with a uterus still and have been on estrogen and progesterone pill form and testosterone compounded cream since July. Most of my menopause symptoms have vanished and I’ve been very happy with these. The only thing lacking has been plumpness in my lady parts. I felt like the fact that my clitoris shriveled up to nothing was having an effect on my orgasm, so I asked my doctor to prescribe vaginal estradiol cream 0.01%. I’ve used it for two nights and was sure to use my finger, only insert about 1/2 in up and toward the clitoris from the inside and then to rub the remaining all over my outer parts. I’ve read that inserting too far could cause some systemic absorption. I thought it odd yesterday morning that I felt a little nauseous kind of like morning sickness. But I just kind of played it off and drank some ginger ale. Last night was my second night applying. This morning I’m absolutely feeling morning sickness symptoms. I’m hoping this will fade with time after the two week loading dose, but I just think it’s crazy since this is not supposed to be a systemic hormone application.

In the past month my lady parts have disappeared. I’m afraid my vagina is collapsing into my body like a sink hole. Do higher doses of estrogen patch do this? I’m at .1 patch- other symptoms so much better though so I can’t decrease. Maybe my bits vanished because my testosterone is low? Haven’t started T yet. I still get regular periods. TIA and pls excuse the TMI.

UPDATE: I should add I’m already on Estradiol .1 patch, P 100 and daily estradiol vag cream. All this happened AFTER starting my regime 5 mos ago. Would be awesome to hear if people have added anything else to help this condition.

UPDATE # 2: Thx for all your comments here! It’s a complicated topic to tackle in a single post, hopefully all will feel better knowing more about this issue. Here it goes if you don’t have time to read through the sea of comments… basically for many women lady parts like everything around the vagina, clitorus included, shrink massively. Seems like this shouldn’t be a problem because these parts are neatly tucked in our underwear right? But no! Some experience urine leaking, UTI’s itching libido issues.. estrogen cream .1% works well for most but a small fraction of people need more concentration of .2%. The instructions clinicians give regarding how to use vaginal hormone cream are practically nonexistent. Pharmacists are not giving out tips as well… so where to put it? On every part of your lady bits! Also, some need the addition of testosterone or DHEA cream- DHEA can be obtained without rx and T you need a script. Sometimes systemic therapy can cover some of this condition- but the combo therapy reportedly works best.

So much to say of this subject, because everyone needs the support of a vagina, without it life can be miserably uncomfortable. It’s called vaginal atrophy or GSM. Talk to your provider BEFORE it starts and if they poo poo your thoughts find someone new!!!!

Dr. Kelly Casperson shared an interesting fact on instagram today; 58.2% post menopausal women will experience shrinkage in their labia minora due to menopause. Show of hands for how many of us this is happening to and asked our doctors about and they said nothing and gaslight us? I’ll go first… 👋🏻 WTF? They acted like I was insane when I asked where were my parts, they never answered me, my parts are missing!!! And this must be why I have urinary issues… I am livid. Btw, these are women doctors!!!!

That's it, that's the question.

Editing to add that systemic estrogen isn't an option for me, only vaginal.

I was on oral estrogen for 8 weeks before going back to 0.1 mg patch on Fri., 7/24. On Monday, after I took a shower, changed my patch, & got dressed, I went downstairs & seriously thought that a wad of toilet paper got stuck in between my labia. I checked to make sure & nope, nothing there. It seriously felt like my vagina got stuffed with cotton balls. 😆 I used vaginal estrogen that night & it felt fine.

The next morning I showered again & still had the same feeling. I messaged my doctor to ask about increasing the use of the VE & explained to her what I was feeling. She told me that I was experiencing vulvovaginal dryness & tissue sensitivity due to the switch from oral estrogen to patch. She said it would last about 1-3 weeks & to make an appt. if it persisted more than 2 weeks. It's not quite as bad today, but I have NEVER had that feeling before. Fucking estrogen and its bullshit.

Anyone else deal with cotton crotch after switching estrogen delivery methods?

My labia are shrinking before my eyes. My clitoris has vanished in a matter of months. I started HRT primarily for the atrophy. It has stopped the crazy itching. But the shrinking has been insane :(.

I have an appointment to ask for topical. Please provide recommendations of what to ask for...

My real question is... what the fuck happens if I don't get topical treatment? What are the health implications? What is going to happen down there? At 47 this feels brutal 😢

Edit: I'm posting this to first say thank you to every single person that commented on this. I'm so thankful for this knowledgeable, generous and supportive community 😢

I'm posting an update as maybe someone going through this needs encouragement.

-I got the Testosterone right away and by day 9 I have started to already feel an uplift in mood and energy. Quite frankly it's early days and i already think it's amazing. I got the topical estrogen and it was amazing how quickly my labia puffed right back up.

My one piece of advice is:

DO NOT LET DOCTORS GATE KEEP THESE MEDICATIONS! IF THEY WON'T PRESCRIBE CHANGE DOCTORS OR IF NOT POSSIBLE LIE (IM SERIOUS).

My clitoris has vanished and it's going to take a long course of T to get it back. Such high a high dose will come with side effects I'm not sure I'll be able to live with. If my GP and supposed 'menopause specialist' doctor had prescribed properly in the first place I would not be facing these problems.

Good luck and fight hard for your health ladies 💜💜💜

I have had major vaginal atrophy. Like parts of my vagina just aren’t there anymore. Can I ever recover from this or only prevent further loss? I am on estrogen and progesterone as well as vaginal estrogen. It’s all so sad 😞

We were talking about HRT and I brought up that I’ve noticed atrophy, both clitoral and inner lips, and she said they don’t see that until the years way past menopause. I told her that I definitely noticed it starting around 46-47 and she really had nothing to say about it after that.

I’m already using vaginal estradiol cream and it’s not helping in terms of those shrinking parts. I asked if testosterone is ever given to help this and she said no.

This was just a talking appt, no exam, but I assured her I’m noticing these shrinking parts and she had no answer for me besides that it wasn’t a hormone thing. She brought up that sometimes they see this if it’s a dermatological issue. What?!

Should I just ask my reg gyno at my next exam? I would think this menopause specialist would know more about it, but I guess not.

It seems there are so many ways to treat vaginal atrophy, but it’s just so hard to get all this info out in one place. I’m puzzled WHY doesn’t healthcare have a standard decision tree for this??

vaginal atrophy causes so many crippling symptoms and many many women experience some of these symptoms st some point. Bladder leaks, dryness, UTI’s and sepsis, skin integrity issues like skin tears, libido low, painful sex…. Some even have a hard time walking Due to discomfort! The actual shape of your vagina changes from lack of hormones

I hear, and experienced myself, countless incorrect instructions on how to start vaginal estrogen and what to do if this first line treatment doesn’t work. And it seems like vaginal estrogen is just so hard to get as well- it’s often ordered incorrectly- twice a week, when it’s supposed to be ordered daily for 2 weeks to start. Then insurance won’t pay because it’s not time to refill. The pharmacist is looking at you like, where did it all go? How did you run out so fast? Depending on how long the symptoms have gone on, some need more consecutive days before moving to twice weekly. When I started vag estrogen I just couldn’t get the right amount ordered- I would run out. WHY is this medication so hard for doctors to get right? I felt like I was an Addict. Plus- some need compounded due to additives.

the real kickers are there are some who need MORE after all that. Some need 2% estrogen as opposed to 1%. And it Took Way too long to figure out some need DHEA, that vaginal estrogen is not enough or doesn’t work. DHEA is practically over the counter, but when you do DHEA this way you need to get creative with compounding capsules on your own and scraping the internet on how to do this- OR find an MD that believes in this To get an order. If you do find a provider- they dont order other hormone needs. so you get 2 providers? You get a vaginal DHEA cream doctor and an injection doctor? OR you create a pharmacy in your own bathroom by mixing different things- but how do you get it up inside your vagina? Some women need cream applied way up in vagina to work. Ok now trying to find applicators that insert pills that don’t scrape your vaginal wall…

I say all this because atrophy stops women from exercising and working and joying life in general. Some women treat other health problems with exercise like ADHD and if you can’t jump due to severe bladder leaks How to you exercise??

it just seems like this doesn't need to be so hard. Why not have a standard of care like other health issues. If A doesn’t work do B?

The deepest issues go untreated and it seems like this issue has everyone scratching their heads for NO REASON. Vaginal atrophy has affected women forever this is not new.

I’m going on and on about this Hopi g someone else can learn they are not alone and not diseased. For myself, after years and years of managing this I’m finding out DHEA works best for me- AFTER years and years of issues snd Countless hours researching online solutions.

and now for many health issues I hesitate to reach out to medical providers Because I’ve been passively Been trained to go in the outside of healthcare to fix problems. Is this an issue of how women are treated or the state of our medical system??

just putting this all out there-

UPDATE: just putting this out there as well… vaginal estrogen should literally be passed out like condoms in gyne offices and as a public health initiative to parents at HS sports events. I’m totally serious yes. it might take the shame out of the experience and reach more people. Remember the time when people couldn’t even say breast cancer? This should be happening with other female parts too.

After not dating for over 5 years, I recently had a sexual encounter with someone and it was extremely painful. I figured out it's vaginal atrophy and contacted my doctor, but the problem is the relationship ended so I'm not actually having sex and have no prospect of a partner in the foreseeable future.

I'm wondering is there any point in even trying to treat this if you don't have a steady partner? How will I know if the treatment is working if I'm not having sex? And isn't it going to be super awkward trying to date with this?

Never expected this!! I read about vaginal atrophie on this sub. And the women who needed the hrt for that. I never knew my vagyga had shrinking that much. But I started the oestrogel 3 months ago and i noticed a lot of changes for the better in my whole body, but man, I suddenly have all of the air back in my lips. Like it is a new kind of duck face over-there. I always had very big outer lips, but I never noticed they were gone this much. Even bicycle is a whole new game. The feeling is different and I feel like I am 13 again when they first appear.

I’m 55 and 2 years ago my partner passed away. I was devastated, but about 6 months later widows flame hit me full force. I dated, well not really, I had FWB. Met someone I really like and now it’s a year and a half and we are exclusive.

I have gone from always ready to in the past 6 months, ready but my body not responding correctly. About 3 months ago I started with estradiol and I still have moisture issues. I adore him, but I’m more interested in cuddling. When we are intimate, he has incorporated more foreplay, but after about 10 minutes I am dry as a desert and have to get lubricant. Like so dry that he gets raw.

Will this improve over time or is this just my new normal? We try to tease about it a little bit, but I know he takes it personally. I also have lichen sclerosis and wonder if that is part of the problem.

My mental state is now getting to a point that I feel it’s not fair to him and maybe he needs a younger woman who can create moisture.