Christine rec'd a call from a G3P3 c/o painful intercourse, has been rx/d
topical Betamethasone which provides some relief when used, advised by doc
that she may have to stop bfing since the "it is the hormones of
breastfeeding that are causing this problem." Perineal area is reddened
when the cream isn't used.
Am incredulous enough to keep a file on unsupported medical recommendations
to stop breastfeeding. Jack Newman MD has done a lovely job of countering
some of these in his handout, "You Can Still Breastfeed When . . . ." This
is a good, empowering handout for prenatal classes, along with his "Myths
About Breastfeeding," "More Myths About Breastfeeding," "More and More
Myths About Breastfeeding," and "Still More Myths About Breastfeeding."
See pages 418-419 of the current Breastfeeding Answer Book by Nancy
Mohrbacher & Julie Stock: "Low estrogen levels associated with
breastfeeding may cause vaginal dryness, tightness, and tenderness. If
intercourse is painful or uncomfortable for the mother, more foreplay may
help. Suggest she try using a water-based lubricant, such as K-Y jelly.
Another possibility is using estrogen-based creams or suppositories, which
are available by prescription. One study found these to be helpful and
showed no apparent effect on lactation (Wisniewski and Wilkinson
1991). . . . Jan Riordan, EdD, says in her book, A Practical Guide to
Breastfeeding, 'Pressures and problems of sexual relations while lactating
are as ancient as woman herself. Physicians during the 17th century
recommended breastfeeding, but insisted that sexual relations during
lactation would spoil the milk and endanger the life of the child.' Because
artificial feeding was not safe at that time, wet nurses became popular and
allowed women to stop breastfeeding to accomodate their husbands' desires
without compromising their babies' health."
The Hale 2002 (I do not yet have the 2004 Hale) lists Betamethasone as L3,
notes that this med is used in pediatrics and states, "see Prednisone," L2
per Hale and approved by The American Academy of Pediatrics for use in
breastfeeding mothers.
I would also suggest saliva as an effective, no-cost and readily available
lubricant, and would reinforce the many benefits of extended foreplay.
The following books by Barbara Ehrenreich & Deirdre English are interesting
reading:
1) Witches, Midwives and Nurses
2) For Her Own Good: 150 Years of The Experts' Advice to Women
3) Complaints and Disorders
Debra Swank, RN BSN IBCLC RLC
Winchester, Virginia USA
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