@celia16 I'd like to validate every thing you are doing to maintain function. Like you, I used estradiol twice a week and I will tell you it really helped. Several years after I began using estradiol I learned from a nurse educator at the Minnesota Mayo Menopause and Women's Sexual Health Clinic that it wasn't necessary to plunge all the cream all the way up the vagina. That's messy and not needed. Instead, I applied a smaller amount the opening and about the lower 1/3 of the vagina and that worked very well. I also saw a pelvic floor physical therapist and followed up with the exercises at home. This also helped as I incorporated those exercises into my yoga practice.

Unfortunately I can no longer use estradiol because I had endometrial cancer 4 years ago. I was advised by my doctors not to use it anymore. I now use HyaloGyn which is an over the counter vaginal lubricant. It can only be purchased through the website. It works but not nearly as well as the estradiol.

Hyalo Gyn

-- https://hyalogyn.com/

I've used a vaginal dilator as I had vaginal brachytherapy for the endometrial cancer. The dilator worked very well however that type of radiation therapy shortens the vagina and there is scar tissue at the site of brachytherapy so sexual intercourse is painful for me. That's a huge disappointment however there are many other ways to be together and have orgasms. So that's what we do. I should add that we always use a lubricant and there are many over the counter choices for that.

I was told by the nurse educator I saw at Mayo Clinic that vaginal health is important whether or not you are sexually active. Since we, as women, will. have pelvic exams for a variety of reasons over the years these measures will make us more comfortable and provide a good "view" for the medical provider.