(031) Postpartum Vaginal Estrogen for Sexual Function in Lactating Patients: A Randomized Controlled Trial

Abstract Introduction Dyspareunia and vaginal dryness are common in the early postpartum period, particularly among lactating individuals in what is known as Genitourinary Syndrome of Lactation (GS-L). Vaginal estrogen may mitigate hypoestrogenic symptoms, but its impact on postpartum sexual function and activity is not well characterized. Additionally, it is currently considered “off-label” during this time period pre-menopause, due to lack of research. Objective To compare postpartum sexual activity, pain with sex, and sexual function over time among breastfeeding individuals randomized to vaginal estrogen vs vaginal moisturizer. Methods This was a single-site pilot study conducted at an academic hospital. Participants were postpartum, actively breastfeeding individuals recruited from the obstetric service. Inclusion criteria: full term birth, breastfeeding or pumping, absence of obstetric anal sphincter injury, and no contraindications to estrogen. Participants were randomized to receive a 4 mcg vaginal estradiol suppository or a non-hormonal vaginal moisturizer beginning at 6 weeks postpartum. Structured REDCap surveys were administered weekly through 12 weeks postpartum. Sexual activity and pain were assessed weekly. FSFI and symptom assessments (eg, dryness, pain, desire) were completed at baseline, 6 weeks, and 12 weeks postpartum. This analysis includes participants who successfully completed enrollment and at least one follow-up during the pilot phase. Primary outcomes were self-reported sexual activity and pain with sexual activity. Secondary outcomes included FSFI domain scores. Because of variable response rates by week, data were pooled into 4 intervals (0–3, 4–6, 7–9, and 10–12 weeks postpartum). Group differences were analyzed using Fisher’s exact test. Data analyzed represent only participants who successfully enrolled in the pilot phase. Results A total of 25 participants were enrolled (13 vaginal estrogen, 12 moisturizer). Mean age was 29 years (p = 0.55); most identified as Black or White. Baseline vaginal dryness was reported in 2/13 (15%) estrogen vs 2/12 (17%) moisturizer (p = 1.00); baseline pain with sex in 2/13 (15%) vs 0/12 (0%) (p = 0.50). (Table 1) Sexual activity rates increased over time, with the largest significant difference at 7–9 weeks postpartum (12/16 75.0% estrogen vs 5/15 33.3% moisturizer, p = 0.049). Activity rates were similar between groups earlier (0–6 weeks) and later (10–12 weeks). Pain with sex decreased steadily in both arms, with no significant between-group differences at any interval. (Table 2, Fig. 1). Conclusions Among lactating postpartum individuals, vaginal estrogen was associated with higher rates of sexual activity in the mid-postpartum period (7–9 weeks) compared with moisturizer, though pain rates improved in both groups over time. This pilot supports the feasibility of vaginal estrogen use during lactation and provides early signals for improved sexual function recovery, warranting larger, fully powered studies. Ongoing longitudinal FSFI data collection in the larger trial will further clarify the impact on sexual function. Disclosure No.