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Physical changes in the vagina As perimenopause progresses, the drop in estrogen can create thinning, tightening, and dryness in the vulva and vagina. These changes can lead to such discomfort that some women come to dread sex because of the pain. [24-26] Current Evidence on Oral Drugs Yoram Vardi (Rambam Medical Center, Haifa, Israel) discussed the current evidence on oral treatment for FSD.
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