to the editor: I appreciated this article, which discussed several options for helping women deal with this difficult issue. However, I would suggest another treatment modality for postmenopausal dyspareunia, particularly if hormonal options and ospemifene (Osphena) are contraindicated. In one small study, 90% of patients with menopausal dyspareunia reported comfortable penetration when 4% aqueous lidocaine was applied to the vulvar vestibule for three minutes before intercourse.¹ I have since recommended this to patients in my own practice with good results, because lubricants alone often are not enough. I would recommend this option in patients with vaginal atrophy who are unable or unwilling to use estrogen preparations or ospemifene.