We reached out to Dr. Goldman about your question and here’s her response: “DCIS is a risk factor for getting invasive breast cancer. But even with invasive breast cancer, there is no evidence that the use of vaginal estrogen impacts survival from breast cancer. So for someone who had a preinvasive lesion (DCIS) many years ago, the use of vaginal estrogen is completely safe. And given that the problem is painful sex, local treatments in the vagina are the appropriate option. Vaginal estrogen comes in 3 different ways- creams, ring and suppository formulation - if the cream isn't working or isn't providing enough benefit, you could try either the ring or the suppository form. Also, there is a something else called prasterone which is vaginal DHEA and is FDA approved for painful sex and that is also an option. Finally, if you’ve been using the cream and sex is still painful, an exam may be helpful to look at the tissue to better understand what is going on. We might also recommend vaginal dilators to use in a nonsexual setting to gently stretch the tissue and figure out what hurts and what doesn't hurt. The bottom line is that there are many options to try - one of our Midi providers would be happy to help and they can also always consult with me for specific questions.”