 Japanese American women at menopause not only have the lowest rates of hot flashes in the U.S., they also have the lowest rates of vaginal dryness. Might it be due in part to their greater soy consumption? One consensus panel of experts concluded that soy can be considered a first line treatment for menopausal hot flashes, innate sweat symptoms, but what about for vaginal dryness? There have been a few studies on the topical application of soy isoflavone vaginal gels, which in general have shown beneficial effects, for example, showing a significant improvement in dryness and pain with intercourse over placebo gels, in fact roughly on par with estrogen cream in a head-to-head test, but what about just eating soy? Soy isoflavones improve female sexual dysfunction of mice, significantly increasing vaginal blood flow, but what about in people? The data using isolated soy supplements is mixed. Some studies totally flopped, showing no benefit over placebo, all the way up to studies showing comparable efficacy when pitted head-to-head against hormone therapy for both hot flashes and muscle pain, as well as vaginal dryness with no significant differences between the two. And of course, soy has the benefit of no increased risk of breast and uterine cancer or cardiovascular disease, unlike systemic hormonal menopause therapy. What about soy foods, though, rather than soy supplements? Well, there was a muffin study. Women randomized to daily muffins containing soy flour or ground flax seeds saw no difference in menopausal sexual symptoms compared to wheat flour placebo muffins. Similarly, women randomized to 12 weeks of a daily scoop of soy protein powder experienced a significant improvement in sexual quality of life symptoms, but not compared to the milk protein control group. What about soy milk? There have been three studies. Compared to women randomized to drink about two cups of dairy milk a day for eight months, those randomized to soy milk ended up with significantly fewer menopausal sexual symptoms, though this appeared to be more due to symptoms getting worse on the dairy than getting better on the soy. That reminds me of a study in Thailand where women randomized to a soy-free diet experienced a worsening of vaginal dryness and overactive bladder type symptoms, but adding extra soy didn't seem to make them better. The second soy milk study found about two cups a day over two months appeared to drop vaginal and sexual symptoms by a whopping 60 to 70% compared to the Do Nothing control group, but since the control group didn't drink anything special, it's impossible to rule out placebo effects. The latest study found significant improvements in sexual symptoms after just six weeks of less than a cup of soy milk a day, but again, the control group did nothing. So does soy milk work? We really don't know, but it can't hurt to give it a try unless you overdo it. A 44-year-old New Yorker presented to her gynecologist with an increase in desire that required her to self-stimulate to orgasm approximately 15 times daily. Turns out a month before she started eating in excess of four pounds of soy foods a day, thankfully within three months of cutting back her desire cooled to the point that she was able to engage in satisfying sexual activity only twice daily.