DEAR DR. ROACH: I read your recent column from the woman with vaginal atrophy. I am experiencing the same problem. The next problem is that a small tube of Premarin cream is $250. I’m wondering if progesterone cream applied topically can do any good. I’m currently using an OTC moisturizer. I can’t afford the $250 Premarin, and there is no generic. I have had recurring UTI issues for over 20 years, and this may explain them. — M.M.

ANSWER: I received a lot of mail about the cost of vaginal estrogen. I found a coupon through goodrx.com for generic estradiol cream. It is similar to, but not exactly the same as, Premarin, which is conjugated equine (horse) estrogens. Estradiol is the bioidentical human hormone, manufactured to be molecularly identical. The estradiol is $95, which is better than $250.

Over-the-counter vaginal moisturizers are a good place to start for women with symptomatic dry vagina from atrophic vaginitis, but estrogen creams are more effective and are much more likely to prevent urine infections. Another writer told me that Premarin vaginal cream is available in Canadian pharmacies for $60 for a three-month supply.

Progesterone has not been shown to be effective. The lining of the vagina gets thicker and healthier with estrogen. Progesterone is being studied for use in treating vaginal atrophy, and I hope that this may be an additional option, but I am skeptical.

DEAR DR. ROACH: I’m a 71-year-old male who just underwent surgery for tongue cancer. It was diagnosed as an invasive squamous cell carcinoma with strong P16 staining consistent with human HPV. We’ve never been vaccinated for HPV. Is it advisable for my wife (66 years old) and me to be vaccinated with Gardasil 9? She was tested by her gynecologist and does not have HPV at this time. — R.L.

ANSWER: Human papillomavirus is an increasing cause of cancer in the head and neck, and it is believed that vaccination is likely to prevent most cases of this type of cancer, which mostly occur in men. Although there are clinical trials ongoing now to see whether vaccination may help treat existing HPV-related cancers, it is not routinely recommended for people with HPV-related cancers.

Your wife was wise to get tested for HPV. Given her age, she would not normally be considered a candidate for the vaccine. Odds are she has already been exposed to the virus during your marriage and has successfully resisted the infection. Some people in her situation might consider the vaccine, given its low risk of side effects, despite lack of proven effectiveness in this situation. However, it would be three doses of the vaccine, which would not normally be covered by insurance in the U.S.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.