QUESTION: My sex life with my husband was good until I entered the menopause and developed severe problems with dryness. I now find our lovemaking is almost too painful to endure, although my husband is very gentle. I know I should see my GP, but I’ve been seeing the same male doctor for 20 years, who’s become a family friend, and I simply feel too embarrassed to discuss something so intimate with him. Nor can I face talking to a total stranger. What should I do?
ANSWER: Embarrassment will be the death of us Brits; all too often we’d rather suffer than run the risk of blushes and temporary indignity. There’s also a fault in our healthcare system, which means women aren’t steered towards proper “well woman” maintenance.
All my friends in France and America see their own gynaecologist regularly, but that remains a rarity here. French and American women believe it’s their God-given right to claim the best possible maintenance, whereas here in Britain we can barely say “vagina”.
No wonder we often get twisted in knots when problems arise. One woman I know makes a round trip of 120 miles twice a year to see her gynaecologist because, as she says: “I can’t talk about my bits with a doctor who goes to my church - that would be sacrilegious!”
About 80 percent of women suffer problems with dryness as the menopause progresses. So it’s hardly an embarrassing disorder, more a rite of passage.
As oestrogen levels drop the mucous membranes that lubricate the vagina become less productive and there’s less blood-flow to the pelvic region, resulting in a thinning of the vaginal walls.
Then there’s the fact that the body’s natural lubricant has a slight acidity to counter bacteria; so, as production decreases, women can become far more vulnerable to yeast infections and cystitis. This is why sex can become painful and why it’s so important to seek help.
Fortunately, we live in the 21st century and there’s a whole raft of products and advice available. The first and easiest remedy to try is one of the many good lubricants now available online - internet shopping reduces everyone’s blushes.
I would recommend trying one that uses natural ingredients, such as Yes (which is free from parabens and glycerin and uses organic ingredients) or Coco de Mer’s Spill.
You can apply lubricant before you make love, if you feel embarrassed by the thought of introducing it during the act. Having said that, I am sure your husband would welcome anything that decreases pain for you.
The other simple remedy - highly recommended by many of my friends - is a vaginal oestrogen cream or pessary. The benefit of such creams is that a smaller dose of hormones enters the bloodstream than if you were taking a full course of Hormone Replacement Therapy (HRT). They help restore blood flow to the vagina and improve lubrication, too.
However, you will need to brave the doctor for your prescription. If you can’t face the thought, why don’t you make an appointment at your local sexual health clinic?
Or book yourself in with a gynaecologist for an MOT. Women need to keep a watchful eye on their pelvis and uterus, just as men need to be vigilant about their prostate. Gynaecologists are used to putting even the most nervous women at ease.
If you steel yourself to see a doctor, you may well be recommended HRT, but they will also advise you of the health issues, such as increased risk of a thrombosis and a small increased risk of breast cancer.
For those reasons, most medics only recommend a short course initially. Some women feel instantly rejuvenated - you may remember how the Tory MP Teresa Gorman used to skip around like a teenager, singing HRT’s praises - but I do know others who just didn’t get on with it.
My greener friends swear by natural remedies, often dubbed “natural HRT”, with many varieties available online, but it’s hard to establish whether they’re merely reaping the benefit of a placebo effect.
What is clear is that exercising and eating healthily (with more fruit, vegetables, pulses and oily fish and reduced salt, sugar, caffeine and alcohol) can have significant benefits.
Do also remember that intercourse needn’t be focused around penetrative sex and that there are other pleasurable ways to reach orgasm.
One relationship counsellor I know, who’s now in her mid-50s, points out that stress can exacerbate sexual problems during menopause, because it’s such a big readjustment. She says: “Women find that their initial fears that they’re waving goodbye to their sex life are misplaced; they just need to embrace new ways of doing things.”
That is the case among my 50-something female friends. Several have said that once they stopped mourning their lost youth, they could appreciate the benefits - such as having to be more innovative in bed and being free from the fear of pregnancy.
As one said with a glint in her eye: “I’m 55 and I promise you my sex life has never been better.” - Daily Mail