Lets talk frankly
Experts advise on managing intimate problems
Sex should be a pleasure – so of course when it causes pain something is amiss. This is often caused by vaginal dryness, which can affect women of all ages at some stage in their lives but is commonly a side effect of the menopause (although it can be a symptom of diabetes, certain medications, breast feeding, cancer treatments or even stress). Declining or fluctuating levels of the hormone oestrogen are often the problem and this typically affects vaginal lubrication, making sex uncomfortable.
WHAT CAN HELP
✢ This might be a short-term issue resolved simply by using a vaginal moisturiser (different from a lubricant) to line the inside of the vagina, providing moisture, lubrication and comfort. Try Replens Vaginal Moisturiser (£11.49, Boots, Superdrug, amazon.co.uk). Or take a supplement of buckthorn oil – studies suggest this helps support the health of mucous membranes and increases vaginal lubrication. Try Healthspan Omega 7 Sea Buckthorn Oil (£16.95).
✢ There are also newer laser vaginal treatments available. The Mona Lisa laser treatment helps to restore vaginal tissues to their normal, pre-menopause thickness, elasticity and level of moisture. The treatment is painless and takes between 5-10 minutes.
✢ ‘We usually suggest three treatments a year at 4-6 weekly intervals, and then one maintenance treatment every year,’ says Tania Adib, a specialist gynaecologist at The Medical Chambers Kensington. ‘Of course, everyone is different, so that’s why a patient should only be treated by an expert in vaginal health, such as a gynaecologist.’ At £650 per treatment it isn’t cheap but might be worth considering.
✢ But satisfying sex is also generally about emotional intimacy and communication and if you are not getting what you want from your partner (in or out of bed) you are less likely to become aroused. As sex expert Tracey Cox says, ‘Your partner isn’t a mind reader: be honest about what works for you and what doesn’t.’
Vulval pain
This chronic condition, known as vulvodynia, causes women to feel pain in the vulva and the skin surrounding the vagina. While its cause is not known, the pain stems from nerve fibres firing abnormal signals. It is neither an infection nor an inflammation, and it may last up to three months. Vestibulodynia, also known as vestibular pain, is another chronic pain condition that is usually provoked by tight clothing, tampon insertion, and sexual intercourse. While there’s no underlying root cause for vulvodynia, the condition could be due to one or more of many things, including nerve injury or irritation, hypersensitivity to yeast infections and hormonal changes.
Because there are no visible signs of vulvodynia, women sometimes find it difficult to get a diagnosis – especially in cases where they visit their GP as opposed to a gynaecologist who would have experience of the condition.
Irritated vulva
Who knew vulval disorders are some of the most common problems seen by gynaecologists? Common causes include infections like thrush and generally harmless skin conditions like lichen sclerosus (which typically causes itchy white patches around the vulva – or opening of the vagina). This condition can be irritated by perfumed soaps and perfumed products, plus, spermicide or panty liners/sanitary towels and it can also be exacerbated by wearing tight, restrictive clothing.
WHAT CAN HELP
✢ Vulval disease that is dermatologically related can be treated with emollient soap substitutes, using a barrier cream on the affected area, such as petroleum jelly, and possibly a prescription steroid cream.
✢ Try to avoid anything likely to inflame the condition – including perfumed bath and body products, perfumed toilet paper, or restrictive or tight clothing. Wear loose clothing and/or natural breathable fabrics (including your underwear) instead of man-made fibres to improve the condition and if vulval irritation is making sex uncomfortable, use a vaginal lubricant/ moisturiser daily to help. Always schedule in a gynae examination at the earliest opportunity to catch any problem quickly and to rule out anything potentially serious like a pre-cancerous condition (the risk is very low but having lichen sclerosus does increase your risk of cancer of the vulva). >>
After the menopause, your vaginal walls respond to falling levels of oestrogen hormone by becoming thinner, drier, less elastic and generally more fragile. Known as vaginal atrophy, these changes also affect the natural acidity of the vagina, and make it difficult for normal, protective bacteria to flourish. ‘Vaginal atrophy isn’t much discussed because women are embarrassed but it can be incredibly debilitating, and many women just put up with it and live with it believing that there are no treatments for their condition,’ says Tania.