For men sexual function remains reasonable well into old age, but if not, help is available (e.g. Viagra). The general complaint is that they don't get enough! But for an increasing number of women sex becomes a chore or literally a pain after menopause.

Since HRT has been attacked and labelled dangerous millions of women in so-called democratic countries have gone off HRT or have refused to start it, and some doctors have refused to prescribe it.

Closer consideration of the WHI and other studies has revealed that the so-called dangers are mostly unfounded especially in the very women who need it most. These are women in the late forties or early fifties who do not have risk factors for heart attack and stroke and have no familial risk of breast cancer.

Oestrogens do not cause breast cancer but they do stimulate the growth of breast tissue and therefore the growth of an existing cancer.

It is true that acute symptoms of menopause do subside with time and for some fortunate women never occur at all. But most women with increasing age and lack of oestrogen develop degrees of vaginal dryness and shrinkage which cause painful sex or refusal to have sex. In addition, oestrogen deficiency causes the vagina to become alkaline. Resistance to organisms such as Group B strep is lost (These are normally commensals and only dangerous to babies passing through the vagina).

Bacterial vaginosis can occur and will give rise to an increased susceptibility to bladder infection and cystitis since the urethra is also sensitive to oestrogen lack. Many doctors seem unaware of bacterial vaginosis and mistake it for thrush. This is then treated many times without relief.

The distinctive symptom is burning in the vagina though there may also be some itching. The treatment is vaginal Dalacin V cream and then future protection with vaginal oestrogen therapy twice a week. This should be continued long term, especially if the woman is sexually active.

To my amusement Medscape recently had an article titled "An Epidemic of Atrophic Vaginitis". Well ! They have caused it by scaring women off any kind of HRT.

My advice to all post menopausal women is to use vaginal oestrogen therapy long term.

If a woman has had breast cancer she will have been warned off any kind of HRT but oestriol as cream or pessaries is a weak oestrogen and studies have shown it to be perfectly safe for such women.

There are two other conditions which make sex undesirable or painful for postmenopausal women. Loss of libido may be helped by the use of testosterone though not everyone agrees with this. It should be measured and administered with care.

Painful sex may be due to a thin tight band which forms at the introitus with age and oestrogen deficiency. The woman will tell you that she feels as if her vaginal opening is splitting. Perineotomy is a suitable solution to this problem.

Back to Top