At menopause as hormone levels decline, women start noticing signs of dryness or tightness and sex may become uncomfortable
There are several reasons for this, and a number of conditions that can arise at this time may need to be investigated.
Dealing with dryness
This is most common at menopause and related to the declining oestrogen levels that occur at this time.
This is not serious physically, though can certainly be distressing, and there are a number of lubricants available.
If you have mild to moderate vaginitis, using a lubricant can help relieve pain and discomfort while having sex but they provide short-term symptom relief and can improve vaginal dryness during sex, but there’s no evidence to show they’re an effective long-term treatment.
Several types of lubricant are available – some are water-based and some are silicone-based. You may need to try a few before finding one that’s suitable or your GP may wish to prescribe a local oestrogen cream, gel or pessary.
If you prefer a natural alternative then 20-1, which is a combination cream with the majority ingredient of progesterone with two natural oestrogens added, can help particularly if internal vaginal application is used.
This is inflammation of the vagina that can cause itching, discomfort and discharge. It can be caused by any of the following infections or irritants:
• thrush – a common yeast infection that affects most women at some point
• bacterial vaginosis – a bacterial infection where the balance of bacteria inside the vagina is disrupted
• trichomoniasis – an STI (Sexually Transmitted Infection) caused by a tiny parasite
• chemical irritation – for example, from perfumed soap, bubble bath, or fabric conditioner, or from spermicide and some sanitary products
• washing inside your vagina
• chlamydia – an STI caused by bacteria
• gonorrhoea – an STI caused by bacteria
• genital herpes – an STI caused by the herpes simplex virus. and symptoms include:
Symptoms can include the following
• an abnormal vaginal discharge
• vaginal irritation or itching
• pain when peeing or having sex
• light bleeding or spotting
A strong, unpleasant smell, particularly after sex, can be a sign of bacterial vaginosis or trichomoniasis, which can sometimes cause vaginitis.
Time to see your GP or go to a sexual health clinic if you have any unusual vaginal symptoms, particularly if:
• you have vaginal itching or an unpleasant smelling vaginal discharge
• you haven’t had a vaginal infection before
• you’ve had vaginal infections in the past, but this time your symptoms are different
• you’ve had a number of sexual partners or you have a new sexual partner – you may have a sexually transmitted infection (STI)
• you’ve finished a course of medication for vaginal thrush, but your symptoms are persisting
There’s no need to see your GP if you’ve been diagnosed with thrush in the past and your symptoms are the same. If you’re sure you have thrush and you’ve treated it successfully in the past with over-the-counter medication, you can treat it yourself again.
Treatment for vaginitis depends on what’s causing it. Yeast infections, such as vaginal thrush, are usually treated with antifungal medicines, and bacterial infections are usually treated with antibiotics.
This refers to the thinning of the lining of the vagina after the menopause and the resulting dryness, itching or discomfort (particularly during sex). It can also sometimes be caused by a decrease in oestrogen levels after the menopause.
Your GP may recommend HRT or an additional local oestrogen and that is usually necessary with atrophy until the condition is more stable.
Unlike combined or other forms of HRT, this only restores oestrogen to your vagina rather than to your whole body, reducing the risk of side effects.
You can balance this additional oestrogen with bioidentical progesterone, and once the atrophy is under control you can use a combined bioidentical progesterone and oestrogen cream.
How to help yourself
There are number of self-help measures which can reduce the risk of these problems and help once they are diagnosed.
• keep your genital area clean and dry – take a warm bath rather than a hot one and use unperfumed soap to clean your genital area and dry yourself thoroughly
• avoid douching (spraying water inside your vagina) – it may make your vaginitis symptoms worse by removing the healthy bacteria that line the vagina and help keep it free from infection
• do not use feminine hygiene products – such as sprays, deodorants or powders
• use pads rather than tampons if you’re using intravaginal creams or pessaries to treat an infection – tampons may ‘soak up’ the treatment meaning there’s less available in the vagina
• wear loose-fitting cotton underwear – this may be beneficial if you have external soreness, but it won’t prevent you getting vaginitis in the future
For any of these condition it is best to practice safe sex by using condoms to avoid getting or spreading STIs.