When was the last time you chatted to your friends about vaginal dryness? Or swapped tips on sexual health over a coffee? As we get older, we\u2019re generally better at having healthy relationships, are more independent and know what we want. Yet while many of us are happy to be open about other aspects of our lives, talking about our intimate regions can still be taboo.<\/p>\n
This silence is something that Dr Philippa Kaye, a GP and author of The M Word: Everything You Need To Know About The Menopause<\/a>, thinks needs to end. \u2018The words vulva and vagina should be words like elbow or nose,\u2019 she says. \u2018After all, if we can\u2019t name our genitals, how can we look after them? And if we can\u2019t look after them, how can we think of getting pleasure from them?\u2019<\/p>\n Testosterone and the vagina<\/p>\n There\u2019s been a 10-fold increase in prescribing testosterone for women in the last decade, writes Dr Sarah Jarvis. Testosterone cream is approved for use in the NHS by women with low sex drives if HRT isn\u2019t enough and once other problems, such as painful sex due to dryness, have been excluded. However, despite widespread publicity, an international panel of experts confirms there\u2019s no conclusive evidence that testosterone helps with depression, general wellbeing, cognition (mental abilities), body fat and body muscle or muscle strength around the menopause.<\/p>\n Menopause doesn\u2019t cause testosterone to plummet in the way that oestrogen does \u2013 instead, levels gradually decline from our mid-20s and are usually stable around the menopause. However, Dr Juliet Balfour, a GP and menopause specialist at the British Menopause Society, says that when women are plunged into chemical menopause from chemotherapy, or surgical menopause because the ovaries are removed, testosterone levels can rapidly drop by up to half compared with women in natural menopause. <\/p>\n Women only need a pea-sized blob applied to the thighs once a day. The idea is to avoid side-effects, such as acne, developing a deeper voice or growing facial hair \u2013 we don\u2019t yet have evidence on long-term safety. Most women on testosterone will be offered blood tests to monitor their levels and potential side effects. Women shouldn\u2019t ever self-medicate by using more gel than they\u2019ve been prescribed.<\/p>\n Effects of the menopause <\/p>\n Vaginal dryness affects up to four out of five women after menopause, and at least half suffer from genitourinary syndrome of menopause (GSM). Symptoms can develop years after hot flushes have disappeared and include loss of tone of the vagina; fragile, thinner tissue; itching and burning; incontinence; and dryness.<\/p>\n Dr Clare Spencer is an NHS GP, a registered menopause specialist and co-founder of the My Menopause Centre online clinic. She says, \u2018Hormonal changes can cause the vagina to lose elasticity and even become shorter. Sex can become uncomfortable or perhaps painful. This, in turn, can sometimes lead to vaginismus, an involuntary contraction of vaginal muscles that can make penetrative sex impossible.\u2019<\/p>\n \u201cVaginal oestrogen can reduce UTI risks\u201d<\/p>\n HRT can help to reduce or prevent these symptoms, but if you can\u2019t or don\u2019t want to take HRT, or it\u2019s not making enough difference, topical vaginal oestrogen is worth considering. It comes in the form of a cream, gel or pessary, applied up to five days a week, or as a vaginal ring, which disperses oestrogen over three months.<\/p>\n \u2018Although technically it\u2019s a form of HRT, very little gets into your system,\u2019 says Dr Kaye. \u2018Using vaginal oestrogen for a year is the equivalent of taking two HRT tablets. That means there are no significant risks to taking it and it can be used lifelong.\u2019<\/p>\n Dr Spencer adds: \u2018Vaginal oestrogen is available on the NHS via your GP. You can also buy a type of vaginal oestrogen called Gina over the counter from a pharmacy or online.\u2019<\/p>\n Vaginal oestrogen can reduce the risk of UTIs and, says Dr Kaye, \u2018It can also normalise the vagina\u2019s pH and microbiome, the healthy bacteria that live in the vagina. This is hugely important and may help to prevent gynaecological cancers.\u2019<\/p>\n Vaginal moisturisers can also be the menopausal woman\u2019s best friend, especially when it comes to soothing the itching caused by GSM. Dr Kaye advises, \u2018Start by using them daily. After a week or two, you may be able to use them less frequently.\u2019 Try Yes Vaginal Moisturiser<\/a> or Regelle<\/a>.<\/p>\n Protect yourself<\/p>\n Up to 60% of first marriages end in divorce. And while dating and new partners can bring renewed sexual energy to later life, there can be a downside. Dr Spencer says she\u2019s seeing increasing numbers of midlife women who have contracted a sexually transmitted disease (STI) for the first time.<\/p>\n Any changes to your usual vaginal discharge, pain on urination, lumps or sores should be checked out. But many STIs have no symptoms. This means the only way to know for sure is to get tested. NHS sexual health clinics are the experts in testing and treating STIs.<\/p>\n You can usually walk into a sexual health clinic without an appointment, and you don\u2019t have to give your real name. No information will be shared with your GP without your express consent, and you can ask to see a female nurse or doctor if you prefer. You may need to give a urine sample or have a painless swab using a small cotton bud. You don\u2019t pay for prescriptions and some clinics even offer home testing for STIs. <\/p>\n