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  • Q&A with Australian Health Practitioners

    What is causing my sexual health problem after menopause?

    I am a 59 yr old woman who has gone through menopause and still have some symptoms but have decided to not continue with HRT after taking them for many years. I have separated from my husband just over 2.5 yrs now and had my first sexual encounter just recently...whilst I enjoyed the intimacy and touch unfortunately the penetration was extremely painful even with a lubricant..I also had bleeding and had an infection with burning on passing urine for 2 days. I want to continue to have sexual relations so please what can I do to make sex painless or less painful?
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    Dr Joseph Jabbour

    Gynaecologist, Gynaecologist - Infertility (IVF) Specialist, Obstetrician

    Dr Joseph Jabbour is a specialist Obstetrician & Gynaecologist and Fertility Specialist with Monash IVF situated in Sunnybank (Brisbane Southside). Dr Jabbour has had the … View Profile

    I would recommend you see your GP in the first instance. The likely cause of the pain, bleeding and potential Urinary Tract Infection (UTI) is the hypo-oestrogenic state of your vagina. This is not uncommon after menopause and is caused by the lack of oestrogen to your vagina. This condition is known as atrophic vaginitis.

    Your GP will need to obtain a thorough history, examine you, perform a Pap smear if required, and perform a pelvic ultrasound scan. A Urine specimen should be sent off to rule out a UTI. It is important to rule out any other pathology that may have caused the bleeding and the pain.

    If a pathologic cause is excluded, I would recommend you commence on vaginal oestrogen therapy. There are 2 different treatments: Ovestin cream and Vagifem. I would recommend the latter which is Vagifem 10mcg (low dose). The risks with this treatment are minimal, and it is different from other forms of HRT as only small amounts of oestrogen is absorbed into your system and the majority of its effect is local. You can use this type of treatment life long with no increased risk of Breast cancer (there is now a lot of evidence in the medical literature proving the safety of this medication even in the context of a patient with a history of Breast Cancer).

    You can be referred to a gynaecologist for further counselling. 

    If this fails, there is LASER treatment for severe atrophic vaginitis with good success rates. You can research your options in your area. This is not subsidised and can be a costly treatment though. There are several machines now such as the Mona Lisa or the Femme Touch.

    Good luck.

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