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Dr Phil: After the menopause

I thought I just had to pad up and shut up. So said a 52-year-old woman who'd finally got through the menopause and thought she could relax, only to be faced with a whole host of unpleasant symptoms down below. Vaginal dryness and soreness, painful sex, leakage of urine and recurrent urinary tract infections that didn't seem to respond to antibiotics. Trouble was, she was too embarrassed to discuss these, either with her partner or her GP, so she suffered in silence until she heard a radio broadcast about the post-menopause and realised she wasn't alone.

So what's going on here? Women (and men) have oestrogen receptors all over their bodies and after the menopause, the lack of oestrogen affects many organs. Most women are aware of the hot sweats, emotional changes and longer term risks of osteoporosis, but symptoms down below are harder to talk about. Without oestrogen, the skin and support tissues of the vulva (lips) and vagina become thin and less elastic. This makes them more easily damaged, especially during sex if lubrication is poor. Even the everyday friction of your vulva rubbing against underwear can cause discomfort. The oestrogen lack also changes the pH of the vaginal secretions, suppressing normal levels of good bacteria (e.g. lactobacilli) and leading to a watery, discoloured, slightly smelly discharge that can cause burning and irritation. Unsurprisingly, some women think they must have contracted a sexually transmitted infection.
Lack of oestrogen also makes your pelvic floor sag, and many women get some prolapse as the womb drops down against a weakened vaginal wall (usually at the front). The hood that protects the clitoris can shrink, which can leave the clitoris sore, exposed and very difficult to talk about. And then there are the urinary tract symptoms, ranging from incontinence to overactive bladder and recurrent symptoms of urinary tract infections.
So, what can be done about all this? Clearly we need to recognize and discuss symptoms openly, with friends, partners and health professionals. Soap tends to make skin dry, which is bad news for an already dry vagina, so switching to aqueous cream can make a difference. As for lubricants, the best well-known (KY Jelly) is a lot messier than Liquid Silk or Replens MD (available on prescription or over the counter).
Local oestrogen therapy can make a huge difference to vaginal dryness, soreness and urinary symptoms. It comes in the form of daily tablets, pessaries and creams, or a vaginal silica ring that can be inserted for 3 months. The good news is that the dose of oestrogen is low and the risk of side-effects associated with HRT is much smaller. Pelvic floor exercises are always worth doing, and there are even pelvic-floor physiotherapists who know all the tricks and tools to strengthen things up. Occasionally, surgery is needed for stress incontinence (the kind that makes you leak when you cough or jump), but it's much less invasive than it used to be and rarely is a hysterectomy performed.
For more information, take a look at the specialist site, or you can surf this site for related articles: Menopause - a guide to symptoms, Smooth riding the menopause, Flushing at the menopause, Ageing skin, Cystitis in women, Dry vagina, Hairiness in women, Hair loss in women, Memory problems, Night sweats, No interest in sex, and Sex and ageing . The bottom line, as ever, is don't be embarrassed to ask for help. There's plenty that can be done.
Interesting fact: After the menopause, women often have lower oestrogen levels than men.
Dr Phil Hammond is a medical doctor, comedian and commentator on health issues.

Written by: Dr Phil Hammond
Edited by: Dr Phil Hammond
Last updated: Friday, February 1st 2013

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Comments on this article

Posted by Optional on 27/06/2019 at 12:33

My clitoris is very sore. I have fibromyalgia which doesn't help. I have diabetic neuropathy, ME. In a wheelchair, so no air can get there properly and very dry which leads me to itch a lot. It drives me insane. I have lubes but applying it hurts. Also, I am finding sex hurts and a small scar bleeds during the act due to childbirth

Posted by Optional on 01/09/2017 at 01:09

I am 52 and going through the menopause - and have been suffering from embarrassing vaginal spots and lumps (a lot of them around my bottom) and have also noticed that whenever I wash or comb my hair, I am losing clumps of it!! I have always had thick hair and am becoming quite conscious of it. :(

Posted by Optional on 29/08/2017 at 03:56

Please provide some feedbacwith menopause I find it is so dry down there it feels like vaginal skin in peeling and itches due to dryness. Any suggestion, and embarrassing to me

Posted by Optional on 20/07/2017 at 10:06

Iam 57 years old and havent had sex in 10 years i already pass my menopause and iam not on any estrogen because i smoke. Recently a boy friend from the past came back into my life and he has a pretty big penis. It never hurt me before, but now it hurt while he entered me. Im pretty tight and hurt me a little but until i fully relaxed but it still hurt me on the opening of my vagina. After i was sore and it hurt when i peed. I think it was from being extremly tight, the size of his penis and maybe beung dry. Im still feeling this issue uts been 1 week we tried again and it was still sore down yhere. I went and bought some vagisil and its seems like its helping. It i was chapped from rubbing because we had intense sex for 2 days in a row. I started to worry that i had a STD got checked and the test came out negitive. Is it normal to be sore for this long after sex. It dosent huet me inside only a little bit because of his size but then goes away, but the soreness and burning is still there its seems the vagisil is working. What xan i do so it dosent hurt me. What kind of gel or lubricant can i use to help me. What advice can you give me. Its fusteating for the both of us.

Posted by Optional on 05/06/2017 at 06:41

the last week or so, I have been having horrible iching and burning, at my clitoris area, and not every time I wipe, but there have been small spots of brownish spots!

Posted by Kirsty80 on 17/05/2017 at 11:54

Can lack of ostregen give continuous sore anus. Have been put on vageferm pesseries yesterday for first time after suffering for two yrs and hope this does the trick

Posted by Optional on 20/03/2017 at 07:24

I am going through menopause and had a couple of tears about two months ago through lack of lubrication. I use something called Vagisan which moistens the vagina and relives itching a little. I am not keen to go on HRT and this cream is hormone free.

Posted by Optional on 02/12/2015 at 08:16

I can see that many of you are really suffering with the symptoms of menopause. Make sure to examine your vulva for any irregularities. My vulva was extremely itchy when I was 42 and was told that it was the beginning of menopause. When I examined my vulva, it was completely white. When I googled this, it sounded like lichen schlerosis. I went back to the GP and asked for a referral to a OB/GYn who did a biopsy and confirmed it. I now have to use cortisone cream for the rest of my life. So be aware that there can be other conditions that can make you itchy, sore, painful sex, splitting skin, atrophied vagina, which can also include the perineum and anus. I wish I could help all of you who submitted these questions. Good luck and keep perservering. To the people who are reacting to KY jelly, get an oil based lubricant. They are much softer and milder.

Posted by Optional on 22/09/2015 at 02:07

I have been prescribed vagifem by my gp for vaginal dryness,but have also been using replens in between. Can this seep through the vaginal wall and affect bowel movements?

Posted by Optional on 15/09/2015 at 11:32

I have been having problems hurting while having sex since in my teens and I have always been dry. It has been very embarrassing and it hurts so so bad to have sex. It's causing problems in my relationship because we hardly ever have sex, maybe once or twice a week. What I don't get is he knows I hurt really bad but yet he goes behind my back and orders some pills to make his penis bigger. I wish someone could please help me understand why any man would do this....? I really wish one day I will be able to enjoy intercourse, because I have no clue what it feels like to have sex without hurting, and he has no idea how bad it hurts my feelings when he throws it up in my face because I can't enjoy it the way I want to..

Posted by Optional on 29/08/2015 at 02:38

Have not had a period for over a year but am getting bad dryness during sex. Replens does not seem to do much or lube. It feels like my entrance has closed up and got smaller and feels like something is down low sort of blocking deeper intercourse in missionary position. Its painful like i cannot bear anything male going in there. After being very lubricated during my life this is odd and upsetting. Where im dry if im not careful it bleeds slightly too.

Posted by Optional on 27/08/2015 at 06:01

Are there natural alternatives-food- that contain good levels of oestrogen,that can help combat vaginal dryness.?

Posted by Optional on 18/08/2015 at 05:22

No clitrois sensation no sex desire since menopause

Posted by Optional on 23/07/2015 at 11:33

My vagina is so dry during sex and my sex drive is low

Posted by Optional on 23/06/2015 at 09:42

I expected vaginal changes after menopause, dryness and the like. What I was not prepared for was the dull aching in the vulvar, specifically the labia majora. I must keep reading and learning. Thank you.

Posted by Lorraine on 24/05/2015 at 12:11

I am 54 and suffer with dryness your information has helped me a lot thank you

Posted by Optional on 30/04/2015 at 10:30

My clitoris appears to be getting smaller.. I'm getting rather worried about this. Is it a normal part of the post menopause?

Posted by an on 29/04/2015 at 04:06

I am sore around inner vagina. When my dr did a pp sme and when she inserted a lubricant, I felt a burning sensation from the lubricant. Also, she had to use a very small speculum to open my vagina which was pinful. I haven't had sex for 10 years and am ondering that I am tih or is it because I am very dry, which my dr suspects dryness is the cause.

Posted by heather on 06/04/2015 at 09:18

Yes have a problem down below my bare bottom and haven't had a period in five years now .also been having few spots of blood too.

Posted by Optional on 04/04/2015 at 04:00

Hi i need someone to help me iam 49 and going though the menopause but my vigina is very dry, itchy and feels scalay which is sore and have gone of sex complety please help

Posted by Optional on 29/03/2015 at 05:45

My clitoris is no longer there. What can i do. I am ashame my husband might notice.

Posted by Optional on 07/03/2015 at 11:12

I'm going through menopause. Using estrogen patches which totally relieved hot flashes. But feel my vagina is drying up and shriveling away:( The patches are bio identical . I can't use vagifem which worked GREAT, because it sent my migraines with aura and partial paralysis into overdrive!!!! Just don't know what to do.

Posted by Optional on 02/02/2015 at 10:32

I feel very hot and sweat alot.The problem now is that ,l feel hot & burning sensation around my anus that lasted for few minutes now am experiences piles due to frequent burning sensation in that part.Can it be one of menopausal problems?

Posted by Optional on 23/01/2015 at 12:51

What can I use for itching on the outside (lips) of my vagina

Posted by Optional on 06/12/2014 at 02:31

Postmenapausel stinging clitorus after urinating with small tear really hurts

Posted by Kathy. Maynard on 29/10/2014 at 09:53

very. dry i don't. have any ovaries and i have diabetes what. can i do to have sex. with. my husband

Posted by Optional LW on 10/10/2014 at 04:15

After reading your article I realized I have a problem when I have sex... I am going to make an appointment with my doctor and get something for the dryness and pain that I experience during sex... Hopefully this will make my sex life a lot more enjoyable... I cannot thank you enough for your information Sincerely LW

Posted by Susan on 04/08/2014 at 05:19

Thank you sooo much, I have a problem with vaginal atrophy and had little to no idea of what effect lack of estrogen has on the Vulva area !! I found obtaining information difficult, I didnt know what was " normal " and what wasnt. This article of yours has helped me greatly, Thankyou again.

Posted by Optional on 28/07/2014 at 10:48

I have had a painless white spot on my left nipple for well over a year. I think it is slightly raised, like a spot and is hard, cannot squeeze, no discharge. The closest image and description I've found is related to breast feeding but as I'm post-menopausal surely that is impossible.

Posted by sally l on 30/06/2014 at 12:14

have found your advice very helpfull , as i was worried assbout taking h.r.t. now i know i can do it with out that. thanyou. xx

Posted by buterfly on 01/02/2014 at 10:32

I keep getting vaginal adhesion over my clitoris they partly rip open but not always. I use lube and try to get them to stop growing together. I sure miss my hormones!!!I miss being horney also...

Posted by Optional on 24/11/2013 at 06:21

This has been very insightful it is sort of a relief knowing I'm not in this alone and there's. Help out there, ...

Posted by Optional on 13/11/2013 at 12:41

I am on htr but i am still experiencing vaginal dryness and loss of any sexual desire cannot even reach a climax any more what can i do

Posted by neville on 11/10/2013 at 08:50

Sir.I do not have sperm discharging after intercourse. Is it due to my age or any other problem. pl. help me.

Posted by Gillian on 28/04/2013 at 03:02

Having started the menopause I am now finding sex extremelly painful. Started using Replens about 4 weeks ago and this has helped with the inside of the vagina but the initial entrance of the penis still hurts and I bleeed. Next day really sore. Not had sex for about a year but have now started a new relationship and don't want to put him off. Should I swap to a different lube?

Posted by Barbara on 14/02/2013 at 06:20

I wondered if you could possible help me. I have found it very difficult and painful to have intercourse. Not only the dryness but my inner vagina seems as if it blocked, is it possible that it shrinks or changes shape making it very painful and also embarresing. It the old saying if you don't use you lose it.

Posted by TAHL on 27/01/2013 at 06:21

I have started taking HRT a month ago. Expereince vaginal dryness and soreness, painful sex. Vagina bleeds as well. Upon initial entrance of the penis there is a burning sensation. Have not experience an orgasim during intercourse.

Posted by stella on 12/01/2013 at 11:48

I started hrt at 51 with bleed and struggled constantly to remain on them due to the negativeness of medics. Always told to come off hrt even though it suits me and i have no menopausal problems. Last year my doctor made me go on a combined hrt low dose. I had extreme bouts of dry burning mouth, lethargy and no sex drive i now have had bouts of painful burning around labia and anal areas and pain on intercouse. I am amazed that menopause still remains a taboo subject. If i was pregnant there is every help available to relieve pain and discomfort. Male gp in particular just seem to say its getting old and just grin and bear it. Imagine the outcry if that was said to a woman in labour? I percevere with low dose hrt but it obviously isnt giving me sufficient oestrogen. I fear my visit to gp every six months due to the onslaught of bad atitide and continually trying to get me to cease it altogether. Isnt quality of life what matters. I understand the small risks associated with hrt. But i find it a wonder drug.

Posted by Optional on 10/10/2011 at 02:52


Posted by mac on 22/09/2011 at 09:08

I have used ky jelly for years now they have changed the formula and so it burns each time we have sex is there anything else we can use also allergic to lanolain

Posted by Optional marianna on 11/05/2011 at 06:02

vagina dryness causes pain during intercourse. any suggestions for treatment? thank you

Posted by Linda A on 21/03/2011 at 05:18

Has anyone used a Vaginal Slica Ring, if so did it help, & was it easy to use?

Posted by Stormy on 03/03/2011 at 02:11

I had a complete hyst. when I was 32 yrs old. for the past 20 years my vagina has been so dry that it bleeds. the lining tissue in the walls of the vagina are so thin. Also I had my cervix removed during hyst. I take premwein .625 mlg. it keeps my vagina from bleeding, but i have to use a lubricant to have sex. and also drys out befor the at is over. I do not ever get a climax during sex. why and can you help? but without the premerin I would never be able to have sex again. also I have this real thick discharge. I use a vinegar douch about 4 times a year. the discharge has got worse the past few months. As I have had sex more in the past year than I have in about 7 years. Does this cause the thick discharge. Well actually it is not discharge it does not run or drip out. I just can get it out with my finger when I apply the lubricant befor sex.

Posted by on 04/02/2011 at 12:28

I am using Replens, although this helps a little, can you advise an alternative as I appear to be alergic to oestrogen based products.

Posted by Franka on 28/08/2010 at 02:54

Thank you for the useful information. Franka

Posted by Symptoms of Menopause on 26/08/2010 at 05:12

Menopause can be an utterly confusing and traumatic time. Turn here to find the answers for questions that have been unanswered for so here