At menopause there can be a number of issues around sex, low libido is certainly one, but the other is itchiness and/or painful sex due to a lack of lubrication or possibly vaginal atrophy.

It is estimated that at least 3 out of 5 women have experienced painful sex but that less than half seek help as they are too embarrassed to discuss it with their GP or don’t know where to go for advice.

A study published in the British Journal of Obstetrics and Gynaecology earlier this year (2017) found middle-aged women are struggling to enjoy their sex lives because of vaginal dryness.

The researchers discovered that this is forcing many to abandon their sex lives, fearing the discomfort will strike again.

Just what is ‘normal’ at menopause?

As our hormone levels decline at menopause so it is helpful to know what is usual and ‘normal’ and what might need additional help.

It is normal to experience a lessening of the libido as progesterone levels drop – this is the hormone responsible for sex drive in women – and dryness and itching can occur as oestrogen levels drop too. If you have signs of oestrogen dominance this is much less likely, but a combination cream with both hormones can help in those cases.

Painful sex can occur at any age and for a variety of reasons including:

• Insufficient lubrication

• Certain medications

• Injury, trauma or irritation

• Inflammation or skin disorder

• Vaginismus (recurrent or persistent involuntary tightening of muscles around the vagina whenever penetration is attempted)

• Congenital abnormality

Apart from the commonly experienced symptoms associated with vaginal problems, some women do also suffer from vaginal atrophy (known as atrophic vaginitis) which is the thinning, drying and inflammation of the vaginal walls.

This is relate to low oestrogen and will generally need to be treated initially with a single oestrogen product from your GP normally in the form of a pessary or gel, and can be balanced with progesterone if needed.

Vaginal atrophy occurs most often after menopause and it not only makes intercourse painful, but also leads to distressing urinary symptoms, so if you are regularly experiencing painful sex it is best first to see your doctor to have it diagnosed.