I love my husband but sex is uncomfortable – what can I do?
Dr Miriam Stoppard with advice for older women on coping with dryness and UTIs - and what can help.
Image credit: Alun Callender
Dr Miriam Stoppard with advice for older women on coping with dryness and UTIs - and what can help.
I am 60 and had my menopause around ten years ago, which I managed without HRT as I dealt with the symptoms through exercise and cutting back on alcohol. However, I now find that sex with my husband is increasingly uncomfortable due to dryness, and I have been getting recurring urinary tract infections (UTIs), perhaps as a result.
I don’t want to start taking HRT at this stage, having managed without it, and I have read that gels and pessaries I could use also contain oestrogen.
What options do I have and what are the implications of creams and gels that contain hormones?
I’m very sorry you’ve had repeated UTIs. I've had them myself and know they’re extremely painful, debilitating and demoralising. UTIs are quite common in women over 65, 10% having had a UTI within the past 12 months, increasing to almost 30% in women over the age of 85.
Vaginal dryness and irritation during penetrative sex could be the cause so I’d like to suggest you tackle your UTI in two different ways. The first is to get rid of the infections, the second is to make your bladder more resistant to infection.
Firstly, you could speak to your doctor about a one-off treatment called Fosfomycin, a broad-spectrum antibiotic. It comes in the form of granules that you dissolve in a glass of water and drink last thing at night. You’ll have relief the following morning.
The second strategy is to improve the integrity of your bladder lining. I need to do a little explaining here. As we get older, the lining of the bladder and the vagina becomes thinner and bruises easily during penetrative sex. Plus, the vagina can no longer maintain a healthy acid-based balance (pH) – the vagina is at its healthiest and most comfortable when it's acid (pH4, neutral is pH7).
Loss of this acid environment after the menopause due to lack of oestrogen causes vaginal dryness and makes you prone to bladder infections.
For recurring UTIs, experts recommend oestrogen via the intravaginal route in the form of a cream or tiny pessary introduced with an applicator. The oestrogen is weak and low dose. Used intravaginally, its effect is confined to the vagina and the bladder, consequently it doesn’t reach the rest of the body and side effects of oestrogen are avoided.
The bonus of using intravaginal oestrogen is that not only does it protect you from urinary tract infections, but also it rejuvenates your vagina, and the dryness will be ameliorated or even disappear. I’m convinced by the evidence of its effectiveness, and I use it myself (at 88!).
Be kind to your bladder by emptying it completely every two hours. And drink eight glasses of water a day to continually flush it out. Always wipe from front to back.
Avoid tight jeans or tights and use only cotton underwear. If penetrative sex is on the menu, apply some pH-controlled water-based gel around the entrance to your vagina. Or, in an intimate moment, get your husband to do it for you.
If you have a problem for Dr Miriam, please email askdrmiriam@saga.co.uk marked ‘Ask Dr Miriam’. All emails will be treated in confidence.
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