Doctor Q&A: Why does it hurt when I have sex?

Hi Doc, this is about you but I hope you can give some advice. I am a woman in my 40s and for the past few months, I have found sex to be very painful. Especially the pain during the intervention. It’s a burning kind of pain. I’m starting to worry. Why does it hurt when I have sex? If you can provide any information on this and treatments I would appreciate it. thank you

This is a great question and I have talked about it many times as I am interested in women’s health and this issue can debilitate women who suffer and about 50 percent of women do! It is also a topic that is often embarrassingly not discussed and that 50 percent may be higher for that reason.

During perimenopause and after menopause, hormones begin to change and are often imbalanced. Estrogen – the hormone responsible for the gradual lubrication of the vagina – decreases and this causes changes in the vagina which causes less natural fat, the cells around the vagina become thinner , they become less common and the penis becomes dry. This causes irritation, aches and pains during sex but often this discomfort extends to everyday activities such as walking, sitting down and exercising.

There are things you can do to help, and while you may be suffering early in your menopause journey, I can practice now and give you some feminine love. Why? Because sex is so important as part of a loving relationship, it produces natural happy hormones in the brain and prevents depression and relationship breakdown. In addition, taking care of the vagina can help prevent urinary tract infections and thrush and BV. So, what can you do?

Do not use soaps, bath oils or shower gels in or around the vagina – they can worsen dryness. Instead, use lukewarm water alone or with a soap-free cleanser; the female organ is a good organ for cleaning.

Additive-free cosmetics should be used for sex, and additive-free ones include E, Sylk, Replens and KY Pure.

Feminine products such as Yes and Regelle can also be effective in improving the vaginal environment, and can be used regularly and away from sex.

Feminine estrogens are used topically. These come in the form of creams or pessaries that are inserted by a person or an estrogen-releasing ring that stays in place for three months at a time. There is very little systemic absorption from female estrogens (a year is equivalent to taking one HRT tablet). I think these are somewhat important.

•Hormone replacement therapy (HRT) can also be added to female estrogen and increase overall protection.

If you do all this and things are still a problem, the price is expensive, but I think the most important treatment is the feminism laser. There is not enough evidence to bring it into regular use but the first data on improving the quality of the vaginal tissue with thickness and lubrication are encouraging even for women who do not find the above measures to solve their problems with completeness, can be a valuable addition. – here. The most commonly used laser is CO2 and is often known as the Mona Lisa. This is not the ‘designer vagina’ you may read, this is for the internal tissues of the vagina and will not change the appearance of your vagina from the outside. I saw Dr. Amanda Tozer at Aria Fertility.

I have made VLOG’s on this and you may find these helpful:

I hope this helps – and good luck.

Hey Dr. Renee, big fan! Can you advise what to do about dizziness? I get it mostly during the day. I have cut back on caffeine but it hasn’t made much of a difference. Could I be missing something? Thank you

Dizziness is a frequent issue I see at the GP, especially as winter approaches and viral infections are on the rise. Frustration means that you may feel overwhelmed and confused or that you are about to lose your balance. Many things can cause you to be noisy, such as anxiety or a reaction to medication. But dizziness can be a sign of a serious medical problem and for this reason I would always start by asking you to see your doctor.

People get confused when something affects the power of balance. Balance is achieved by equal and acceptable messages sent and received by the brain from the ears, eyes, tissues and central nervous system (CNS). Your CNS integrates this constant information to tell your body how to maintain balance. When something interrupts the flow by interfering with one of those message centers, your central nervous system receives conflicting information and you may feel unsteady and dizzy. Inner ear problems, neurological conditions, medications and even stress can make you feel dizzy.

Causes of dizziness are many but include:

• Inner ear problems
• Benign paroxysmal positional vertigo (BPPV) – a feeling of spinning when the head is moved.
• Labyrinthitis – inflammation of the inner ear system called the labyrinth which is responsible for hearing and balance · Vestibular neuritis – inflammation of the inner ear vestibulocochlear nerve
• Persistent posterior vertigo (PPPD)
• Dizziness caused by things or activities happening around you, such as being in crowds. PPPD symptoms come and go
• Other medical conditions

Lack of blood is also a common cause of dizziness, as is acoustic neuroma – non-cancerous tumors in your inner ear that can affect your balance and make you feel dizzy.

Other reasons include:

• Heart problems – issues that affect the blood flow to your brain such as irregular heartbeat (atrial fibrillation), low blood pressure (hypotension) or narrowed arteries (atherosclerosis) can make you feel dizzy.
• Concussion – this head injury damages your brain and causes dizziness, among other symptoms
• Diseases or neurological problems
• Migraine headaches, multiple sclerosis and Parkinson’s disease are examples of neurological diseases that affect your sense of balance and make you feel dizzy.

Other common causes:

• Anxiety and stress – you may feel dizzy when you hyperventilate because you are anxious or stressed.
• Dehydration
• Low blood sugar
• Sudden dizziness is a symptom of hypoglycemia
• Medicines – blood pressure medicines often cause dizziness.
• Motion sickness – this can make you feel dizzy and affect your balance.

It is fair to say, it is impossible to suggest a treatment for dizziness without knowing the cause, so please go with your doctor for an examination and a blood test.

In the meantime, if you think you have an upper respiratory infection and this happened together or after it might be worth trying some decongestants to relieve the pressure in the ears and you can try to. steroid nasal spray and/or oral tablet such as Sudafed. If that has an immediate effect then maybe this is the answer.

You can also try the Epley maneuver at home as there is nothing cheap to try and see if this helps, then it could be BBPV. It is available here.

If you feel nauseous and movement worsens the problem, then it may be labyrinthitis and use pain tablets until it passes.

But please see your doctor if it persists or is long term.

Hello doc, what do you recommend to treat gout? My job is friendly and involves taking customers out for drinks. I often have severe gout the next day. I’m trying to avoid alcohol but I also wonder what to do about it once it starts since I’m usually out of action. What would you recommend? thank you

Gout is a temporary form of arthritis that causes short periods of inflammation, pain and swelling. It usually affects the big toes, ankles, knees and fingers and can be completely debilitating. Some people experience regular flares that last days to weeks. It is caused by uric acid crystals building up in the affected joint. This buildup can happen because of the food (and alcohol) you eat or if your kidneys don’t remove enough uric acid from your blood.

Getting gout is influenced by genetics but also by lifestyle factors such as weight, drinking too much alcohol and eating certain purine-rich foods. It is more common in men and people over the age of 40 or of Asian ethnicity.

I know you don’t want me to say this, but you know the reason that aggravates yours; alcohol, so cutting back on alcohol should help. I will try to add more…

Food

Maintaining a healthy weight is important, limiting alcohol (especially beer) and staying well hydrated. Do not cut out carbohydrates completely, as this can increase uric acid levels in the body and worsen gout. Try the Mediterranean diet or the DASH diet.

Pain relievers/other medications

Try non-steroidal pain killers (NSAIDS) like ibuprofen and if you can’t take them your doctor can give you short-term pain relievers like colchicine.

If these do not help or the gout lasts longer than expected, you may be given steroids.

If it continues to flare regularly there is a medicine that can be taken every day to try to stop the flares called allopurinol. Your doctor can help you with this.

Natural remedies

Eating at least 10 cherries a day can cut the risk of gout attacks in half according to a 2012 study. Another study found a 50 percent reduction when patients took just one tablespoon of 45 to 60 cherries – twice a day for four months.

Other than cherries I haven’t found much support for natural remedies for gout other than those mentioned above. All in all I would say try to do what is recommended and maybe find a way to drink a little at lunch and hit the cherry!