Doctor Q&A: Why does it hurt when I have sex? Dr Renee Hoenderkamp answers your questions

Hi Doc, this is personal but I am hoping you can offer some advice. I'm a woman in my mid-forties and over the last few months, I've found sex really painful. Particularly feel pain during penetration. It's a burning sort of pain. I am getting quite concerned. Why does it hurt when I have sex? If you could shed some light on this and treatments I'd be grateful. Thank you

This is a great question and one I have addressed often as I have a special interest in women’s health and this issue can be absolutely debilitating for women that suffer and approximately 50 per cent of women do! It is also a subject that is often embarrassing so does not get discussed and that 50 per cent may be higher as a result.

During perimenopause and then after menopause itself, hormones start to change and are often out of balance with each other. Oestrogen - the hormone which is responsible for lubricating the vagina slowly - declines and this causes changes with the vagina which results in less natural lubrication, the cells lining the vagina become thinner, less elastic and the vagina basically dries out. This creates irritation, soreness and pain during intercourse but often this discomfort extends to everyday things like walking, sitting down and exercising.

There are things you can do to help and as you have pain early in your peri-menopause journey I would get into a routine now and give your vagina love. Why? Because sex is very important as part of a loving relationship, produces natural happy hormones in the brain and staves off depression and relationship breakdown. In addition, looking after the vagina can help prevent recurrent urine infections and thrush and BV. So, what can you do?

Don’t use soap, bath oils or shower gels in or around the vagina – they can aggravate dryness. Instead, use lukewarm water alone or with a soap-free cleanser; the vagina is an excellent self-cleaning organ.

Additive-free lubricants should be used for intercourse, and the ones that are definitely free of additives include Yes, Sylk, Replens and KY Pure.

Vaginal moisturisers such as Yes and Regelle can also work quite well to improve the vaginal environment and can be used more often and away from sexual intercourse.

Vaginal Oestrogens applied topically. These come in the form of creams or pessaries applied by applicator or an oestrogen-releasing vaginal ring which stays in place for three months at a time. There is very little systemic absorption from vaginal oestrogens (in a year it is equivalent to taking one HRT tablet). I think these are almost essential.

·Hormone replacement therapy (HRT) can also be added to vaginal oestrogen and add to the overall protection.

If you do all of this and things are still problematic, an expensive, but I think worthwhile treatment is vaginal laser. There is not enough evidence yet to bring it into mainstream use but the initial data in terms of improving the quality of vaginal cells in thickness and lubrication are encouraging and for women not finding the above interventions solving their issues entirely, it can be an important add-on. The laser used is normally CO2 and commonly is known as Mona Lisa. This is not the ‘designer vagina’ you may read about, this is for the internal vaginal cells and will not alter the look of your vagina externally. I saw Dr Amanda Tozer at Aria Fertility.

I have done VLOG’s on this and you may find that these help:

https://youtu.be/EtzNoN_33-w?si=xzk1lOgJl1Kyryh-

https://youtu.be/5oi4wVewMjQ?si=2J76_ZCZ5dl1aEcb

I hope this helps - and good luck.

Hey Dr Renee, big fan! Could you advise on what do about dizziness? I get it a lot during the day. I've cut down on caffeine but it hasn't made much difference. Could I be deficient in something? Thanks

Dizziness is an issue I see in GP regularly, particularly as winter approaches and viral infections rise. Being dizzy means that you may feel woozy and disoriented or that you are about to lose your balance. Many things may make you dizzy, such as anxiety or a reaction to medication. But dizziness may be a symptom of an underlying medical issue and for this reason I would always start with asking you to see your doctor.

People get dizzy when something affects the irsense of balance. Balance is achieved by equal and complimentary messages being sent and received by the brain from the ears, eyes, tissues and central nervous system (CNS). Your CNS combines this constant information stream to tell your body how to maintain balance. When something disrupts the flow by interfering with any one of those message centres, your central nervous system gets conflicting information and you can feel unsteady and dizzy. Inner ear disorders, neurological conditions, medications and even stress may make you feel dizzy.

Cause of dizziness are multiple but include:

• Inner ear disorders
• Benign paroxysmal positional vertigo (BPPV) - a spinning sensation when the head is moved.
• Labyrinthitis - inflammation in the inner ear system called the labyrinth that is responsible for hearing and balance· Vestibular neuritis - inflammation of the inner ear vestibulocochlear nerve
• Persistent postural perceptual dizziness (PPPD)
• Dizziness that’s triggered by things or activities going on around you, like being around crowds. PPPD symptoms come and go
• Other medical conditions

Anaemia is also a common cause of dizziness, as is acoustic neuroma - noncancerous tumours in your inner ear that may affect your balance and make you feel dizzy.

Other causes include:

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

• Anxiety and stress - you may feel dizzy if you hyperventilate because you’re anxious or under stress
• Dehydration
• Low blood sugar
• Sudden dizziness is a hypoglycaemia symptom
• Medications - blood pressure medications often cause dizziness.
• Motion sickness - this may make you feel dizzy and affect your balance.

It's fair to say, it is impossible to suggest treatment for dizziness without knowing the cause so please go along to your doctor for an examination and some blood tests.

In the meantime, if you think you have had an upper respiratory infection and this has happened along with or after that it may be worthwhile trying some decongestants to take pressure off the ears and you could try a. steroid nasal spray and/or an oral tablet such as Sudafed. If that has an immediate effect then this is likely the answer.

You could also try the Epley manoeuvre at home as there is no downside to trying and see if this helps, then it may be BBPV. Found here.

If you are feeling nauseous and movement exacerbates the issue then it may well be labyrinthitis and using motion sickness tablets until it has passed is common.

But please do see your GP if it is persistent or long-standing.

Hello doc, what do you recommend for treating gout? My job is quite social and involves taking clients out drinking. I tend to have almighty gout the next day. I am trying to curb alcohol but also wondered what to do about it once it kicks in as I am often out of action. What would you recommend? Thank you

Gout is a type of transient arthritis that causes short periods of swelling, pain and inflammation. It commonly affects the big toes, ankles, knees and fingers and it can be absolutely debilitating. Some people get regular flares which last from days to weeks. It is caused by crystals of uric acid building up in the affected joint. This build-up can happen due to the food (and alcohol) you eat or if your kidneys are not removing enough uric acid from your bloodstream.

Getting gout is influenced by genes but also lifestyle factors such as weight, drinking too much alcohol and eating certain foods that contain purine. It is more common in men and people over 40 or from Asian racial groups.

I know you don’t want me to say this, but you know the factor aggravating yours; alcohol, so cutting down on alcohol should help. I will try and add some others…

Diet

Keeping to a healthy weight is crucial, reducing your alcohol intake (especially beer) and staying well-hydrated. Don’t completely cut out carbohydrates, as this can actually increase uric acid levels in the body and make gout worse. Try a Mediterranean diet or the DASH diet.

Pain relief/other medications

Try non-steroidal pain killers (NSAIDS) such as ibuprofen and if you can’t take these your GP can prescribe a short-term medication such as colchicine.

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

If it continues to flare constantly there is a medication to take daily to try and stop flares called allopurinol. Your GP can help with this.

Natural remedies

Eating at least 10 cherries daily can cut your risk of recurrent gout attacks in half according to a 2012 study. Another study saw a 50 per cent reduction in flares when patients took one tablespoon of tart cherry extract – the equivalent of 45 to 60 cherries – twice a day for four months.

Other than cherries I didn’t find much support for natural remedies for gout other than those discussed above. So overall I would say try and do those suggested and perhaps find a way to drink less at your lunches and hit the cherries!