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Menopause Pain & Low Arousal? Expert Guide to GSM, Oestrogen & Intimacy Solutions 💡

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Menopause Pain & Low Arousal? Expert Guide to GSM, Oestrogen & Intimacy Solutions 💡
🔗 Read the full article here: https://thewomenshealth.clinic/faq/do...
The transition through menopause often brings hormonal shifts that profoundly impact sexual function, commonly leading to reduced arousal and increased pain during sex.
Dr. Farzana Khan (MD, MRCGP, DFFP), who has expertise in vaginal health, sexual function, and lichen sclerosus, authored and medically reviewed this guidance.
Understanding Genitourinary Syndrome of Menopause (GSM)
These changes are medically recognised as Genitourinary Syndrome of Menopause (GSM). This syndrome affects up to 50% of postmenopausal women and is progressive if left untreated. GSM encompasses vaginal dryness, burning, irritation, urinary urgency, recurrent infections, and dyspareunia (painful sex).
Why Does This Happen? 📉
Oestrogen Decline: Declining oestrogen thins the vaginal tissue, reduces lubrication, and lowers blood flow to the genital area. This process is called vulvovaginal atrophy.
Increased Pain (Dyspareunia): The vaginal lining becomes thin, pale, and dry, losing elasticity and making it prone to micro-tears and irritation during penetration. Lack of lubrication creates friction that can feel raw or burning.
Reduced Arousal: Lower oestrogen means less vasodilation, resulting in reduced genital blood flow, slower arousal, and reduced clitoral sensitivity. Arousal loss is also often linked to low Testosterone, not just Oestrogen.
The Importance of Treatment:
It is essential to understand that this is a predictable, treatable consequence of hormonal change, not "ageing badly" or "losing interest". Addressing these physical symptoms can restore comfort and intimacy.
Evidence-Based Solutions & Treatment Hierarchy ✨
Level 1: Self-Care & Non-Hormonal Options
Lubricants & Moisturisers: Use water-based or silicone lubricants generously during intimacy. Regular use of non-hormonal vaginal moisturisers (like Hyaluronic Acid moisturisers) every 2–3 days can rehydrate tissues.
Pelvic Floor Relaxation: Gentle stretches and mindful relaxation can help release the pelvic floor muscles that tighten in response to pain (Secondary Vaginismus).
Maintain Activity: Regular sexual activity increases blood flow, helping tissues remain elastic ("Use it or lose it" is medically true).
Level 2 & 3: Hormone & Specialist Options
Topical Vaginal Oestrogen: This is considered the gold standard for GSM, available as creams, pessaries, or rings. It thickens the tissue and increases lubrication with minimal systemic absorption, making it safe for long-term use for many women.
DHEA (Intrarosa): This drug converts locally to both Oestrogen and Testosterone, addressing both tissue quality and nerve sensitivity.
Testosterone: Recommended by the British Menopause Society for HSDD (Hypoactive Sexual Desire Disorder) when HRT alone has not restored libido.
Vaginal Regenerative Therapies: Non-surgical options like CO2 laser or Radiofrequency (e.g., Morpheus8V) stimulate collagen and improve hydration and elasticity.
Pelvic Health Physiotherapy: Specialist physios can help "down-train" tight pelvic muscles and address the "Pain Loop" caused by anticipating pain.

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Keywords: Genitourinary Syndrome of Menopause, GSM, Vaginal Atrophy, Painful Intercourse, Dyspareunia, Low Arousal, Menopause Sex, Oestrogen, Topical Estrogen, Vaginal Dryness, HRT, Testosterone for Women, Pelvic Floor Physiotherapy, Laser Vaginal Rejuvenation, Dr Farzana Khan, Intimacy Solutions, Vulvovaginal Atrophy, Vagifem, Ovestin
#Hashtags: #GSM #Menopause #WomensHealth #SexualHealth #Dyspareunia #VaginalDryness #MenopauseSymptoms #HRT #TopicalOestrogen #PelvicFloor #Intimacy #GenitourinarySyndrome