There
are a number of recurring themes that account for the lion’s share of
those seen by most GPs, and they can be divided into three
broad complaints.
It’s uncomfortable If making love hurts then it is only natural to avoid
it. Vaginal dryness is one of the most common causes and a real
problem for many women who are going through, or have been through
the menopause. Lack of oestrogen thins the tissues in and around
the vagina, reduces lubrication and can make sex very
uncomfortable (dyspareunia).
Fortunately this responds well to using extra lubrication
(such as KY Jelly) and the application of oestrogen creams or pessaries (a type of local HRT that doesn’t carry the risks associated with
the conventional form).
Endometriosis, where the lining of the uterus extends out of
the womb into the pelvis, is a common cause of
dyspareunia in younger women.
Telltale signs include deep discomfort on making love and
heavy painful periods. Treatment depends on the
severity but milder cases
can often be helped by the Pill.
Back
pain and arthritis also interfere with sex life, but few share
concerns with doctors. Fortunately there is advice from websites such as
www.rheumatoid.org.uk
and
www.arc.org.uk.
Headache
may be a clichéd excuse but some types can be triggered by sexual
activity — the best known being orgasmic cephalalgia, a
sudden onset headache that often occurs at the point of
orgasm and which affects as many as one in 100 people. Treatment involves using
migraine drugs such as propranolol.
I’m
not in the mood Poor libido in men and women is nearly always a
symptom of an underlying problem rather than a
medical condition.
Common causes range from depression and changes
associated with the menopause, to being too tired to bother and/or not fancying your
partner any more. And that’s assuming that you have a
“problem”. Sex drive only becomes an issue when it doesn’t match that of your
partner. Wanting to make love once a month may
be normal for some couples, but will lead to tension in others if one partner wants to do it
more often.
Although
hormones are often the first thing that springs to mind in older
women, relationship problems are far more common. Many people
simply don’t find their partner sexually attractive any more — a
point ably demonstrated by the behaviour seen in those having an affair. The
same woman who dreads her husband’s touch can be an
insatiable tiger in her lover’s bedroom.
Men
tend to have higher sex drives, so it’s little surprise that most of
the women I see complaining of low libido are there only because their
partners think there’s a problem. A surprising number admit
to being happy with the status quo.
In
younger women on the Pill, loss of sex drive can result from its mix
of hormones, a problem that can often be helped by switching to
another brand.
I
can’t manage it Viagra celebrates its 11th birthday this month.
Although once controversial, the little blue pill is now part of the
establishment and has transformed the sex lives of millions of men. It has
also de-stigmatised erectile dysfunction (ED) making it much easier
for men to admit that they have a problem maintaining n
erection — as around half of all of those over 40 do at some time. Nearly every
man can now be helped, but men have to pluck up the
courage to ask.
It
pays to mention ED to your doctor as it is often a sign of underlying
problems such as
diabetes or
high blood pressure which,
left untreated, can lead to early stroke and heart attack.
For more information visit www.patient.co.uk E-mail
questions to
drmark@thetimes.co.uk or write to times2, 1 Penningon Street,
London E98 1TT
