Oestrogen is the hormone which helps to keep the genital tissue and bladder healthy.

When oestrogen declines, vaginal tissues become less elastic, thinner and produce less mucus. This is called urogenital atrophy

• Sex can become painful if lubrication is poor. Even underwear can rub.
• There can be a change in vaginal discharge to watery, discoloured and slightly smelly, as the PH balance changes to more alkaline, suppressing then lactobacillus bacteria – ‘good bacteria’.
• The skin of the vulva can suffer from inflammation, redness, and irritation. Vulval dermatitis conditions can become more common.
• The vulva and clitoris can shrink/become less plump.
• Sex drive can reduce or disappear, and orgasms lose potency or are difficult to achieve.
• Women can suffer urinary frequency, incontinence, urgency, and leakage of urine.
• Urinary tract infections can become more common.
• Women can lose confidence in body image reducing desire for sex.

The good news is there is a lot that can be done to help including: –

• Use of vaginal lubrication, moisturisers, and vaginal oestrogen.
• Advice regarding care of the vulval area with soap substitutes to wash, and emollients.
• Treatment of vulval skin problems.
• Other treatments for severe cases of urogenital atrophy can be considered by specialists if the above methods do not help including Ospemifene, DHEA pessary and vaginal laser therapy.
• Psychosexual counselling may be helpful for some women.
• Sexually transmitted infections and advice about reducing risks and screening should also be considered where relevant.