Dryness, pain, and what actually helps

First, the thing nobody mentions

If sex has been painful for a while, the body braces against it. You stop wanting it. You assume something is wrong with you, or with the relationship. The pain itself becomes part of why you have stopped having it.

It is almost always treatable. The dryness, the pain, the discomfort, the “sandpapery” feeling, the burning, the tearing. These are not things you have to live with. They are symptoms of low oestrogen in the vaginal and pelvic tissues, and there is good, simple, cheap, prescribable treatment for them.

Almost none of this is something you have to live with. Almost none of this. Please tell your GP. They have things they can prescribe that change your life.

What the symptoms can look like

• Dryness. The lubricant your body used to produce on its own has gone or reduced.
• Pain during sex, especially on penetration.
• Burning, itching, or stinging, even without sex.
• Discomfort wearing certain underwear, jeans, tight trousers.
• Recurring UTIs that don’t seem to have a cause.
• Needing the loo more often, urgency, leakage when you sneeze or laugh.
• A general “something doesn’t feel right down there” that you can’t put your finger on.
• Less feeling. Less responsiveness. Less of the body cooperating.

All of these are part of the same thing. The medical term is genitourinary syndrome of menopause. Long phrase. Treatable thing.

Vaginal oestrogen, the secret nobody told you

This is the single most underused treatment in midlife women’s health, and the one that changes the most lives.

Vaginal oestrogen is a cream, a pessary (a small tablet you insert), or a ring. You use it locally. Almost none of it gets into your bloodstream. It is not the same as systemic HRT.

It is suitable for almost every woman, including most women who can’t take regular HRT, including women who have had breast cancer (this is increasingly accepted; ask a menopause specialist if your GP is unsure).

It works on the tissue directly. It restores moisture, elasticity, comfort, and resilience to UTIs. Most women feel a difference within a few weeks.

You can use it for the rest of your life. You probably should.

It is available on the NHS. Some forms are now available over the counter without a prescription.

If your GP is uncertain

Some GPs are still hesitant. Some still believe outdated cancer concerns about vaginal oestrogen. You may need to advocate for yourself, or ask for a different GP. The British Menopause Society guidelines are clear and your GP should be following them.

If you can stretch to a one-off private menopause consultation, it is often worth it just to get the prescription started, after which most NHS practices will continue it. The British Menopause Society has a find-a-specialist directory.

Lubricants, and which ones to actually use

For sex, vaginal oestrogen is the real fix. Lubricants are useful alongside it, not instead of it.

Water-based lubricants are fine for occasional use but dry out quickly. They are also what most chemists sell.

Silicone-based lubricants last longer and are better for penetrative sex. They are not safe with silicone toys.

Oil-based lubricants (coconut oil, for instance) can be lovely for non-condom sex, but break latex condoms.

Avoid anything with glycerin, parabens, fragrance, or warming/cooling effects. Your vaginal tissues are already inflamed; you don’t need irritants.

Brands many women recommend: Sutil, YES, Sliquid, Pjur. None of them are perfect for everyone. Try samples if you can.

Pelvic floor, the muscle you forgot you had

The pelvic floor matters far more than most women are told. It supports the bladder, the womb, the bowel. It affects continence, sexual sensation, orgasm, and pain.

In midlife, it often weakens (from childbirth, hormones, age) or tightens (from chronic stress, anxiety, holding-it-all-together).

Both versions can cause pain, leakage, and reduced sensation. Both are treatable.

NHS pelvic health physiotherapy is free. You can self-refer in most areas. Worth the appointment, even if it feels embarrassing the first time.

Apps like Squeezy (NHS-approved) can support a daily practice at home.

If your pelvic floor is tight, not loose, the worst thing you can do is more kegels. A pelvic physio will tell you which one you have.

When sex still hurts, even with everything

Sometimes the dryness and the medication and the pelvic floor are all dealt with, and there is still pain. This is real, and it deserves further investigation.

Things that can be going on: vulvodynia, vaginismus, endometriosis, scar tissue from childbirth or surgery, lichen sclerosus, latex sensitivity, infection that hasn’t been properly diagnosed.

None of these mean it is in your head. All of them have treatment. A women’s health physio, a menopause specialist, a vulval clinic. You are entitled to a proper referral.

Pain during sex is a symptom, not a verdict. You are entitled to investigation, treatment, and someone taking it seriously.

And the part about feeling broken

A lot of women in midlife reach a point where they secretly believe their body is now broken. That something is wrong with them. That sex is over and they are going to have to live with it.

Almost none of that is true. The body is changing, yes. The body is not broken. The treatments work. The dryness reverses. The pain eases. The sensation often returns.

It may take months. Sometimes it takes a year of trial and error. It is almost always worth the trial.

Start here, this week

• Book a GP appointment. Use the word menopause, and the word dryness, and the word pain. Ask specifically about vaginal oestrogen.
• If you can’t face the in-person conversation, write the words down in advance, or use our Letter Generator.
• Order a small bottle of a decent lubricant.
• Self-refer to NHS pelvic health physio if it is available where you are.
• Tell one friend who has been through this, if you have one. The conversation gets easier the second time you say it out loud.