HEALTH BULLETIN .CO: ASK THE DOCTOR: Cream that can perk up a woman's sex life

Despite being happily married for 45 years, my husband and I struggle to have sex and it is making me miserable. It has become too uncomfortable since the menopause - I used to be on HRT but my doctor doesn't want to prescribe this any more as she's worried about me getting cancer. Are we older women supposed to go without sex because our doctor will not prescribe HRT?

Name and address withheld.

Sex has become too uncomfortable since the menopause - and the patient is no longer on HRT

Thank you for raising this important issue. I am sympathetic to your plight and convinced there is a suitable and effective remedy.

The reason intercourse is now so difficult and painful is that over the years you have gradually developed a condition called atrophic vaginitis.

This occurs because women's genital tissue needs the hormone oestrogen for optimum health, and following the menopause your oestrogen production has fallen.

As a result, the lining of the vulva and vagina have lost elasticity and become dry. This can trigger itching, a more frequent need to urinate and recurrent bladder infections.

You are correct in your understanding that hormone replacement (HRT) would help, though it would take time, perhaps a few months.

Using oestrogen gel, cream or pessaries in the vagina on a long-term basis can help

However, your GP is aware there is some evidence of a slightly increased incidence of breast cancer in women taking HRT long-term (the risk drops back to normal within five years of stopping taking it).

This is the reason for her reluctance to prescribe it.

I must stress that the risk from other forms of cancer - womb and ovarian - is minimal.

However, the solution I propose is that rather than taking tablets that affect the whole body, you use oestrogen gel, cream or pessaries in the vagina on a long-term basis.

It may take two or three months to notice the difference as the tissue needs time to be restored and strengthen.

Even then the improvement will continue to build for up to a year, fully restoring the previous feelings and appearance.

The oestrogen will have to be applied every night at first, and once there is an obvious improvement the frequency can be lowered to alternate nights and, eventually, to twice weekly.

I know of no evidence that local treatment in this way has any harmful effect in terms of increasing the risk of breast cancer.

In short, there is no added risk and, therefore, this is a discussion to re-open with your GP as she will be aware that vaginal oestrogen therapy is more effective than HRT pills, which she is determined to avoid.

Studies show symptom relief is significantly higher for vaginal treatment versus oestrogen tablets.

I hope that you can, on this basis, persuade your doctor to change her mind.

Our daughter, who is 28 and under enormous pressure to juggle work with two young children, has recently been diagnosed with neuralgia after developing a swollen, painful face. She has been prescribed the painkiller gabapentin and though this dulls the pain slightly, she still has a constant ache. What are her options for managing this unpleasant condition - and could stress have played a part?

Name and address withheld.

A woman with neuralgia has been prescribed gabapentin - but she still has a constant ache

How stressful for your daughter and this sounds like a difficult situation for all of you.

Neuralgia is pain caused by damage or irritation to a particular nerve. The most common form of neuralgia that affects the face is trigeminal neuralgia, and it sounds from your description as if this may be the type your daughter has.

There is a trigmenial nerve running down each side of the face - it supplies sensory information to the brain.

The neuralgia is thought to be caused by irritation of the nerve at the base of the brain, perhaps due to an abnormal blood vessel pressing on it.

Pain strikes in bouts, often down one side of the face, and is often described as an electric shock or stabbing sensation.

In an earlier era, this neuralgia was called tic douloureux because it is frequently accompanied by spasms involving some of the facial muscles.

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It is unusual for it to affect someone as young as your daughter - the condition usually affects the elderly. However, I can find no suggestion in the research that it is connected with stress.

You also tell me in your longer letter that your daughter was diagnosed as a child with Ehlers- Danlos syndrome, a genetic disorder characterised by skin stretchiness, hypermobile joints and fragile tissue. But there is no evidence I know of that links this to neuralgia either.

I fear your daughter has simply been very unlucky.

Often medication can help with neuralgia. Carbamazepine is the best known treatment - it is an epilepsy medication, but also helps nerve pain. Evidence from a number of studies suggests it is effective for trigeminal neuralgia.

Your daughter has tried this medication, you tell me, but found the side-effects - such as drowsiness, dizziness and nausea - too much to bear.

The second choice is usually gabapentin, another epilepsy drug. The dose is usually started low then increased until the attacks stop.

But this also has potential side-effects such as tiredness, headaches and nausea. In extreme cases, where medications have failed to provide any relief, surgery can be considered.

This can relieve pressure on the nerve or deaden the nerve in some way.

One possibility is Gamma Knife radiosurgery, a form of highly focused radiotherapy that relieves the neuralgia about a month after the procedure, though the neuralgia can sometimes recur.

All these treatment options should be discussed with a specialist such as a neurologist, pain specialist or maxillofacial consultant.

You tell me your daughter is seeing the latter. Hopefully, this will provide a resolution to her symptoms, enabling her return to a normal working and family life.

Write to Dr Scurr

To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street,

London W8 5TT or email drmartin@dailymail.co.uk - including contact details. Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.

By the way... Supplements may do more harm than good

A reader wrote to me recently about confusion over the benefits of omega 3 supplements.

There are studies showing that increasing the intake of these essential fatty acids may help defer the onset of dementia (which makes sense, as 60 per cent of the dry weight of the brain is made up of these substances).

However, another study has revealed that high omega 3 levels are associated with an increase in the risk of prostate cancer.

So, what are we to think faced with conflicting advice? The roots of the confusion lie in a large study published in late 2011, involving 35,000 men. It found vitamin E supplements raised the risk of prostate cancer.

However, that increased risk was reduced if a selenium supplement was given at the same time. So far so good.

But then in 2013 we learned that using the same blood samples from the 2011 study, the researchers identified a higher risk of prostate cancer among men with higher omega 3 levels.

This is not the same as saying taking added omega 3 will push up the chances of getting prostate cancer, but is highly suggestive. We already know vitamin A supplements increase the risk of lung cancer in smokers. Vitamin E supplements do not reduce the incidence of coronary heart disease or cancer in post-menopausal women, but a vitamin E rich diet does.

What is the answer to these puzzles? Meddle at your peril; concentrate on eating a healthy balanced diet and do not waste your money on supplements.

And as for dementia protection, the only thing proven to work is regular physical exercise.

HEALTH BULLETIN .CO

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Wednesday, February 11, 2015

ASK THE DOCTOR: Cream that can perk up a woman's sex life

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