Sexual Health, Vaginal Symptoms & GSM
Low libido, vaginal dryness and painful sex deserve proper assessment
Doctor-led assessment for women with low desire, arousal problems, dryness, burning, dyspareunia, urinary symptoms, and overlapping hormonal, pelvic floor, relational, medication, mood, and menopause-related contributors.
Low libido is multifactorial
Low libido in midlife is rarely explained by one factor alone.
Hormonal change may play a role.
So can pain, sleep disruption, relationship strain, stress, body image, mood disorders, medications, thyroid or prolactin issues, and prior sexual experiences.
GSM is often under-recognized
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dryness
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burning
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irritation
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painful intercourse
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urinary symptoms
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recurrent UTI-type
symptoms in some women
(progression over time if untreated)
What WHI reviews
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libido and arousal changes
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dryness, burning and pain
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entry pain vs deeper pain
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urinary symptoms
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pelvic floor symptoms
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orgasm change where relevant
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relationship context
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body image and emotional context
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trauma history
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medications and mood factors
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hormone, thyroid, and prolactin context
Pain, arousal, sleep, mood, medications, relationship factors and trauma history all matter
Sexual symptoms in midlife are often mixed. Pain may reduce desire. Poor sleep may reduce arousal.
Medications such as antidepressants may affect libido.
Relationship strain, shame, past trauma, or pelvic floor dysfunction can all amplify symptoms.
Good care looks at the whole pattern rather than blaming one hormone.
Treatment may include different layers
Local vaginal treatment
Moisturisers, lubricants, local estrogen, vaginal DHEA where appropriate.
Systemic hormone review
Where full menopausal hormone treatment will help.
Pelvic floor support
Exercises, pelvic floor physiotherapy, further referral where appropriate.
Counselling / relationship-aware support
Particularly where desire, communication, intimacy, or past experiences are relevant.
Sensitive care and complete WHI privacy
Many women do not initially volunteer sexual symptoms.
WHI approaches these concerns respectfully, discreetly, and as a normal part of women’s health rather than something peripheral or embarrassing.
When needed, we also have available our experienced relationship and intimacy counsellor (Cecilia).
Treatment is individualised. Some women mainly need GSM treatment. Some need pelvic floor work. Some benefit from HRT review or selective androgen discussion. Some need counselling support or broader medical review. Many need a combination.
When testosterone is considered for sexual symptoms
In selected postmenopausal women with persistent low sexual desire, testosterone may be considered after broader contributors such as GSM pain, relationship issues, depression, medication effects, and sleep problems have been reviewed.
It is not a routine treatment for every woman with a lower libido.
Your next step at WHI
For vaginal dryness, pain with sex, low libido or other sexual-health concerns, your first step at WHI is the Vital Blueprint. It helps clarify the causes and which treatment options may be appropriate for you.
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Your €240 Vital Blueprint includes advance review of your completed intake questionnaire and available laboratory results or reports, a full one-hour online consultation with Dr Rui, and a personalised treatment plan prepared afterwards.
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Book your Vital Blueprint first. We will then advise which tests, if any, are needed. Laboratory charges and medication costs are separate.