Sexual Health, Vaginal Symptoms & GSM

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

• dryness
   

• burning
   

• irritation
   

• painful intercourse
   

• urinary symptoms
   

• recurrent UTI-type
  symptoms in some women 
  (progression over time if untreated)

What WHI reviews

• libido and arousal changes

• dryness, burning and pain

• entry pain vs deeper pain

• urinary symptoms

• pelvic floor symptoms

• orgasm change where relevant

• relationship context

• body image and emotional context

• trauma history 

• medications and mood factors

• 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).