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                     Are health problems ruining your sex life?

 It’s uncomfortable If making love hurts then it is only natural to avoid it. Vaginal dryness is one of the most common causes and a real
 problem for many women who are going through, or have been through the menopause. Lack of oestrogen thins the tissues in and around
 the vagina, reduces lubrication and can make sex very uncomfortable (dyspareunia). Fortunately this responds well to using extra lubrication
 (such as KY Jelly) and the application of oestrogen creams or pessaries (a type of local HRT that doesn’t carry the risks associated with
 the conventional form). Endometriosis, where the lining of the uterus extends out of the womb into the pelvis, is a common cause of
 dyspareunia in younger women. Telltale signs include deep discomfort on making love and heavy painful periods. Treatment depends on the
 severity but milder cases can often be helped by the Pill.

 Back pain and arthritis also interfere with sex life, but few share concerns with doctors. Fortunately there is advice from websites such as
 www.rheumatoid.org.uk and www.arc.org.uk.

 Headache may be a clichéd excuse but some types can be triggered by sexual activity — the best known being orgasmic cephalalgia, a
 sudden onset headache that often occurs at the point of orgasm and which affects as many as one in 100 people. Treatment involves using
 migraine drugs such as propranolol.

 I’m not in the mood Poor libido in men and women is nearly always a symptom of an underlying problem rather than a medical condition.
 Common causes range from depression and changes associated with the menopause, to being too tired to bother and/or not fancying your
 partner any more. And that’s assuming that you have a “problem”. Sex drive only becomes an issue when it doesn’t match that of your
 partner. Wanting to make love once a month may be normal for some couples, but will lead to tension in others if one partner wants to do it
 more often.

 Although hormones are often the first thing that springs to mind in older women, relationship problems are far more common. Many people
 simply don’t find their partner sexually attractive any more — a point ably demonstrated by the behaviour seen in those having an affair. The
 same woman who dreads her husband’s touch can be an insatiable tiger in her lover’s bedroom.

 Men tend to have higher sex drives, so it’s little surprise that most of the women I see complaining of low libido are there only because their
 partners think there’s a problem. A surprising number admit to being happy with the status quo.

 In younger women on the Pill, loss of sex drive can result from its mix of hormones, a problem that can often be helped by switching to
 another brand.

 I can’t manage it Viagra celebrates its 11th birthday this month. Although once controversial, the little blue pill is now part of the  establishment and has transformed the sex lives of millions of men. It has also de-stigmatised erectile dysfunction (ED) making it much easier
 for men to admit that they have a problem maintaining n erection — as around half of all of those over 40 do at some time. Nearly every
 man can now be helped, but men have to pluck up the courage to ask.

 It pays to mention ED to your doctor as it is often a sign of underlying problems such as diabetes or high blood pressure which, left  untreated, can lead to early stroke and heart attack.
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