The Dr Louise Newson Podcast - 036 - Sex and the Menopause - Samantha Evans & Dr Louise Newson

Episode Date: February 25, 2020

In this week's podcast, Dr Newson talks openly and candidly to Samantha Evans about sexual problems and the menopause. Sam Evans is a sexual health and pleasure expert, with a nursing background. She is also co-owner of the company www.jodivine.com Together, Sam and Dr Newson discuss the various ways in which libido and sexual difficulties can arise during the menopause. There are various treatments depending on the underlying cause and these are explored in detail in this episode. Too many women are not experiencing the right help and advice to improve their sexual relationships with their partner and clearly this needs to change.  Samantha Evans' Top Three Tips for sexual wellbeing during the menopause: Talk to your partner about your symptoms - communication is key! Invest in a good sexual lubricant and/or vaginal moisturiser. Don't forget to check the ingredients. Invest in a simple sex toy, maintain the intimacy with your partner and have fun!  

Welcome to the Newsome Health Menopause podcast. I'm Dr Louise Newsom, a GP and menopause specialist, and I run the Newsome Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. So today I'm absolutely delighted to have with me Sam Evans, who is the co-owner of the company Joe Devine. She's actually got a nursing background, but she's a sexual health and pleasure expert. So we thought we would break even more taboos during the podcast today talking about sex and the menopause.

So hi, Sam. Thanks for coming. Hi. Hi, Louise. Finally at last. Yeah, so it's very hard. We're both very busy to try and find a time to meet and to discuss. But I was trying to remember when we first met.

And I think we met not in real life initially, didn't we? I think it was over social media, which is a new concept for me. I have teenage children who are very social media savvy. and they persuaded me to join Instagram and Twitter about 18 months ago. And it's quite a weird world, isn't it? But I think it's very powerful if you get it right. I agree with you. I mean, I just joined Instagram, so I'm really quite terrified.

My children have said it and also lots of people have said it to me as well. But also, I've been on Twitter for quite a few years. And I've met you and other people. And actually, that's been the really, really positive side of social media. For me, personally, I mean, some of it, you know, you learn that. actually that some stuff you just avoid. Absolutely. But I think certainly, I mean, my Instagram following has escalated. And I think it's because it's a safe way, almost, you can talk about things that you're typing that you might not want to talk verbally or talk to your friends about.

And this is one of the reasons I'm very keen to talk about sex because being very British, people don't like talking about sex, do they? A lot of younger people talk about how much sex they have, but people don't talk about how little sex they have. And there's lots that really saddens me in my clinic, as you know, but most women I see in my menopause clinic, when I talk to them about sex, they admit that they haven't had sex often for a few years. And sometimes it's because they have reduced libido because of their lower hormone levels. Sometimes it's because they've put on weight or they've got no energy, they just don't feel the same. but sometimes they have local symptoms like vaginal dryness.

We'll talk about some of these issues, but what saddens me is that they've never asked for help. And they often say, well, my partner, I really love him, and he's very forgiving and he's understanding. But that's not right, is it? It's not right. And I think the issue is that people think that they should have to put up with these problems. I do.

I have to cross that quite often. It's like, it's the men of pause, therefore your sex life is going to end or not be so good. And, you know, for me, I love sex, but my body hasn't always love sex. I'm a form of vaginism sufferer. I've had lots of vaginal health issues, which is why I'm so passionate about vagina health. Is that how you got into it, Sam? No, not really. We set up the company as a, it was a different thing, but actually getting into it made me realize what my problems were that had never really been diagnosed properly and the causes of them. You know, for me, it was using irritating lubricants that caused all the design of infections. And that then led to virginism. And that then led to

Virgin is because every time we had sex I thought I was going to get an infection. But no one ever looked at this, not one person. So I knew that heading towards menopause, as I'm 51 and you know, in menopause, that my vagina health had to be really tipped up. So that's the thing for me is actually a lot of women have no awareness of their vagina health, which obviously then is often compromised when you do hit menopause, the, you know, the infections, urinary retract infections, the cytitis, it feels sore, things change, slap on a bit of vagina. dryness and for some minute it's almost like it comes out of the blue the conversations of how they go what is this vaginal dryness and it's like well yeah because we're in the know and we

talk about it all the time we think what are you talking about this is you know we normalize try to normalize it but for these people it's not it's actually a taboo and also people don't tell their partners how they're feeling no and we know that from some research that we've done just questionnaires studies looking at how people don't want to talk to their partners. And it's very scary and very isolating. And some of you are listening, I'm sure, know, but with low estrogen and also testosterone levels, certainly in the vagina, the vagina warm becomes thinner, it becomes less elastic and often less lubricated. So we often use the term vaginal dryness. But some people don't get dryness as such, do they? They just get pain. And it's not

all about sex. Sometimes people find putting on underclothes or sitting down can be very uncomfortable. And like you quite rightly say, a lot of women have urinary symptoms because we have estrogen receptors in parts of our bladder and our pelvic floor and our urethra. So they might not have any vaginal symptoms, but they're getting infections. And commonly after sex, people can get infections, aren't they? And don't realize that actually it's related to the low estrogen levels. And like you say, a lot of people go often over the internet or they go to a chemist and they'll buy a vaginal moisturizer or lubricant and that can make things worse, can't it's not the right.

Unfortunately, you know, the whole feminine hiding industry is actually contributing to the issues that we have and certainly in menopause, a lot of women, that's the first thing they turn to because then means they don't have to go and talk to their GP, they can just grab it off the shelf in the supermarket and actually they have no idea that those ingredients are actually contributing to their problems and making their issues worth. They might temporarily help, but actually they could then cause thrush or bacteria or vaginosis. And they disrupt them to the vegans. So what should women be looking for? If they want to self-help initially, they've got some hopefully mild symptoms, because if they're severe, they should certainly be seen a doctor.

And there is a whole plethora of different products out there, aren't there? So before we talk about the moisturizers, what about vaginal health? So there's the whole thing, isn't there, douching, cleansing products that never existed when I was younger? Just talk me through. What should we be putting anything like this? Well, from my own. own personal history, having discovered that these ingredients were irritating my vagina and causing them. For me, I avoid glycerin, anything that contains glycerin, and that's in a lot of these products. So often in a sexual lubricant as well, that will meet sort of like the sticky tackiness. Some people are fine with glycerin, but glycerin is a sugar and it can cause thrush. And if you

know you're prone to thrush, then I would say avoid it. The other biggest thing that's most commonly in these products, doucheers, lubricants is glycols. And they are very well-known vagina lyrotin. that irritate the walls of the vagina, they disrupt vagina pH. That causes you that bit of stinging. But it's not just vaginas, it's penile tissue too. So if you're using it on a partner, some men actually, you know, I've said to me, or their partners have said to me, you know, it's stung. And when you get that, that puts people off using a lubricant because they think all the lubricants are. So then they don't use a lubricant. And the other thing is paraben's, which we shouldn't be putting inside our bodies. They are known histogenics. And we should be avoiding them. But it's not just that. It's things that warm you up or cool you down. There's all these. lubricants that sort of there to stimulate you. And, you know, basically the warming ones contain what you would find in chilies, the same ingredients, and the cooling ones contain menthol. So that's peppermint. Not ideal. And also ones that, you know, I've got flavourings. When flavour leaves are great for oral sex, but I wouldn't say for penetrative sex. And also, you know, we've got perfume products. It drives me potty. The recent one was perfume condoms. And no one needs to

put anything perfumed inside their vagina on their vulva or inside their anus. We don't need to. So all this stuff disrupts vagina pH, it causes irritation, it can lead to infections. So that's really important, isn't it? So it's not just the products that are going inside. It's looking at condoms as well. And we know that obviously contraception is really important, but it's not being lured into all this marketing. Some people go for K-Way jelly because we often use KY jelly to examine women, but that's, we shouldn't be used as a lubricant or a moisturiser, should it? No, basically there's a lot of research come out now. And K-1 Jelly is the pH, not even pH balance to that of the vagina. It contains all those ingredients

that I've talked about. And also, it's known as hyperosmotic. So that means it actually draws moisture out of the walls of the vagina. It doesn't hydrate the walls of the vagina. K.Y was my downfall. I will say that K.Y. Jelly did destroy my vagina health and our sex life in my 20s and 30s, and it led to the vaginas. But it wasn't just KY. It was other well-known lubricant brands. It was using feminine hygiene products, of which there were as many. 20, 30 years ago, but I was using these products to ease my symptoms. And I was constantly getting thrush and bacterial vaginosis and urinary tract infections and cystitis. And then it impacted upon our sex life. So, you know, K-Y, it's not good for you. So people shouldn't be getting it.

But a lot of lubricants are the same. You know, well-known lubricant brands, high street brands. Winds are being bored out now, you know, sort of being aimed at, you know, the menopause market, or certain groups of women. I always say, check the ingredients. Check the pH, check, you know, it's hard to know because sometimes some products don't even contain the ingredients on them. Yeah. And it's the same with condoms as well. Often condoms I've said about being perfume, but also it is the lubricant on them. And sometimes they're not well lubricated.

That will cause friction during sex. Or, you know, it's actually the lubricant on the condoms. A lot of people think they're allergic to condoms. So they switch to a non-latex condom, but they're actually allergic to the lubricant on it. Yes, that's very interesting. So lots look, but it's really important to look at the ingredients if you can. And a lot of women are still worried about, because of changes in the vagina, they want to be clean, obviously. So they're using soap or they're using products that, like we say, there's a huge amount.

But I always say to women, we don't wash our mouths out with soap. So we don't need to wash our vaginas out. I presume you agree with that. I completely. I mean, I've written extensively about this. And for myself, I've only watched with water. I've always been really careful about not using, I have to use sensitive problems. but I've never washed my vulva or my vagina with anything other than water.

But I think, unfortunately, this market is worth lots of money and it's growing. And, you know, we've just got to keep educating people and saying, please don't use this. Unfortunately, while they still exist, people will still think they need them and they will buy them. That's why we just need to keep educating everybody. Yeah, so I think it's really key. I mean, quite often if someone does have irritation and some women have a dermatitis or an X-a-type reaction, because after all the vulgar area is skin, so it can be inflamed. We often recommend an emolence or something, but it's very plain, like dermal or something

like that, which could be very useful to wash with as well as use as an ammonia as well. So I think that's really important. So that can help, certainly with people who are menopausal, that can help short term having moisturisers and lubricants. But we also need to replace the estrogen anyway, and that's really important. So talk us through the local. estrogen, what that is. So basically, the local estrogen is something that you put inside your vagina. I personally use Vagy Femm. I use it three times a week and it has been transformative.

I have to really, really help me. And basically, because it's only absorbed locally, it doesn't go into the bloodstream system because that's the problem I hear. I even had a conversation yesterday with a lady really worried about using Vagy Fem and I was trying to explain to her that, well, it's not going into your bloodstream. And that is a very, very common conversation I have with people. I'm sure. And I think this is interesting. There's a few things. Firstly, you're using it three times a week, which is fine. It's actually licensed for twice a week. So the dose of Vagifem, and Vagifem is, like you say, a local estrogen product comes as a pezzary. It's only 10 micrograms. The lowest dose of a tablet,

oral tablet, of HART is one milligram. So it's 100 times more. So actually using it twice a week is the same as having one tablet a year. If you use it twice a week for a year. So just to put it into perspective, we used to be able to prescribe a 25 microgram Vagifem and it's not available anymore. So a lot of women were taking or using 25 micrograms twice a week, which is 50 micrograms a week. You're only using 30 microgram. So it's very, we often recommend like for you three or four times a week and that's safe. And as you quite rightly say, it's only used in the vagina. The first couple of days when the vaginal tissue is very, thin, there might be a very small amount of absorption, but the amount so small, the amount

absorbed is going to be very small. The problem is, in the inserts for the patients, and I'm sure you've looked inside your packet, because it's a hormone, it will say risk of clot, risk of heart disease, risk of breast cancer, which is really scary. I am doing some work behind the scenes to try and change this, but it's really hard to change things like this. But I always warn women that this information is incorrect. And we know that even women who have had estrogen receptor breast cancer in the past can still usually safely use local estrogen products. And I think this is really important that people know. It's not HRT. It doesn't have the same risks. Even using it slightly more than license in the way that you are, you don't need to have a progesterone

to protect the lining of your wound. So it's very different, isn't it, to HRT? Yeah, very much. I'm using it three times a week because I started having bounce of bacterial vaginosis last year. It's quite difficult to get rid of bacterial vaginosis. And I had about two or three bounce of it. That was the reason why we increased the dose. But it works for me. I also use a vagina moisturiser twice a week. And I use an oil-based sexual lubricant for sex as well. And I wash with water. So it is a common thing that I actually talk to people about and also people who've had breast cancer as well. Because so many of them have no idea, they just think I can't use it. and it's actually to do with quality of life as well.

Yes. In fact is, you know, if it feels uncomfortable in your vaginal area or your vulval area, you can't have sex, you know, it's really difficult getting back to sex after any cancer diagnosis or treatment. But, you know, this can actually really, really improve the quality of your life. Yes. And you say, you know, there are people who can actually, you know, have it when they've had breast cancer. So, you know, but again, that's talking to your healthcare provider and sort of, you know, your practitioner and discussing it with them. Absolutely. And I'd like to spend just a little bit of time talking about different types of cancers.

So people who have had gynecological cancers, so cancers of their vulval area, their vagina, also internally their womb and their ovaries. Because of the treatments they have, certainly if they have radiotherapy locally as well, obviously the treatment can be very cruel and it can be very cruel to the vaginal area too. So a lot of women I see and speak to are never given any information about future sex. And when we talk about sex, it's not just penetrative sex, is it? I think there's a lot that can be done without any penetration, isn't there? And I think when we also talk about sex, we're not just talking about heterosexual relationships.

There's a lot of women. And I have a lot of women in my clinic who are same sex. And sadly, they're both going through the men of course together. Double whammy. So it's a double whammy. So we, often in my clinic, we advise people to talk to experts such as yourself to destigmatise some of the things that we can do to make sex more pleasurable, not just punishes of sex. So if you could just talk us through some of the things on your website,

Joe Devine, which is fantastic for someone who's going first, might be a bit overwhelmed with everything that's on there, and clearly not everything is appropriate for every person. But tell us how you sort of help some of the people that speak to you. So I've written extensively on the website, so there's lots of articles. with practical advice and we have actually created a health brochure that you have to give out to your clients, which we created in the NHS with our local hospital, which has some products in it that actually can really help people when they've got gynecological issues after cancer treatments. But the thing I find with people is we generally focus on penetrative sex and actually to stay,

not everybody's having penetrative sex, but also, you know, there are obviously some people want to get back to penetrative sex, but there are other things you can do. And I think that a lot of people, and even men are palsal women, you know, think I can't have penitious, therefore I can't have sex at all. But, you know, all of us hopefully have a clitoris, if people with vulval cancer, obviously they've probably lost some of their clitoral tissue. But what you see on the outside is just the tip of the iceberg anyway. And so basically, you know, there are other things you can do, other things that you can actually enjoy, you know, any other sexual activity beyond penetration. You know, so I always say to people, you know, get yourself

a simple little bullet vibrator, non-threatening, little tiny bullet. It's not going to to threaten anybody. You can use it on yourself on the clitoral tissue externally around the entrance of the vagina. Use it on your nipples because a lot of people are very sensitive nipples. You can use it on a, obviously a female partner, but you can use it on a male partner as well, up and down the shaft of the penis, around the head, around the glands on their nipples. You know, it's actually being creative and a little bullet vibrator. It's inexpensive. I always say to people don't buy one that's powered by button batteries because they're not environmentally friendly. They're not particularly strong. And get one that's got multi-speeds, like the ones that we sell.

They've got three different speeds. They've got about seven different pulsation patterns. But they're really, really fun to use. And if you're worried about using a sex toy, it's always the first starting point. I say to people, you know, that just do that to have a little bit of fun. It will be a giggle. You know, hopefully it'll help you relax. And also, if you're worried about using one with a partner, then use it on your own to begin with.

You know, take yourself off or use it in the bath because the majority of our sex toys are waterproof or in the shower. And then if you feel comfortable, introduce it into your relationship, show it to your partner and say, well, actually, I've been using this. Would you like to use it on me? Do you want me to show you how I've been using it? Can we use it together? And I think it's actually framing it that way is the better way to try and get sex toys into your relationship. Well, I think it's breaking the stigma and the taboo, isn't it? And I think increasingly more people are talking about the clitoris and what it is and how important it is for a lot of women, which is something. we never spoke about decades ago. And I think, I don't know if you've watched Fleabag, but she sometimes must be. And it's great because it shows that it can be normalized.

And it doesn't have to be dressing up kinky sex to use a sexual toy, which I think does have this sort of connotation for some women. And certainly, I was saying to you earlier, I saw a lady who had vaginal cancer in the past and was given some dilators after her treatment and said, I wouldn't bother with these, because they probably won't help and you won't be able to have sex in the future. And she's 36 and she's happily married. And no one had talked about any external stimulation.

And even you're saying, you know, nipple stimulation. You know, I was taught as a medical student, if someone's having sexual difficulties, you tell them that they shouldn't have sex. And then you do, because then you explore your partner's bodies. You explore them and you concentrate. on other areas that can be nice and pleasurable. And it takes that worry about whether it's going to be painful or sore. And then you gradually work up to it. And it works so well for a lot of people because I think a lot of women I speak to tell me that their husbands or partners are so desperate

for sex. They'll close their eyes. They'll get through it. It's so painful and horrible. But they know their husband's better for it afterwards, which is terrible. And I hear that conversation quite a lot. And the other thing about this is sort of exploring your partner's body and your your own body, massage, touch, you know, blindfolds and that sensory deprivation because that heightens your senses anyway, so your sense of touch, your sense of smell, your sense of taste, feathers and silky ties and, you know, just really, really sort of sensual and sort of, you know, sensations. That actually then stimulates your arousal if you're feeling low libido after these cancer treatments. If you're going to menopause. And actually, it's really, really good fun. It actually boosts.

your intimacy, it makes it feel more intimate. Ron, there's just lying back, I've got to tolerate this painful sex. And to tell you the truth, I was one of those women. I didn't tell my husband about the vaginism for a long time. I didn't really understand what's happening to me. And he was really upset the fact that he thought he had, well, he had hurt me because it had been painful, but I had consented to it because I wanted to have sex. And I know this is the case with some of these women. And I think we've lost that sort of intimate size. A lot of people who've had cancer often find once they've gone through treatment, they become more intimate with their partner.

They get that intimacy back or maybe a level of intimacy they've never had before. It's always been a little bit wham-ban, thank you, ma'am. It's very mechanical maybe. And it's sort of just going through the process and they've actually never really thought about whether you happen to be a bit more creative with your sex life.

You actually do explore different things and hopefully open up the conversation and try to things. Something's always worth trying, you know, with content. And if you don't like it, you just say, I don't like it. You know, it's amazing how many couples do open. I go, well, actually, I quite like to try that.

Yes, so would I. Being open is so key and not suffering alone is really important. Because also, I know we sort of joke and laugh about sex, but there are health benefits of regular sex, aren't there? Just talk us through. What are the benefits? I always tell people, have orgasms. But, you know, the aim of sex is about pleasure, isn't it?

So even if you're somebody who's not having an orgasm, that's not there'll be all an end, a knife and the majority of people can actually have an orgasm. Some people just don't know how to. But there are some people who have an orgasmia, so they aren't able to have orgasms, but they enjoy pleasurable sex. So, you know, but the benefits of orgasms are just huge because it basically relaxes you because it feels so nice. It releases those feel-good endorphins, you know, which boosts your mental health, makes you look young. So, you know, you don't need all those expensive face creams helps you sleep better. And obviously that's a big issue in menopause as well.

I've got a lot of customers. And so I've got a lot of older customers who've got themselves a sex toy. They're no longer have a partner. The partner may have passed away or they're no longer together. And they're actually struggling to sleep. So they're having an orgasm before they go to sleep at night. Because it induces this sense of relaxation that helps you drift off. If you wake up, sometimes it's quite nice to have an orgasm and then you helps you go back to sleep. It boost your immunity, you know, so it helps you with all those coughs and colds and things like that. And for men as well, the regular orgasms for men actually can reduce their risk of prostate cancer because it flushes out the prostate and you don't get stagnant buildup of fluid and also it stops sort of, you know,

enlarge prostate. But yeah, so everything's just beneficial for you. And we know that, you know, healthcare professionals are telling their patients to have regular orgasms. And, you know, it's, well, some healthcare professionals are. So I think it is and they're a cardiovascular benefits as well. Absolutely. And also it does bring couples closer together. And certainly we see so many couples in their menopause who are drifting apart because the woman has changed because of the menopause, often doesn't realize it's the menopause, but her personality is changing, maybe her figures changing as well, and then the partner doesn't quite know how to respond, and then they end up just being very separate. And I think sort of 30, 40 years ago, often at my

grandparents' era, they used to sleep in separate beds, and often the husband would have erectile problems. The woman would have vaginal dryness and they didn't talk about it and didn't connect. Thankfully with interventions such as Viagra, men don't have erectile dysfunction in the same way, but women are lagging behind with the vaginal dryness and we know from studies around 70 to 80% of women have vaginal dryness yet only about 7% of women have treatment. And as Sam so eloquently has described, it's very easy to get treatment. And a lot of first-line treatment can be done without seeing a healthcare professional, aren't it? Definitely. And I think it's really important that if women is having any discomfort or any urinary symptoms, they should consider

some treatment. Obviously, there are other reasons why people can get pain and discomfort in the vagina. And if anyone has any concerns or any symptoms that are progressing or symptoms such as bleeding, then they really should see a doctor. But for most women, the first level of treatment, can be done quite simply if you know where to go and get help. Yeah, and you know, we were talking about non-penetitive sets, but obviously quite a lot of people want to get back to penititive sets. Using a slim vibrator can really help with the vaginal tightness that a lot of women do experience. And also, you know, we've talked about menopause and cancer,

but some women have obviously been through hysterectomies. Yes. And that can shorten the vagina and that can make penetration feel uncomfortable. So I always recommend women get themselves a good lubricant and use a slim vibrator and just to get the vagina back in shape. and also to use it with their partner, part of their sex play. They can use it beforehand during or, you know, post-sex. It's whatever they want to do.

But it's actually a bit of self-care that you give back to the patient. Because I hear a lot of people feel like they've been medicalised through their treatment and whatever they're having. And actually, you know, this is something going, well, I wish I'd known about this. And I wouldn't have used the medical dilators, which I didn't use because we know a lot of people don't like using them. We have lovely soft-silicon ones. But also we do recommend slim sex toys because you've got the benefit then. of the vibrations which stimulate the blood flow inside the vagina. It stimulates sensation. You can use it on your clitoris. You can use it on your nipples on a partner. So it's really, really versatile

to actually get yourself a slim vibrator to actually help yourself with those issues and not give up. Which I think is really important. I see lots of women who have had hysterectomies and they often see a pelvic floor physio and they're told about their pelvic floor, which is absolutely essential. but they say, you know, after six weeks, eight weeks, depending on the surgery or sometimes three months, they can have sex again. No one tells them how to have sex or how it might be uncomfortable or what they can do or which moisturisers or lubricants they might want to use. So it's a real missing link for a lot of people. And I also speak to a lot of women and I'm sure you do who are told use it or lose it. So you've just got to get through it, keep having regular sex and then you'll be fine.

And it doesn't work like that when you're menopause on. You can't produce the secretions. If the lining of the vagina is very thin, you won't be able to get that back properly without the right treatment. No, exactly. And that's actually more off-putting than actually, you know, if you give them no advice at all. I think that, you know, we've got to try and get across through

in this whole embarrassment about our bodies. We've got to educate people younger. That's great. You know, we've got to talk about menopause on the school curriculum so that people know what to expect as they get older. Because vagina, for this doesn't. doesn't just affect menopausal women, it affects everybody of any age, basically, you know. Well, this is the thing. There's, you know, people after having babies often have vagina

dryness, people that use tampons, people that have pills, sometimes people who have diabetes and inflammatory bowel disease. So, and sometimes it can just be short-lived. Yeah. It's not long term. And some people find it's one of the last symptoms of the menopause, whereas other people actually find it's one of the first, like Jane Lewis, who we know well, who's written the amazing book when venopals or vagina was one of her first symptoms, which she was. was perimenopausal and wasn't prepared for us. So it's really important that we reduce this whole stigma and just get talking. So it's been brilliant. I could talk for hours because there's so much. But I really hope for women and even men listening there that you've got some tips

that will really help. And I think the most important thing is don't be afraid to ask. Sometimes it's easier talking to a healthcare professional because certainly we're not embarrassed. And Sam gives amazing advice. There's lots of written advice. on her website, but she's very happy for email and even picking up the phone and talking, aren't you, Sam? So before we finish, could I just ask for three take-home tips? So for people who are maybe experiencing some vaginal dryness or reduced libido, just they want to reconnect with their partner.

What were the three things do you think that could help them? The most important thing is they actually talk to their partner and actually tell them because communication is very, very key to start this process. The second thing is invest in a really good sexual lubricant of vagina and moisturiser. Check the ingredients, avoid the ingredients that we've talked about. And actually do a skin test, don't just slap it on. Some lubricant companies will send you a sample to try, which is a really good idea. I'm always giving out samples wherever I go.

And thirdly, you know, invest in a simple sex toy, you know, a bullet vibrators we've talked about, a slim sex toy. You know, there are products for men as well, which is great. So you can have his and her sex toys, you know, there are unisex toy. So actually have a bit of fun. Explore things that you haven't maybe done before within your sexual relationship. But also, you know, just maintain that intimacy, kissing and cuddling, talking to each other, gentle touch, massage, you know, eye contact, you know, just that wink or something. Just keep that in your relationship because, you know, that will be the sort of first steps back to getting back to sex. And the sex may not be the same as it was before you went through menopause.

It may be better. Some women often find it is much better. Some women don't. and they never get back to it, but they try something different, you know. So don't ever give up, you know, if you want to have any sort of sex, just don't give up, you know. So perseverance is key. So, well, thank you so much for your time today. We'll put some links to your website at the end and some notes.

But thank you ever so much for coming today. Thank you. That's great. Thank you for inviting me. For more information about the menopause, please visit our website, www.w. co.uk.uk