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I suffer from very painful intercourse since the menopause! I cannot take hrt

Painful sex after menopause is usually due to lack of estrogen causing vaginal dryness and an inability to lubricate naturally. It occurs very commonly - even in women taking full-dose systemic HRT. If you're unable to take systemic estrogen (i.e oral, patches or gels), most women can take vaginal estrogen pessaries or creams with no significant side effects or risks - even those with breast cancer - as the amount of estrogen absorbed is usually minuscule. In addition to this, vaginal emollients & synthetic lubricants are particularly useful, with brands such as "Yes", "Replens" and "Sylk" being the most commonly recommended.

For those who have been advised not to use intravaginal estrogen - or have had problems with it, two other new treatments can be prescribed: These are estrogen precursor drugs - ospemifene (taken orally) or DHEA/prasterone (taken vaginally), which specifically target the vaginal skin and have both been shown to reduce pain with sex.