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Australian Journal of Pharmacy : August 2005
Sex and the post-menopausal woman S TIs are becoming a problem for women who have been married for some years and when the marriage breaks down enter the dating market again. Older women who get into a new relationship should use a condom, even if they have had a sterilisation because that will not protect them against STIs, according to FPA Health’s Dr Edith Weisberg. If women are using a condom it is advisable to use lubricants that are water-based, not vegetable-based, she added. Post-menopausal women often find that they suffer with a dry, uncomfortable vagina as oestrogen levels decline with age. Vaginal oestrogen preparations can be helpful and will also improve vaginal lubrication. Other preparations that can be used to make intercourse more comfortable are lubricants or a vaginal moisturiser. Older women are also prone to bacterial vaginosis (BV), said Dr Weisberg, frequently wrongly diagnosed as thrush. It produces a watery, unpleasant fish smelling vaginal discharge. Vaginal oestrogens, (tinidazole) in a single dose and a new OTC capsule containing live lactobacilli are effective treatments for BV. The condition comes about when the normal balance of bacteria in the vagina is disturbed by an overgrowth of other bacteria. Thrush is an unusual infection in post-menopausal women unless they are using HRT. Any vaginal anti-fungal is usually effective either as a three- or seven-day treatment. In cases of recurrent thrush, oral therapy in the form of a single tablet of fluconazole is often effective. This will run from 2005 to 2008 concur- rently with national HIV/AIDS and Hepatitis C Strategies. Chlamydia In 2004, there were approximately 36,000 chlamydia notifications, a 20 per cent increase from 2003. Every sexually active person is at risk of contracting chlamydia. However, the risk is higher among sex- ually active young people with multiple partners. Up to 90 per cent of women and 50 per cent of men have no symptoms, so most people infected are not aware of their infection and may not seek healthcare. Once diagnosed chlamydia can easily be treated and cured. If left untreated, chlamydia can cause serious health prob- lems including infertility. The new pilot-testing program will be designed in consultation with experts and targeted at women aged 18–30. Although at a preliminary planning stage, the program will examine a number of options– such as opportunistic testing at the time of a medical consultation for a PAP smear, or contraceptive advice, with other means for testing likely to be considered. Development of the scope, target group testing facilities, methods, and data requirements will be some of the vari- ables requiring discussion over the next few months with relevant sector experts, according to a statement to the AJP from the Department of Health and Ageing. Chlamydia is the major STI problem because, generally, it causes no symptoms, according Dr Weisberg. She said bleeding after intercourse, or bleeding between periods, or spotting before or after periods, should be checked by a GP because that is how chlamydia can present. Although the infection can occur in any age group, health professionals are con- centrating on women under 30 because this group is more likely to be changing partners and the infection is asympto- matic in both women and men. If chlamy- dia is left unchecked the consequences can be infertility due to tubal damage as well as chronic pelvic pain, she said. The screening test is simple and can be done on a urine sample so does not require a vaginal examination. The infec- tion is easily cured with a single dose of antibiotics. 636 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 AUGUST 2005 Herpes Another common STI is the herpes sim- plex virus (HSV) which can be transmit- ted to any part of the body where there is a break in the skin, although it most fre- quently occurs on the lips or the genitals. Type 1 mainly occurs on the lips in the form of cold sores, while type 2 usually affects the genital region. ‘Herpes is painful and recurs often and the virus stays with the person for life, although attacks tend to get further and further apart the longer the person has been infected,’ Dr Weisberg said, and there are very effective treatments to reduce the duration of an attack and assist in reducing the likelihood of recurrence. She said pregnant women need to inform their doctor if they have herpes, although only a primary attack during delivery can cause serious illness in the baby. According to Dr Weisberg it is impor- tant to get the message across to young women that they can become pregnant the first time they have sex if it happens to be at the right time of the cycle. Women need to protect themselves against STIs and the only method that protects against STIs is condoms, either male or female. All women should be advised to use condoms, in addition to any method of contraception they are using, if they feel that they are likely to be at risk of an STI. Sexual dysfunction What causes low libido? Also arousing interest in women’s health is lack of sexual desire, more commonly knows as sexual dysfunction (SD). According to a report in Australian Fam- ily Physician, published in November 2003, large numbers of Australian women, and men too, reported having at least one sexual problem. The high rates of SD in women —around 60 per cent—were similar to