Dr Angela Wright on managing sexual dysfunction and GSM

Middling Along

In this episode I welcome Dr Angela Wright from Spiced Pear Health. Angela is a GP, Menopause Specialist and Clinical Sexologist. She is particularly interested in improving sexual function and menopausal symptoms in women who have undergone cancer treatment. Angela is passionate about women’s health and sexology and is frequently asked to teach or talk about this subject. She is a registered trainer for the BMS & FSRH, involved in training future menopause specialists and is an active committee member of the British Society of Sexual Medicine, and the education committee of the Primary Care Women's Health Forum.

We covered so much in such a short space of time! We started by talking about the impact of localised (vaginal) oestrogen vs what systemic HRT does - both for GSM (genito-urinary syndrome of menopause) and for sexual dysfunction. For anyone wanting to know more about GSM, or pass information on to their GP, Angela recommends the British Society of Sexual Medicine consensus statement on GSM that’s available on their website (linked below).

She goes on to explain that there is no increase in recurrence risk for oestrogen receptor positive breast cancers when using localized oestrogen to treat symptoms (and that it can be used alongside letrozole and tamoxifen). We discuss the need for patients to be able to make an informed choice about risks vs benefits, which can be challenging when healthcare professionals are not taught to understand the impact that GSM and sexual dysfunction can have on quality of life - certainly male sexual dysfunction gets a lot more attention and usually pretty rapid treatment!

We move on to discuss ‘sex tech’ and the burgeoning menopause ‘market’ in this area, including laser therapy (TLDR: more research needed, long term effects not known, it’s expensive, and vaginal oestrogen would be more effective in the majority of cases).

Angela gives an overview of what self-care practices can be helpful for someone struggling with GSM - listen in to find out some very little known information about the clitoris (and how to keep it healthy) that was totally news to me! She also explains that a range of prescription medicines (in particular antidepressants, but also antihistamines, and blood pressure medication) can mess with our sexual responsiveness, so could be something to discuss with our healthcare provider.

For anyone struggling that wants to find out more, or support them in advocating for better care, Angela recommended a wide range of resources listed here:

Mind The Gap, by Karen Gurney

Better Sex Through Mindfulness, by Lori Brotto

Becoming Clitorate, by Laurie Mintz ​​

Institute for Psychosexual Medicine website directory of practitioners https://www.ipm.org.uk/patients/specialists/

COSRT https://www.cosrt.org.uk/ - list of therapists

British Society for Sexual Medicine (email [e-mail] and ask for a local practitioner)

Menopause-ull webinars ​​ https://www.mnetwork.org.uk/resources/recorded-webinars/

You might also be interested in our testosterone episode with Dr Katie Barber: https://middlingalong.com/episodes/middling-along-dr-katie-barber-helps-us-get-to-grips-with-testosterone-dos-and-donts/

You can find Angela online at ​https://spicedpearhealth.co.uk/ and https://www.instagram.com/spicedpearhealth/

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