Vagifem

Post-HRT trial

I stopped taking hormone replacement therapy about eight months ago because of all the scare stories about breast cancer and strokes. It hasn't been fun, but most of the worst symptoms have now gradually receded. Initially, I had frequent hot flushes with sweating several times a day, and at least twice every night. Occasionally, the bedclothes were soaked. I also experienced joint and muscle pains. The flushes and pains are much less frequent now, but a new problem has appeared - my vagina is dry and sore. When I saw the doctor, thrush was diagnosed and I was treated with Canesten cream. This helped a little, but things are still not back to normal. Natural lubrication during sex has virtually disappeared. Can thrush have persistent effects like this? Should I continue with the cream? Can anything else be done?

Oestrogen, the natural hormone that is produced by the ovaries before the menopause, has widespread effects throughout the body. When the ovaries stop producing enough oestrogen, these effects begin to appear. HRT (hormone replacement therapy) artificially replaces the oestrogen that the body is no longer producing. When you are taking HRT, the symptoms caused by lack of oestrogen are kept at bay. By stopping HRT, you have allowed these symptoms to break through. The tissues of the vagina need oestrogen to remain healthy. In the absence of oestrogen, the lining of the vagina becomes thin, dry and red. The medical term for this is atrophic vaginitis. An atrophic vagina is unable to secrete the natural fluids that provide lubrication during intercourse. You may have had thrush as well, but it is more likely that your symptoms are due to lack of oestrogen than thrush. If you don't want to restart HRT, the best solution may be local oestrogen treatment in the form of vaginal tablets, such as Vagifem, which is only available on prescription. Initially, you have to use them every day for a couple of weeks. After that, once or twice a week is enough to keep the vagina healthy. If you are against the use of any hormone treatment, you should use a water-soluble lubricating jelly, such as KY.

Wax and pain

My son suffers badly from painful ears, especially in the summer. Our GP says that this is caused by chlorine in the swimming-pool reacting to his waxy ears. The situation is made worse by my son's overuse of cotton buds to clean his ears. A friend recommends a product called Audiclean, because it's natural. How does it work, and could it tempt my son to ditch the cotton buds?

Pain in the ears can come from either the outer part of the ear or the middle part. There is also an inner part of the ear, which rarely causes pain. The outer part consists of the narrow canal that leads down to the eardrum. The middle part is behind the eardrum. Your son's pain sounds as if it is coming from the outer ear. This is where swimming-pool water can indeed irritate the delicate skin that lines the canal. It is also where wax collects and where cotton buds can do damage. The problem with cotton buds is that, at the same time as they are removing wax from the ear, they are also pushing wax deep into the canal. They also have a tendency to damage the skin lining the canal, making it more susceptible to infection. Audiclean is a product made from sea water. Its manufacturers say that the water comes from Mont St-Michel Bay in France. It is purified in some unspecified way and put into a plastic spray bottle. I suspect it works in exactly the same way as any solution of salt and water works - by gently dissolving and washing away wax. At pounds 5.99 for 60ml, it's much more expensive than top-quality extra-virgin olive oil, another useful treatment for ear wax.

Worrying lump

Six months ago, I discovered a small hard lump on my hand at the base of the little finger. The doctor described it as a "fascia" and recommended its removal by surgery. How is this caused, and does alcohol play a part? An X-ray suggested that osteoarthritis was a possible cause.

This hard lump is the first sign of a condition called Dupuytren's contracture, which has nothing to do with arthritis. It is caused by a thickening of a layer of tissue called fascia, which overlies the tendons in the palm of the hand. As the fascia thickens, the tendons get pulled tight. This causes the fingers to flex in towards the palm. The only effective treatment for Dupuytren's contracture is surgery. Drinking too much alcohol may be a contributing factor, but teetotallers get Dupuytren's contracture, too.

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