The Menopause and Sex

World Menopause day is Thursday 18th October. This year the theme is sexual wellbeing after menopause.

As women age and our ovaries stop producing eggs, oestrogen levels in the body drop. This lack of oestrogen can affect the vulva, vagina, urinary tract and supporting pelvic structures. For around 50% of women this can lead to a collection of symptoms (labelled GSM – genitourinary syndrome of the menopause, sometimes still referred to as Atrophic Vaginitis). These can include: vaginal or vulval discomfort -burning, dryness, irritation, itching or a prolapse;  bladder symptoms – frequency, urgency, problems emptying the bladder, leakage or repeated bladder infections and sexual difficulties including painful sex.

All of these aspects impact on sex and the desire to have sex. Post menopausal sex is more complex though than just a lack of oestrogen. I once saw sex after the menopause likened to riding a unicycle (bear with me here!) Lots of factors can make it problematic:

  • You may have no unicycle (You may have no partner, or an unwilling one, one you don’t fancy, or one with medical conditions that make sex difficult for them)
  • You may worry about looking silly. (This could be linked to changes in appearance, hot flushes or sweating)
  • You are out of practice, or can’t make time to practice. (Many women are juggling multiple, competing responsibilities such as work, elderly relatives, children at this stage of life)
  • You aren’t able to ride the unicycle (You may have other ill-health that impacts, or be exhausted, or worried about other aspects of life)
  • You may worry that everyone else rides their unicycle more (There is no normal frequency of sex at any age).

What can we do to help the aspects that are influenced by lack of oestrogen?

There are topical oestrogen creams and pessaries – these are very low dose oestrogen applied locally to the tissues that need them. Regular use of vaginal moisturisers (such as Yes available on prescription) can rehydrate the skin and lubricate the vaginal wall giving a few days’ relief. Lubricants can be used during sex – and it is worth experimenting to find the best ones. There are several available, but Yes and Sylk have been found really useful by many of my patients.

Pelvic floor rehabilitation can be important. This can include self examination and treatment and treatment by a physiotherapist, to help increase blood flow to the area, keep the muscles toned, maintain vaginal length and flexibility and deal with any troublesome GSM symptoms.

Further information on sexual health after the menopause

International Menopause Society leaflet on sexual health after the menopause

British Menopause Society 

The Royal College of Obstetricians and Gynaecologists have an information hub which brings together evidence based information and advice for women.

For information about physiotherapy and how we can help, or to book an appointment you can contact Carolyn Lindsay.

She has been working with peri-menopausal and menopausal women for the past 13 years as a specialist pelvic health physiotherapist. She is also currently training towards a diploma in Psychosexual Medicine (with the IPM), so that she can integrate physical and psychological support and treatment for the best outcomes for patients.







World Continence Week 2018

It is World Continence Week this week


The aim being to raise awareness and get people talking about the difficulties and problems suffered by a wide range of people. Around 1 in 3 people struggle with urinary incontinence. It has a significant impact on quality of life, impacting on daily activities such as work, leisure and intimate relationships.

It is slightly more difficult to get accurate statistics about bowel incontinence (because people are even more embarrassed about discussing it or seeking help). But around 1 in 10 people admit to problems with bowel control.

The difficulty with not talking about continence / incontinence is that people then lack support with the problem and may not realise that treatment is available.

Training the pelvic floor muscles is the recommended first line treatment for with urinary incontinence.

Specialist physiotherapists have post-graduate level training in pelvic floor function and dysfunction and will be members of the Pelvic, Obstetric and Gynaecological Physiotherapy Organisation (POGP). They have a number of useful patient leaflets that can be accessed here 

As specialist physios we constantly aim to raise awareness and bust the myths around incontinence – so that women know that bladder weakness is not normal (whatever the Tena adverts may suggest!). Physiotherapy is proven to help. It takes work on your part but can be very effective in improving or completely resolving symptoms.

One physio who has taken up the education gauntlet and is really raising the profile is the excellent @GussieGrips – she is a women’s health physiotherapist and stand-up comedian raising awareness of the pelvic floor.  You may have heard her on the BBC or come across her on Twitter (or even seen her at the Edinburgh festival). Have a listen here:

She is also involved in #pelvicroar raising awareness of rehabilitation. Their website has a range of blogs about pelvic floor issues and other useful links

As well as easier access to good quality information on the internet, there is a range of technology to assist women with pelvic floor rehab. From apps to help you do your pelvic floor exercises such as the squeezy app, to a range of electrical stimulation or biofeedback devices to help with your exercises. It is always best to get a proper assessment from a suitably qualified physiotherapist to fully evaluate your pelvic floor, before deciding to use any devices, to make sure they are suitable.

Don’t suffer in silence or put up with using pads. Find a suitably qualified physiotherapist and start getting help.

If you want to know more about the impact of Menopause on the pelvic floor and what you can do to help, then I’ll be addressing this at our menopause support evening. Further details of which you can find in this blog or you can book by clicking here: Menopause evening July 12th booking

You can find more information about pelvic floor problems on this page  and contact me to find out about assessment and treatment here.




Menopause Support Evening

An Evening of Information, Activity and Support

Thursday 12th July

7 – 9pm


My colleagues and I at The Treatment Space are hosting an event to support and inform women about the menopause.
The evening will be a combination of talks, advice and techniques from a Physiotherapist me, Acupuncturist Kat Love, Counsellor Caroline Weeks and Nutritional Therapist Penny Dembo, (whose practical demonstration will provide us all with tasty snacks to try).

There will  be plenty of time for discussion and questions.

Thursday 12th July ’18.
7 – 9pm


Sum Studios – 7
1 Hartley Street, Heeley, Sheffield, S2 3AQ



A reminder email with further details will be sent to you the week before the event.

Endometriosis Awareness Week

Endometriosis – How can we help?


Endometrial tissue lines the uterus (womb). Each month the lining thickens in preparation for pregnancy. If no pregnancy occurs, hormones will cause the womb lining to break down and this is shed as a period.

In endometriosis the endometrial tissue is also found in other locations in the pelvis such as the ovaries, vagina, bladder or bowel. Although not in the womb, this tissue is also affected by the monthly cycle. When the cells are shed the bleeding has nowhere to go, causing inflammation and adhesions (scar tissue).

It is difficult to know how common it is, but around 5-10% of women are affected during their reproductive years (between the onset of periods and the menopause).

Diagnosis can often be delayed because the symptoms are similar to many other conditions. The most common symptoms are painful periods (dysmenorrhoea); pelvic pain between periods; prolonged, heavy or irregular periods and painful sex (dyspareunia). It can also lead to difficulty conceiving, or infertility.

Endometriosis awareness week runs from  3rd – 11th March 2018 and aims to raise awareness of this condition and help women be diagnosed earlier. Further information can be found here: Endometriosis UK: Awareness Week

Pain can be severe and significantly impact on a woman’s daily activities, which can also lead to depression and fatigue.  There is no evidence that delaying starting a family makes the condition more likely, but there may be a genetic link.

Personal stories about living with endometriosis (from Endometriosis UK website) can be found here: Personal stories


Medical treatment is hormonal and aims to mimic the non-reproductive state, by altering levels of oestrogen and progesterone. Surgical treatment can involve local removal of the endometriosis or more major surgery, such removal of the womb or ovaries.

Some women manage the condition without medical intervention, using pain relief.

How physiotherapy can help

Although Physiotherapy doesn’t modify the endometriosis itself, it can help to treat the postural and movement disorders that, for many women, contribute to ongoing pelvic pain.

By evaluating:

  • Postural changes and adaptations
  • Tense abdominal and pelvic floor muscles
  • Muscle imbalance
  • Stress and anxiety

Physiotherapy uses a range of approaches including:

  • Posture and movement correction through manual therapy and exercise
  • Improving pelvic floor and abdominal muscles flexibility and strength
  • Exercise to aid rehabilitation following surgery procedures.
  • Helping with pain management – through exercise, acupuncture, relaxation and coping strategies.

Carolyn uses her experience as specialist pelvic physiotherapist to help women struggling with the symptoms of endometriosis. To make an appointment, or to discuss further please Contact Carolyn

 Carolyn works from The Treatment Space, a shared space where western and traditional therapist work alongside one another. Her colleagues Kat Love (Traditional Acupuncture) and Penny Dembo (Nutritional Therapy) also work with women experiencing symptoms from Endometriosis.  Kat uses acupuncture to help regulate the cycle and treat symptoms, whereas Penny advises on food choice and nutritional support to reduce symptoms.

More details can be found on their personal websites here:

Kat Love: Traditional Acupuncture:

Penny Dembo: Nutritional Therapy:


Pucker Up Your Pelvic Floor

As we approach Valentine’s Day, specialist Physiotherapists are again running the ‘Pucker Up Your Pelvic Floor’ campaign. The aim is to raise awareness that specialist physiotherapists can help with sexual problems.

The media is beginning to discuss pelvic floor problems and sexual difficulties a little more, however the fact that physiotherapy can really help is rarely mentioned.

See the BBC news article here: ‘Sex is painful for nearly one in 10 women study finds’

Most people associate pelvic floor exercises and physiotherapy with reducing bladder problems, however research also shows that strengthening, toning and knowing how to relax the pelvic floor muscles has an impact on sexual enjoyment and performance too. Pelvic floor treatment can help strengthen the muscles and improve blood supply and nerve activity. All of these lead to greater pleasure.

Appropriately trained pelvic health physiotherapists (who will be full members of the POPG – Pelvic, Obstetric and Gynaecological Physiotherapy Organisation), specialise in the assessment, examination and treatment of the pelvic floor.

So whether you are struggling with painful intercourse, vaginal tightness, lack of sensation, orgasm problems or urinary leakage physiotherapy treatment can often really help.

You can access helpful, evidence-based booklets about the pelvic floor from the POGP website POGP leaflets

Carolyn Lindsay has postgraduate training in assessment and treatment of the pelvic floor. She has been a specialist physiotherapist since 2004 and regularly (and successfully) works with patients who are struggling with painful, or unsatisfactory, sex. She continues to work towards her diploma in Psychosexual Medicine (with the Institute of Psychosexual Medicine).  All treatment (as with any physiotherapy treatment) is completely confidential.

She is also a Mummy MOT practitioner – offering postnatal checks (including pelvic floor checks) for Mums.


If you would like to book an assessment, or discuss how physiotherapy can help then  Contact Carolyn Lindsay here


Small Park Big Run

IMG_0008I’ve had a brilliant time over Saturday and Sunday massaging runners who were taking part in Small Park Big Run. This 24 hour event took part in Meersbrook park with continuous circuits being run in shifts by multiple entrants.

People of all ages took part, doing from half hour stints up to more than full Marathons – which if you consider the hill in Meersbrook park is pretty amazing. Well done everyone!! Don’t forget that you can use your 50% off vouchers until the end of the year. Vouchers can be used for treatment by me (Physio, Massage or Medical Acupuncture), or my colleagues at the Treatment Space: Kat (Traditional Acupuncture) and Rachel (Sports and Remedial massage).

The run aimed to raise awareness of the movement restrictions faced by Palestinian people on a daily basis. And also to raise money for two charities supporting women’s university scholarships and children’s projects. There was also a free community fun run which linked up with a children’s run in Gaza.

Time lapse of the event Where you can briefly glimpse me working in the back left of the white tent.

Well done to all the amazing organisers – some of whom stayed up for the whole time and many ran too. As well as raising money and awareness it was also a lovely community event full of friends and neighbours, so it didn’t even feel like work.

If you’d like to know more about the charities supported by the run you can go the webpage Small Park Big Run


Exercise during pregnancy and in the postnatal period

Recent media articles have outlined how women may be looking at the wrong sources for information about exercising during pregnancy and the post natal period.

Women can feel a lot of pressure when looking at social media posts and images of exercise during and after pregnancy. It’s also difficult to judge the quality of the information being put out.

This Guardian article outlines some of these issues. Instagram-filtered images of celebrities ‘put pregnant women’s health at risk’

A certain amount of scepticism can be useful when looking at pictures and reading information from celebrities. Striving to match an airbrushed image is always going to be impossible for real women. Our individual situations are all different, so it is better to look for reliable information, based on research evidence and follow this. The follow sites are evidence-based and regularly updated and can be trusted to give appropriate and relevant information:

‘This girl can’ adverts show real women exercising

NHS choices – This is great for general exercise and advice and specific advice around pregnancy NHS Choices: Exercise in Pregnancy

Another source of free information, based on the most recent research is the patient information leaflets from the POGP (Pelvic, Obstetric and Gynaecological Physiotherapy Organisation).

There is a leaflet on safely exercising during pregnancy and one for postnatal recovery.

The full list of leaflets, including leaflets on pelvic floor exercises can be accessed here 

You can also get individual advice and support.

Carolyn is a qualified fitness instructor so is able to offer exercise and advice from both a physiotherapy and fitness instructor perspective.

Contact her for advice on:

  • Exercising with a medical condition or injury
  • Starting exercise for the first time
  • Exercise for weight loss
  • Safe exercising during pregnancy
  • Effective and safe postnatal exercise to get back into shape
  • Improving mood and psychological state through exercise
  • Improving bone density



The Mummy MOT

Mummy Mot LogoI am very excited to be offering The Mummy MOT in Sheffield. This thorough postnatal check reviews a Mum’s posture, tummy and pelvic floor. The aim is to pick up potential problems and enable women to start on appropriate functional activity training. This helps Mums to get back to what they want to be doing – whether it be normal daily activities, or high level sport.

It was devised by two excellent professionals Maria Elliot (a specialist pelvic physiotherapist) and Jenny Burrell a dynamic exercise professional who saw the need for an integrated approach to rehabing post natal women. This resonated with my own approach. I have increasingly seen the need to integrate functional exercise within my physiotherapy practice and, to this end, have also become a fitness instructor.

As Mums we needs to move! We need to bend, twist, squat and lift and our rehab needs to reflect this. Pelvic floor exercises alone wont get us there. The Mummy Mot is holistic. It looks at the whole woman and helps move her towards her activity goals.

Mums are great at putting themselves last. But to support others and keep our busy lives on track, we need to be functioning well and that’s where the Mummy MOT comes in.

Further information can be found on my Mummy MOT page here


#puckerup your pelvic floor

POGP #puckerup female campaign picture

Your amazing pelvic floor muscles are even more vital than you might think. As well as supporting your bladder, uterus and bowel, helping with bladder and bowel control and assisting your posture, they are also vital for sexual satisfaction.

Training your pelvic floor, including learning how to properly contract and relax the muscles, can have a huge benefit for sex – whether you are struggling with painful sexual intercourse, or a lack of sensation.POGP2 colour (2)

The POGP have free leaflets on working your pelvic floor, that you can access here (for both men and women)

How do you know if your pelvic floor muscles are working optimally? POGP-registered physiotherapists have postgraduate training in proper assessment and treatment of the pelvic floor. They can teach a correct contraction, help relax and release overtight muscles and devise an individual treatment programme appropriate for you.




Carolyn Lindsay has postgraduate training in assessment and treatment of the pelvic floor and is also currently training towards a diploma in Psychosexual medicine with the Institute of Psychosexual Medicine.  She has been a pelvic floor physiotherapist since 2004 and regularly works with patients struggling with painful or unsatisfactory sex. You can contact Carolyn using the details here

Go on…..#puckerup


Effective Headache treatment

Acupuncture plus Physiotherapy for Headache relief.

Recent research shows that acupuncture treatment is beneficial for both migraine and tension-type headaches. Combined with physiotherapy to treat neck and spine stiffness and trigger points, the effects can be even more pronounced.

A recent large research project into migraine headache reviewed 22 trials (with 5,000 headache sufferers) comparing drugs, sham acupuncture treatment and true acupuncture. (Trinh et al, 2016).

They found that acupuncture treatment can cut the incidence of headaches over a monthly period by nearly half.

AACP Logo‘If people have six days with migraine per month on average before starting treatment, this would be reduced to 5 days in people receiving usual care…..and to 3.5 days in those receiving true acupuncture’

This represents a significant improvement in the quality of life of sufferers.

A review of tension-type headaches looked at 12 trials with 2,349 headache sufferers. They found high quality evidence that acupuncture worked better than routine care (medication) or sham acupuncture (Linde et al, 2016)

A recent Cochrane review (January 2016) of 12 high quality studies concluded:

‘A course of acupuncture consisting of at least 6 sessions can be a valuable option for people with frequent tension-type headaches’

GRI_4642For many people headaches are associated with and indeed cause, musculoskeletal problems including postural issues, muscle imbalance and discomfort and neck and back stiffness. These problems are also exacerbated by our modern lifestyles including work stresses and positioning, leisure and use of mobile devices.

Physiotherapy can help with this through postural advice, mobilisation of the spine and soft tissues, exercises and massage.

Combining physiotherapy with acupuncture provides a comprehensive treatment to target contributing causes and the pain of persistent headaches.

Carolyn Lindsay has additional training in medical acupuncture and can combine both treatments within a usual 45 minute treatment session at no extra cost. She works from the Treatment Space in Heeley, Sheffield.

To discuss treatment, or to enquire about appointment contact Carolyn here.

Information about acupuncture for migraines from the Migraine Trust can be found here.