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Painful intercourse, also known as dyspareunia, is especially common after menopause. In fact, one-quarter to one-half of postmenopausal women experience some pain during sex. Causes include hormonal changes, medical conditions, medications such as antihistamines, and anxiety or depression. As estrogen levels fall with menopause, the vaginal tissue becomes thinner, less lubricated, and less elastic, leading to vaginal dryness, burning, itching, and pain. Using lubricants during intercourse can help reduce friction. Extended foreplay can help with vaginal lubrication. Certain sexual positions may be more comfortable than others. And sex doesn’t have to involve penetration. Oral sex and masturbation are other ways to achieve sexual pleasure that may be less painful.

The cause of multiple sclerosis is unknown though it is considered an autoimmune disease, in which the body’s immune system attacks parts of the nervous system.

The disease may be hereditary. There are hundreds of genetic variants linked to the development of multiple sclerosis and in up to 20% of cases there is a family member with the disease. A sibling or a non-identical twin of a person with multiple sclerosis has a 3% to 5% risk of developing the disease (approximately 30 to 50 times higher than expected) while an identical twin has an even higher risk, in the range of 20% to 40% (approximately 200 to 400 times higher than expected).

Someone with macular degeneration will find it easier to read content written in black letters with a white background. But so do many people without the condition or any eye disease. If you have any concern about your vision, you should make an appointment for a thorough visual exam.

There are two forms of macular degeneration, both of which can lead to significant vision loss. Dry macular degeneration tends to cause subtle symptoms at first that become more noticeable over time. Wet macular degeneration is usually more serious, with a greater chance of more rapid vision loss.

The macula is a part of the retina in the back of the eye that is responsible for seeing sharp details directly in the center of the field of vision. In dry macular degeneration, the cells of the macula slowly break down. This produces blurring then blank spots in the eye's central vision. The symptoms are subtle at first then become more noticeable over time.

Parkinsonism is a broad term used to describe any condition in which a person’s movements are impaired by rigidity, tremor, or the slowness of motion known as bradykinesia. Parkinson’s disease, the most common form of parkinsonism, results from the selective death of cells in the brain’s substantia nigra . But parkinsonism can result from other types of brain damage caused by another type of neurological disease, side effects from antipsychotic drugs, and a rare form of viral encephalitis.

A pleural effusion is an accumulation of fluid in the space between the lungs and chest wall. The decision to drain a pleural effusion is based primarily on whether the cause of the pleural effusion is already known and whether the amount of fluid is large enough to compromise lung function. Most moderate effusions would likely be drained. But there are situations when it would not be necessary. For example, a moderate effusion might not be drained if the effusion was caused by heart failure that could be treated with diuretics.

Lightheadedness is most often a temporary symptom from a transient blood pressure drop when a person goes from a lying or sitting position to standing. There are a number of causes, such as dehydration, a medication side effect, anemia (low red blood cell count), a heart problem and a number of other situations. When a person has “brain fog” and just not feeling like the brain is functioning normally, he or she may describe it as continuous lightheadedness.

Trigeminal neuralgia, also known as tic douloureux, is a painful disorder of a nerve in the face called the trigeminal nerve or fifth cranial nerve. There are several medications used to treat it. They are the same ones used to treat any type of persistent nerve pain. Often, a patient needs to try several different medications to find the one that offers the best pain relief. When medications are not helping enough, a surgical procedure to “deaden” the nerve can be considered.

The treatment of severe spinal stenosis often includes surgery. However, even with significant symptoms, conservative (non-surgical) treatments may be worth trying first. These include:

• oral pain relievers (such as acetaminophen or ibuprofen)

• physical therapy – This may include exercises for stretching, strengthening and improving balance.

• steroid injections – Recent studies suggest that these are not reliably effective. However, they can provide relief in select cases and many doctors still recommend them.

• surgery – This is usually reserved for people with severe symptoms that is not improving with other treatments.

Talk with your doctor for advice if you have severe spinal stenosis; based on your symptoms, examination findings and imaging tests, he or she can recommend appropriate treatment, whether non-surgical or surgical.