The Skin Clinic Fremantle | Dr Sarah Boxley

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Photo of man and womens feet in bed,

Sex in Menopause: The Painful Truth

Findings of a recent health survey in the US suggest that women are not well-informed about one of the most common and troubling symptoms of menopause: painful sex.

Key Survey Findings:

  • 73% of women were still sexually active after menopause.
  • 62% were experiencing pain during intercourse.
  • Of those who reported experiencing pain during intercourse 83% reported experiencing pain in half or more instances of sexual activity with 73% rating the pain moderate to severe.
  • 60% had never discussed their painful sex with a health care provider.
  • 69% did not know that the painful sex they were experiencing is treatable.

The survey, conducted by HealthyWomen, an independent, nonprofit health information source in the US, was conducted among 832 women aged 45 years and older and 305 women’s health care providers (HCPs). It really highlights the importance of women sharing their symptoms with their health care providers for proper treatment and to prevent symptoms from worsening.

About Dyspareunia (painful sex)

Before menopause, oestrogen, the primary female sex hormone, helps maintain the thickness and elasticity (stretchiness) of vaginal tissues. However, as women age, oestrogen levels drop, causing changes in these tissues. These changes can lead to a medical condition called vaginal atrophy (VA), also known as GUSM (Genitourinary Syndrome of Menopause), which can lead to painful sex. Left untreated, painful sex due to menopause can worsen. Dyspareunia is a common postmenopausal condition, with as many as one in three postmenopausal women experiencing pain during intercourse.

The survey also gave some insight into how women were electing to cope with painful sex – 33% of respondents were avoiding sex altogether, and 45% were resorting to lubricants to manage pain.

Lubricants can provide temporary relief, these do not treat the underlying condition. A number of prescription therapies, including hormone replacement tablets or patches, as well as vaginal oestrogen are available. For women who can’t (or prefer not to) take hormonal therapy, laser regeneration treatment can be delivered directly to the vulval and vaginal tissues to specifically treat the dyspareunia related to menopausal lack of oestrogen.

“Women’s health is a topic that is often in the headlines, yet menopause is still an under-discussed stage of life, especially when it comes to lesser-known symptoms and impact on a woman’s sexual health,” said Barb Dehn, NP, and member of the HealthyWomen Women’s Health Advisory Council. “These findings show the need for improved communication between women and their HCPs, as well as general condition and treatment options awareness so women can lead fulfilling sex lives, pain-free.”

If painful sex is an issue for you, please bring it up with your GP.

If you would like to talk to us about quick, painless, non-hormonal laser treatment please send us a confidential message through our contact form or book online for a MonaLisa® Consultation with our experienced female doctor.

Read more about Vaginal Rejuvenation

or Contact Us to Arrange Your Appointment.


sex in menopause info-poster

For more information on the survey:

* This survey titled “What Do You Know about Your Sexual Health After Menopause?” was conducted within the United States by HealthyWomen in partnership with Duchesnay. It was conducted online from December 4, 2017, to March 18, 2018, among 832 women ages 45 and older and 305 women’s health care providers.


  • Davis SR, Lambrinoudaki I, Lumsden M, et al. Menopause. Nat Rev Dis Primer. 2015; 15004. doi:10.1038/nrdp.2015.4.
  • Freedman MA, Kingsberg SA, and Portman DJ. Dyspareunia Associated with Vulvovaginal Atrophy: Innovations in Counseling, Diagnosis, and Management. Supplement to OBG Management. 2018: S1-24.
  • Krychman M, Graham S, Bernick B, et al. The Women’s EMPOWER Survey: Women’s Knowledge and Awareness of Treatment Options for Vulvar and Vaginal Atrophy Remains Inadequate. J Sex Med 2017; 14: 425‐433.
  • Simon JA. Vulvovaginal atrophy: What is it, what causes it? OBG Management. 2015;(suppl):1-2.
  • What Do You Know About Your Sexual Health After Menopause? Healthy Women website. Updated May 2018.
  • Wysocki S, Kingsberg S, Krychman M. Management of Vaginal Atrophy: Implications from the REVIVE Survey. Clin Med Insights Reprod Health 2014; 8:23-30.
  • HealthyWomen. Data on File.
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Melasma on forhead - treat hyperpigmentation

How to Treat: Hyperpigmentation

No matter the natural base colour of our skin, an even and consistent skin tone is universally associated with youthfulness and health.

Unfortunately, excessive patchy pigmentation of the facial skin is incredibly common, particularly in women with darker skin types who are naturally capable of making greater levels of melanin, the substance in skin that gives it a brown colour. Here we discuss a common type of pigmentation issue, what causes it and the most effective ways of controlling it.

“Melasma” is the medical term given to a common, benign skin condition characterised by symmetrical overly-pigmented patches with irregular borders, most often on the face.

The forehead, cheeks, upper lip and chin are the areas most likely to be involved.

The condition is caused by an overstimulation of melanocytes, which are the cells within the skin that produce melanin. These cells can be kicked into overdrive by sunlight and by hormones, specifically the female hormone oestrogen. Melasma is therefore most commonly seen in women who live in geographical areas that have a high degree of UV light, who are pregnant or on the oral contraceptive pill.

Although not medically harmful, the discolouration of the skin that occurs in melasma can be psychologically distressing. Many patients with melasma report feeling they look “dirty” or “old” because of the pigmentation patches. Whilst some are happy to cover the patches with makeup, others would like to remove the excess pigmentation and return their skin colour to a more even tone.

N.B. Not all brown patches on the skin are simple pigmentation, and some forms of skin cancer can present in a similar way. It is important to get your skin assessed by a doctor with experience in skin cancer diagnoses prior to starting any treatments or therapies targeted at pigmented patches.

There is usually no simple solution to melasma, but getting to grips with the complex mechanisms underlying the condition is fundamental to successfully controlling it.

The layers of human skin (diagram)

The diagram above represents human skin. Melanin pigment is manufactured by the melanocytes, which are situated along the basal layer, in the mid portion of the skin where the dermis meets the epidermis. The melanin is then transported down the spider-like arms of the melanocytes and moved over into a different skin cell, the keratinocyte. Keratinocytes migrate upwards through the layers of the epidermis as they mature, until they are shed from the stratum corneum, a process that generally takes around 6 weeks in facial skin.

It is helpful to think of the process underlying excessive pigmentation as having 3 stages:

  1. Production of melanin
  2. Transportation of melanin
  3. Retention of keratinocytes

Rather than addressing only one aspect of this pigmentation process, the most successful treatments for melasma are those that tackle all these stages:

Stage 1: Production of melanin

  • Pregnancy
  • Hormonal contraception
  • Sunlight

The most common ways in which melanocytes are overstimulated are through exposure to sunlight and to oestrogen. If melasma has been brought on by the higher oestrogen levels associated with pregnancy, the melanocytes will tend to continue their overproduction until delivery, after which the hormones settle back to their usual levels and the melanocytes will calm down, however the pigment may remain trapped in the keratinocytes of the upper skin layers.

Oral contraceptive pills that contain derivatives of oestrogen can also be a cause of melasma. Changing to a lower dose pill or to an alternative form of contraception can be helpful in some cases, and this should be discussed with your medical practitioner if it applies to you.

Ultraviolet (UV) light is a powerful stimulator of melanocytes and therefore exposure to UV should be avoided whenever possible. Daily sun protection in the form of sunscreen should be the first step in controlling the pigment production. The visible spectrum of sunlight is also involved in the stimulation and so sunscreen should be broad spectrum, preferably a physical barrier such as zinc or titanium, which will block out the visible as well as the UV light. The most recent generations of zinc-based sunscreens are easy to use, non-comedogenic and can deliver an SPF of >50. There is little point moving on to steps 2 and 3 if you are not cutting off the pigment stimulation at its source, and so when treating melasma in our clinic we insist upon a daily SPF of at least 30+ or higher.

Stage 2: Transport of melanin

As discussed above, the melanin that is made in the melanocyte factories is then moved away and into keratinocytes, which are a different type of skin cell. Keratinocytes migrate upwards and spread through the epidermis as they mature, until they arrive at the uppermost layer, the stratum corneum, where they sit until they are shed as part of the natural skin cycle. Preventing the melanin from entering the keratinocytes reduces the distribution of the pigment into the higher levels of the skin, making it less visible.

There are a number of compounds available in cosmetics, cosmeceutical or prescription creams that disrupt this transportation process. Some of these are listed below:

  • Hydroquinone
  • Retinoids (Vitamin A)
  • Ascorbic Acid (Vitamin C)
  • Niacinamide (Vitamin B3)
  • Kojic Acid
  • Tranexamic Acid

In addition, a variety of botanical products have been found to have alter to some extent both the production and transport of melanin, although many these have not been extensively studied, and therefore we do not know how effective they actually are. The more common of these agents seen in cosmeceutical products are:

Aloesin (isolated from Aloe vera) Marine algae
Arbutin (bearberry) Orchid extract
Boswellia (herb) Pycnogenol (pine bark, witch hazel bark)
Coffeeberry extract Resveratrol (red grapes)
Grape seed extract Silymarin (milk thistle)
Green tea extract Soy extract

Stage 3: Retention of keratinocytes

Once the melanin pigment has been transported into the keratinocyte cells, it will remain there until either natural shedding occurs (which may take many months), or the dead cells of the stratum corneum are targeted for removal by methods such as:

  • Topical vitamin A
  • Gentle dermabrasion
  • Chemical Peels – superficial/medium depth
  • Microneedling
  • Spot cryotherapy (light freezing of the skin surface)
  • Intense Pulsed Light (IPL)
  • Laser (Q-switched or picosecond)
  • Fractional Radiofrequency

Skin types that are prone to melasma are also prone to post-inflammatory hyperpigmentation, whereby inflammation in the skin kick starts the overproduction of melanin. All of the above treatments have a significant limitation in the management of melasma, in that they have the ability to cause inflammation of the basal skin layer, leading to the potential for rebound pigmentation or worsening of existing pigmentation. These treatments should be performed conversatively by practitioners that are well-trained and experienced in dealing with hyperpigmentation.

Although it may seem to have an initial benefit, any treatment that removes the pigment-loaded keratinocytes will be ineffective in the long-term unless the other steps in the pigmentation process are also addressed. Once the pigmented keratinocytes have been removed, unless the underlying stimulation of the melanocytes has also been eliminated, more pigment will inevitably form. Maintenance therapies are therefore as important as initial treatment, and non more so than daily application of a broad-spectrum, high SPF sunscreen 🙂

Contact Us for more information or to see how our team at The Skin Clinic Fremantle can help you with your skin concerns.

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Important Notice – Until 23 Sept ’16

If you have an appointment at our clinic between Monday 29th August and Friday 23rd September 2016, please be advised that there will be extensive works being carried out on the front of our building and entrance via the front of the building will likely be blocked during this period.

The map below shows how to access the clinic via the car park on Leake Street. Please look for The Skin Clinic sign board at the rear of the carpark, showing the way to the back door. When entering, please proceed down the corridor and turn left, walk down this corridor and you will arrive at The Skin Clinic.

At times there will be access but we will not have advance notice of this. Please contact us on the morning of your appointment if you wish to know about access on that day.

We apologise for the inconvenience. If you have any concerns regarding this please contact us on 9336 3066.

See you soon!

Map of access during roadworks

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3D-Lipomed information evening

3D Lipomed Information Evening

Non-surgical fat loss, skin tightening and cellulite reduction with 3D-Lipomed

3D Lipomed Information Evening | 11th February 2016 (EVENT CANCELLED)

Following the successful launch of our 3D Lipomed technology, we shall be having an information evening on Thursday 11th February. If you have ever wondered about alternative options for non-surgical fat loss, skin tightening or cellulite reduction, the 3D Lipomed Information Evening is the event for you. Our doctor and dermal therapists will be giving a presentation on the technology, how it works, whom it works for and what to expect, followed by a Q&A session. Light refreshments will be provided so please rsvp if you would like to attend.

When: Thursday 11th Feb 2016

Where:  The Skin Clinic Fremantle

Time: 6:30pm

Rsvp: Call us on 08 93363066 or Send an Email

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3D Lipomed VIP launch night

New to Perth

Come and experience the next-generation of non-surgical fat removal and body shaping.

Perfect for stubborn fat pockets, loose skin and cellulite.

3D Lipomed is a powerful new step forward in non-invasive body sculpting, enabling non-surgical fat removal, treatment of cellulite and skin tightening for both face and body. With impressive results, it is easy to understand the strong celebrity following this technology has gained.
This treatment is not a weight loss therapy but is designed for adults with excess stubborn areas of fat, with loose skin or with resistant cellulite. Unlike laser-lipolysis, there is no requirement for additional exercise post-treatment in order to metabolise the released fat

When: Tuesday 24th November

Where:  The Skin Clinic Fremantle

Time: 6-8pm


Register now for further details and exclusive launch-night offers.

Enter your details below to receive information about the 3D Lipomed VIP launch night at The Skin Clinic Fremantle on 24th November.

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Prevention of Non-melanoma Skin Cancers with Vitamin B3

This week saw the publication in the New England Journal of Medicine of a trial from the University of Sydney into using vitamin B3, also known as nicotinamide, for the prevention of non-melanoma skin cancers.

The research group found that taking 500mg twice a day of vitamin B3 reduced the risk of developing new basal cell carcinomas and squamous cell carcinomas by 23% over a 12 month period. The incidence of actinic keratoses (pre-cancerous sun spots) was also reduced by up to 14% in those taking the vitamin, which works by protecting against damage caused by UV light. Vitamin B3 is found naturally in foods such as meat, fish, avocado, broccoli, mushrooms, almonds, spinach and Vegemite.

Whilst you would have to consume 1kg of Vegemite a day to get the dose that was used in the trial, 500mg tablets of nicotinamide are readily available from pharmacies and health food stores for around $10 per month. We have been recommending oral nicotinamide to our high-risk patients for a while now, but it is great to see the evidence that it really is effective

Read the full article here >New England Journal of Medicine

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Dr Boxley Skin Cacner College Australasia

Skin Cancer College Australasia – Congratulations Dr Boxley!

After years of hard work and study, Dr. Sarah Boxley has recently become the 5th Western Australian doctor to achieve Fellowship with The Skin Cancer College Australasia. The College represents, supports and educates primary skin care practitioners in Australia and New Zealand. Fellowship is the highest attainable grade of education and we are extremely proud both of Dr. Boxley and of the level and quality of the skin cancer care we provide at The Skin Clinic Fremantle.

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La Roche-Posay

Beautiful La Roche-Posay – Back In Stock!

Back in Stock – Beautiful La Roche-Posay SPF50+ sunscreens and BB creams are now here. Particularly formulated for sensitive skins and for those with sun-related allergies, they use minimal chemicals, are broad spectrum, perfume-free and paraben-free. Available in 50mL and 200mL.

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We Welcome Debra Miller!

Debra Miller is a Micropigmentation Specialist (Cosmetic Tattooing) and will be providing treatments here at The Skin Clinic Fremantle 1 day a month commencing November 2015.
Please see below a list of offered services:

Services offered by Debra Miller include:

  • Cosmetic Tattooing – Eye brow tattoo, Eye liner tattoo and Lip liner tattoo
  • Paramedical Tattooing – Areola tattoo restoration
  • Epi Dermal Levelling Treatment – Epi blade dermaplaning
  • Eye Brown Shaping – including eye brown tinting and threading services
  • Permanent Lash Extensions – longer fuller lashes
  • Hair loss Treatments – Hair tattoos
  • Vitiligo – Tattooing coloured pigment to affected area
  • Scar Camouflage – Cosmetic scar tattooing

Bookings can be made by contacting the clinic on (08) 9336 3066.

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Rohr Remedy

The Perfect Father’s Day Gift.

Give your Dad the gift of great skin this fathers day!

Rohr Remedy being the perfect father’s day gift!  Amazing honey and myrtle body wash & lilly pilly omega 3 daily moisturiser.
Naturally derived Australian bush medicine with no nasty ingredients.

Call in to The Skin Clinic Fremantle to pick up your fathers day package of Rohr Remedy treats! Your dad will love you for it! Visit to discover more about the newest and most ‘natural’ buzz word in skin care products.



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Important: Please read before attending the Skin Clinic- Coronavirus Update