I am a 54-year-old woman and I used to enjoy sex until a year ago. Since I was diagnosed with breast cancer I have had several surgeries as well as radiation and chemotherapy. My cancer is now officially "in remission", but when I asked if I could resume my hormone replacement therapy (which definitely helped my sex life) my doctor said it would be unwise. I am now finding it that I experience dryness and pain during intercourse. Can you suggest ways I might be able to fix that?

Vaginal atrophy and dyspareunia (painful sex) are common problems in post-menopausal women and cancer survivors who wish to continue having intercourse but do not want to or cannot use oestrogen products. To maintain vaginal health, use a penis-shaped vibrator with a silicone- or aloe vera-based personal lubricant to massage your labia, and also insert it for an internal vaginal massage. Learn to both tighten and relax your pelvic floor muscles; relaxing them is particularly important in order to allow for comfortable penetration. Allow yourself to use fantasy for personal arousal – and teach your husband to be patient and to be guided by you.

To ensure maximum comfort and arousal you need to be in control, so whether it's to avoid pain or to increase pleasure, don't be afraid to suggest a change in position or simply to say "stop".

• Pamela Stephenson Connolly is a clinical psychologist and psychotherapist who specialises in treating sexual disorders.

• Send your own dilemma to Sexual Healing. Email private.lives@theguardian.com