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Genitourinary syndrome of menopause (GSM)



Genitourinary syndrome of menopause (GSM) is a broad term that encompasses all vaginal, sexual, urinary, and pelvic floor symptoms that are associated with a lower-estrogen state (i.e. menopause).These include:

  • Vaginal symptoms

  • Vaginal dryness

  • Burning, pain, irritation, itching, or tears in the tissue of the vulva (external female genitalia)

  • thing/graying of pubic hair

  • Vaginal wall prolapse

  • Vaginal pain or pressure

  • Sexual symptoms

  • Loss of lubrication

  • Pain or bleeding with sex

  • Loss of libido, arousal, or orgasm

  • Urinary symptoms

  • Painful urination

  • Recurrent UTI’s

  • Urinary urgency and frequency

  • Stress , urge, or mixed incontinence

  • Urethral caruncle (red growth on urethra)


GSM is more common than you may believe. GSM affects 50% of women by the age of 60 and 75% by the age of 70. Even though this is common many women may feel uncomfortable voicing these symptoms to their medical providers, but the good news is there is treatment!


There are several treatments for GSM. Vaginal estrogen is the number one treatment for GSM. Vaginal estrogen is safe with one of the only possible side effects being yeast or thrush although this is not common. Vaginal estrogen can also help prevent bacterial vaginosis (BV) which is an overgrowth of one or more species of normal vaginal bacteria. A lot of women have concerns with estrogen but overall studies have shown vaginal estrogen does NOT increase the risk of cardiovascular disease or cancer. However, it is encouraged to talk to your provider to see if this is an option for you based on your personal medical history.


Other treatments for GSM include:


Pelvic floor physical therapy can help reduce urinary incontinence, reduce pain, and teach you all of the things to help improve your knowledge of vulvar care. Vaginal moisturizers and lubricants can help with dryness and pain with penetration. Some recommended brands include Good, Clean Love and Replens. There are some products that are better than others (see our previous blog on Lubricants) so be cautious when choosing these products.


Diet and lifestyle can make a huge impact beyond just the use of estrogen.

Avoiding antibiotics (as much as possible) helps to prevent damage to the microbiome in the vaginal canal. Tobacco use lowers estrogen and also damages the microbiome. Avoid using anything such as wipes or douches that would alter microbiome. The vagina is a self cleaning oven, we do not need anything to clean it! Lastly, exercise and functional activities (our specialty!) for the abdominals and back musculature can help with pelvic floor function.


Bottom line: GSM is common, but not talked about enough. Reach out to your provider to voice your concerns regarding your symptoms. There is help!


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