Getting Comfortable Again: Understanding and Treating Genitourinary Syndrome of Menopause (GSM)

If you’ve noticed vaginal dryness, irritation, pain with sex, or urinary discomfort since menopause, you’re not imagining it—and you’re not alone. These are common, treatable symptoms of Genitourinary Syndrome of Menopause (GSM), a condition that affects the vagina, vulva, and urinary tract as estrogen levels decline.

Unlike hot flashes, which often improve over time, GSM tends to worsen unless it’s treated. The good news? There are many options—both hormonal and nonhormonal—that can help you feel more comfortable, improve intimacy, and support your overall quality of life.

What’s Happening to My Body?

Estrogen plays a key role in keeping the vaginal and urinary tissues healthy, plump, and well-lubricated. As estrogen declines during menopause, these tissues can become thinner, drier, and less elastic. That can lead to:

• Dryness or burning in the vagina or vulva

• Pain with sex or pelvic exams

• Burning with urination, increased urgency or frequency

• More frequent urinary tract infections (UTIs)

• Discomfort from tight clothing or wiping after urination

These symptoms may be especially intense for women who’ve had chemotherapy, undergone surgical menopause (removal of both ovaries), or are taking aromatase inhibitors for breast cancer.

You Don’t Have to Suffer in Silence

There’s no one-size-fits-all approach to GSM, and that’s a good thing. You have many effective, safe, and easy to use options.

Over-the-Counter Relief

• Lubricants: Used during sex to reduce friction and discomfort. Choose products that are water- or silicone-based, fragrance-free, and free of irritating chemicals.

• Moisturizers: Used regularly (2–3 times a week) to help maintain vaginal moisture and comfort—even if you're not sexually active.

Lifestyle Support

• Regular sexual activity (alone or with a partner) promotes blood flow and can help maintain vaginal elasticity. Vibrators or dilators can help, especially if penetration has become painful or difficult.

• Broaden your definition of intimacy. Outercourse—like extended touching, mutual massage, and caressing—can be deeply satisfying and relieve pressure to have penetrative sex.

• Pelvic floor exercises, either guided by a pelvic floor physical therapist or done at home with devices, can help strengthen weak muscles or relax tense ones, improving symptoms like incontinence or pelvic pain.

Prescription Treatments

• Low-dose vaginal estrogen: Delivered as a cream, tablet, insert, or ring, this is highly effective for dryness, irritation, and painful sex—and is considered safe for most women. These treatments act locally and result in very low estrogen levels in the bloodstream.

• Vaginal DHEA (prasterone): A nightly insert that helps reduce vaginal dryness and pain with sex.

• Ospemifene: A daily oral medication (a SERM) that helps with vaginal discomfort and sexual pain.

For women with a history of hormone-sensitive cancers, low-dose vaginal hormones may still be an option after a thoughtful conversation involving your oncologist and menopause specialist. The decision is personal and you deserve full information to make it with confidence.

What About Vaginal Laser Treatments?

Laser and radiofrequency therapies are available, but they’re not FDA-approved for GSM. While some women report improvement, studies don’t currently support their widespread use. These treatments are best considered experimental unless you’ve exhausted other options.

Empower Yourself: What You Can Do Today

• Start the conversation: Talk to your menopause care provider. You don’t need to wait until symptoms are severe; in fact, the sooner you start treating GSM, the better the outcome.

• Experiment with lubricants and moisturizers to find what works best for your body.

• Prioritize intimacy on your terms. Stay curious and kind to yourself as you explore new ways to connect.

• Try gentle pelvic floor exercises or ask about a referral to pelvic floor physical therapy.

• Stay informed: If you're not sure what’s normal and what’s not, ask. Yeast infections, allergies, and skin conditions can mimic GSM and need different treatments.

  
  

GSM is incredibly common, but that doesn’t mean you have to live with it. There are real solutions that can help you feel like yourself again—comfortable, confident, and connected. You deserve to feel good in your body at every stage of life.