Genitourinary Syndrome of Menopause (GSM): Why It Burns & Itches

In my practice, I often hear patients apologize for bringing up "down there" issues. They’ve convinced themselves that persistent itching, burning, or "leaky bladder" moments are just the price of admission for getting older.

If that sounds like you, I want you to know that there is a better way. New medical guidelines have finally confirmed what many of us have seen for years: Your bladder, your urinary tract, and your skin are all part of the same team. When these symptoms appear together, we call it Genitourinary Syndrome of Menopause (GSM).

Understanding Genitourinary Syndrome of Menopause (GSM)

It might seem strange that I look at your bladder when you’ve come in for a skin issue, but they are biological neighbors. Both your urinary tract and your vulvar skin are packed with estrogen receptors.

Think of estrogen as the "fuel" that keeps these tissues thick, flexible, and healthy. In Genitourinary Syndrome of Menopause (GSM), those fuel levels drop, causing the shared system to falter:

• The Urethra thins out: The tube you urinate through loses its "seal," making it easier for bacteria to get in and cause UTIs.

• The Bladder gets "irritable": Without enough estrogen, the bladder lining becomes sensitive. You might feel a constant, urgent need to go, even if you just went.

• The Skin becomes fragile: The external skin (the vulva) loses its natural moisture-barrier, leading to a thin, "cigarette paper" feeling that itches and stings.

These are the classic signs of GSM. It feels exactly like a bladder infection, but it’s often just a sign that your tissues are thirsty for the right fuel.

The Detective Work: Diagnosing GSM and Its Mimics

When you come in to see me, our appointment might feel a bit like a detective interview. To accurately diagnose Genitourinary Syndrome of Menopause (GSM), we have to look at your life.

I’ll ask about your laundry detergent and whether you’re using "medicated" wipes or anti-itch creams. Ironically, these often cause contact dermatitis—an allergic reaction that creates a vicious cycle of scratching and inflammation.

We also have to look for "mimics." Sexually Transmitted Infections (STIs) can happen at any age and often masquerade as simple dryness. For example, Herpes can look like tiny skin tears, and other infections can make the external skin raw and angry.

During the exam, I’m looking for "architectural changes" to see if the anatomy has shifted:

• Labial Resorption: The inner lips flattening or "disappearing" into the outer lips.

• Clitoral Phimosis: The clitoral hood scarring or "burying" the clitoris, which can decrease sensation.

• Narrowing: A physical shrinking of the vaginal opening that makes intimacy painful.

  
  

If there’s any doubt, especially if I see white plaques or sores that won't heal, we’ll talk about a biopsy. It’s a quick, essential tool to make sure we aren't treating a skin condition (like Lichen Sclerosus) or a potential malignancy with the wrong medication.

Treating GSM: The "Soak and Seal" Method

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