Genitourinary Syndrome of Menopause

Genitourinary Syndrome of Menopause

estrogen depletion genitourinary syndrome menopause painful sex pelvic floor dysfunction pelvic floor exercises pelvic floor physiotherapist urge incontinence vaginal dryness Jul 23, 2022

Genitourinary syndrome of menopause (GSM) is also known as vulvovaginal atrophy or atrophic vaginitis. It is caused by a decrease in estrogen production.

This condition is progressive and may affect many aspects of a woman's physical, emotional, and sexual health.  

As women face menopause, our ovaries begin to reduce the production of estrogen, leading to thinning of their vaginal tissue and weakening of the muscles of the pelvic floor, which are important in supporting the organs of the pelvis and maintaining continence, and the tissues of the vagina, vulva, urethra, and bladder. This leads to the onset of symptoms of Genitourinary Syndrome.


The symptoms of GSM include vaginal dryness, burning, and itching. There may be a loss of libido, pain during or after intercourse (dyspareunia) on entry, within the vagina or deep in the pelvis, and sexual dysfunction of arousal and orgasm. Bleeding or spotting may occur during or after intercourse.

You may also experience painful urination (dysuria), urinary urgency, urinary incontinence, and recurrent urinary tract infections.  

It is estimated that nearly 60% of women in menopause experience GSM, but most of these women do not bring up this concern with their health care provider, commonly due to embarrassment.

Pub Med Article -  What Is Genitourinary Syndrome of Menopause

You should not feel embarrassed or ashamed to ask for help because getting treatment will improve your overall quality of life. If this is something you find difficult to discuss with your family doctor, reach out to a pelvic floor physiotherapist trained to assess and rehabilitate pelvic floor dysfunction and understand the anatomy of the entire body. They can perform an examination to identify any GSM symptoms that may be impacting your quality of life and sexual function.

Key Points

  • GSM is very common as women experience menopause.
  • Symptoms have an impact on quality of life and sexual function.
  • Women are often embarrassed to discuss concerns with their doctors.
  • Examination of the vulva and vagina will provide appropriate treatments.
  • Non-hormonal and hormonal therapies are available.
  • A multidisciplinary team improves outcomes and quality of life


Non-hormonal therapies include personal lubricants and vaginal moisturizers, effective in relieving discomfort, friction, and pain with penetrative sex. Lubricants are used at the time of intercourse, whereas vaginal moisturizers provide longer-term relief. 

Hormonal therapies include vaginal estriol cream or pessaries, vaginal estradiol tablets, or menopausal hormone therapy. For symptomatic menopausal women who are under 60 years of age or within 10 years of menopause, the benefits of MHT generally outweigh the risks.

For pelvic floor dysfunction, pelvic pain or urinary symptoms, referral to a pelvic floor physiotherapist for pelvic floor training and relaxation will help to reduce symptoms.

Pub med Pelvic Floor Muscle Training as a treatment for GSM


Our Kegel and pelvic floor exercise programs have been designed to give you the tools to overcome incontinence, prolapse and pelvic pain. Build strength and confidence with exercise and lifestyle tips that will get you back to living life without the distraction and discomfort of nagging symptoms.