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Why Haven't I Heard of Genitourinary Syndrome?
Genitourinary Syndrome of Menopause (GSM) is one of the most undiagnosed symptoms of peri/menopause and post-menopause because it’s not something women are comfortable talking about. GSM is also a relatively new term for this symptom. According to the National Center for Biotechnology Information, GSM used to be referred to as vulvovaginal atrophy, atrophic vaginitis, or urogenital atrophy. GSM is a chronic condition that affects the vagina, vulva, and lower urinary tract. It can be similar to the experience with a yeast infection for some. GSM can affect up to 50% of post-menopausal women.
How do I know if I have GSM?
GSM symptoms that have been reported the most are vaginal dryness and painful intercourse, which are symptoms many of us have heard of when talking about what to expect in peri/menopause. These symptoms are more intense for women who are sexually active. Other symptoms women may experience with GSM include:
-vaginal itching or burning
-increased discharge (usually yellow or brown)
-pelvic pain or pressure
-reduced lubrication
-decrease arousal
-bleeding during or after sex
-loss of libido
-painful orgasms
-painful urination
-increased urinary urgency and frequency
-urinary incontinence
-urinary tract infection (UTI)
-bladder dysfunction
What is making this happen?
Low estrogen levels are the main cause of the symptoms of GSM. The following changes to the vulva happen once estrogen levels start to decrease:
- vaginal and vulvar tissue start to thin and weaken
- has less elasticity and lubrication
- shrinkage of smooth muscles
- reduction of vaginal blood flow
Who is at risk of developing GSM? Women who:
- are in peri/menopause and post-menopause
- have had a hysterectomy that included the removal of their ovaries
- smoke
- drink excessively
- don’t engage in sexual activity regularly
- are not having sex
- are having certain cancer treatments
- have immune disorders
What can be done to help?
Many women aren’t comfortable sharing how they are feeling with many of the symptoms listed above. But women need to get help sooner than later so that their symptoms don’t get worse. If you suspect you may have GSM, you will need to get comfortable discussing your sexual history with your doctor.
The tests you can expect when meeting with your doctor include:
- pap test
- urine sample
- ultrasound
- hormone testing
- vaginal pH
- microscopy
To address your symptoms, you may wish to start with natural and over-the-counter treatments. Your doctor may also prescribe estrogen/hormone replacement options.
Other things you can include:
- Stop smoking
- Engage in regular intercourse
- Wear cotton underwear during the day and no underwear at night
- Avoid products with fragrance (like: detergents, dryer sheets, soaps, body wash, bubble bath)
- Use topical lubricants and moisturizers that are as natural as possible, and pH balanced
- Vaginal laser therapy
- Vaginal rejuvenation
- Vaginal estrogen depository
- Vaginal estrogen cream
- Oral estrogen medication
If undiagnosed, these symptoms can make a woman’s life very difficult and uncomfortable. Unfortunately, there is no cure for GSM, just options to make it easier. To make yourself feel more comfortable discussing these symptoms with your doctor, track your symptoms. This way you can be prepared with information about your body that can help you feel more at ease when sharing intimate information. Remember that your health includes your sexual wellness. Don’t be afraid. Be your own best advocate!
