If you’re experiencing vaginal dryness, bladder urgency, or painful intercourse during perimenopause or menopause, you’re far from alone—and there’s a name for what you’re experiencing: Genitourinary Syndrome of Menopause, or GSM.
Despite affecting up to 50% of postmenopausal women, GSM remains one of the most underdiagnosed and undertreated conditions of midlife. Many women suffer in silence or have their symptoms dismissed, believing their experiences are just something they have to accept. But here’s the truth: GSM is treatable, and you don’t have to live with discomfort.
What Is Genitourinary Syndrome of Menopause?
GSM is a collection of symptoms caused by decreasing estrogen levels that affect the vulva, vagina, urethra, and bladder. Unlike hot flushes that often improve over time, GSM symptoms typically worsen without treatment because the tissue changes are progressive.
When estrogen levels drop during menopause, the tissues of your genital and urinary systems undergo significant changes. They become thinner, drier, less elastic, and more fragile—affecting everything from comfort and intimacy to bladder function and overall quality of life.
Common Symptoms of GSM
GSM can show up in many different ways, and you may experience some or all of these symptoms:
Vaginal and vulval symptoms:
- Vaginal dryness, burning, or irritation (sometimes affecting the ability to wear pants)
- Loss of lubrication during intimacy
- Narrowing or shortening of the vaginal canal
- Recurrent vaginal infections or irritation
Sexual symptoms:
- Pain or discomfort during intercourse (dyspareunia)
- Reduced arousal or sensitivity
- Bleeding after intercourse
- Decreased libido (though this can have multiple causes)
Urinary symptoms:
- Urgency or frequency—feeling like you need to go all the time
- Burning with urination
- Recurrent urinary tract infections
- Stress incontinence (leaking with coughing, sneezing, or exercise)
- Nocturia (waking multiple times at night to urinate)
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Why Does GSM Happen?
In our adolescence years, our female body was wired so it was receptive to oestrogen. This means that during our reproductive years, oestrogen plays a crucial role in maintaining the health of your genitourinary tissues. It keeps the vaginal lining thick and moist, maintains the natural acidity that protects against infections, supports blood flow to the area, and helps keep tissues elastic and resilient.
Fast forward to perimenopause and menopause, when oestrogen levels begin changing and overall decline. The health of our genitourinary system is at risk as our body has to ‘re-wire’ to be less receptive to oestrogen. Meaning that for some, the vaginal pH can rise, making you more susceptible to infections. The vaginal tissue can become thinner and more fragile, leading to irritation and discomfort. Blood flow can decrease, affecting lubrication and sensation. And the pelvic floor muscles and surrounding tissues can lose some of their support and function.
How Pelvic Health Physiotherapy Can Help
While hormone therapy is often the first-line medical treatment for GSM, pelvic health physiotherapy plays a vital role in managing symptoms and improving your quality of life.
What we can do:
- Pelvic floor muscle training to improve blood flow, reduce urgency, and support bladder control
- Manual therapy to release tight pelvic floor muscles that can contribute to pain and discomfort
- Dilator therapy when appropriate, to reduce pain with intercourse
- Education on lubricants, moisturizers, and positioning strategies for comfortable intimacy
- Bladder retraining techniques to manage urgency and frequency
- Whole-body approach addressing posture, breathing, diet and lifestyle factors that affect pelvic health
Physiotherapy works beautifully alongside medical treatments like vaginal oestrogen, providing you with practical strategies and hands-on treatment to manage your symptoms.
You Don't Have to Accept Discomfort
One of the biggest barriers to treatment is the belief and acceptance that these symptoms are just a “normal” part of aging. While GSM is common, no one should suffer. Treatment options work.
If you’re experiencing any symptoms of GSM, start by talking to your GP or gynaecologist to rule out any infections and talk about hormone therapy options. In conjunction, work with a pelvic health physiotherapist who can provide targeted treatment and practical strategies to help you feel comfortable, confident, and in control of your body again.
Menopause is a transition. One you deserve to move through with comfort, confidence, and the freedom to enjoy intimacy, activity, and everyday life.
References:
Portman, D. J., & Gass, M. L. (2014). Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause, 21(10), 1063-1068.
Gandhi, J., Chen, A., Dagur, G., Suh, Y., Smith, N., Cali, B., & Khan, S. A. (2016). Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. American Journal of Obstetrics and Gynecology, 215(6), 704-711.
