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  • Erica

Genitourinary Syndrome of Menopause (GSM)

Every person with a uterus will experience menopause during their lifetime as a normal part of aging. Menopause marks the end of a woman's reproductive years. It typically happens naturally in a woman’s late 40s to early 50s, but it can also be triggered by surgical removal of the ovaries.

What is GSM?

Genitourinary syndrome of menopause (GSM) is a relatively new term that describes the various genital, sexual, and urinary signs and symptoms that can occur during menopause associated with a low-estrogen state. Terms used in the past (prior to 2013) such as atrophic vaginitis and vulvovaginal atrophy did not encompass the urinary symptoms associated with menopause. Post menopause there is a decrease in estrogen circulating through the body, resulting in thinning of vaginal tissue, increase in pH levels and decrease in collagen and elasticity. Physiologically, this manifests with symptoms of vaginal dryness, vaginal irritation, vaginal itching which may affect sexual function due to dyspareunia and diminished lubrication. GSM also includes urologic signs and symptoms. Postmenopausal patients are more prone to recurrent urinary tract infections (UTIs), dysuria, urinary frequency and urgency.

Reference: Genitourinary syndrome of menopause: Underdiagnosed and undertreated. © 2020 MJH Life Sciences and Contemporary OBGyn. All rights reserved.


  • Hormone therapy - topical or systemic

    • Estrace, Premarin, Estring and Vagifem

  • Lifestyle modifications

    • Tobacco cessation

    • Regular intercourse

    • Vaginal hygiene

    • Cotton/dye-free underwear

  • Non-Hormone Therapies

    • Vaginal moisturizers and lubricants. Vaginal moisturizers function to replace natural vaginal secretions while vaginal lubricants reduce friction during intercourse.


GSM is underreported and undertreated, despite the large number of postmenopausal women suffering from this chronic condition. Patients may suffer silently, perceiving their symptoms to be a natural aspect of aging, or may be hesitant to bring up this sensitive issue with their providers. Providers have much room to improve on screening patients for GSM. Treatment should always start non-pharmacologically with topical moisturizers and lubricants.

GSM and Physical Therapy

Pelvic physical therapists often see women in menopause who are experiencing symptoms of vaginal dryness, itching, burning or irritation. Our job is to educate patients on proper vulvar hygiene and treatments for irritation and burning. This vaginal dryness and irritation often result in dyspareunia or painful intercourse. Discussing proper lubricants, positions for intercourse and ruling out any other pathology is part of our treatment plan. Often there are hands on manual techniques we can do to relax the muscles and viscera (organ and organ tissue) around the bladder to improve frequency and urgency symptoms.

For more information about how treatment can help you, contact Erica Adams PT, DPT, CKTP, GTS.

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