January 19

Q&A: Genitourinary Syndrome of Menopause (GSM) – Vaginal Atrophy

By fitness

January 19, 2023



Medically reviewed by Sheryl Kingsberg, Ph.D.

If you’re over 50 and intercourse has turn out to be much less pleasurable, and even painful, you’re not imagining it — and also you’re removed from alone. According to Sheryl Kingsberg, Ph.D., chief of behavioral medication within the OB-GYN division at University Hospitals Cleveland Medical Center and a member of HealthyWomen’s Women’s Health Advisory Council, that is in all probability vaginal atrophy, which implies thinning or lack of vaginal tissue. Vaginal atrophy (additionally typically known as atrophic vaginitis) is now known as genitourinary syndrome of menopause (GSM) as a result of it might probably have an effect on extra than simply vaginal tissue — and it’s quite common throughout menopause.

Between 55% and 70% of ladies expertise GSM after menopause. But, as a result of it may be troublesome to convey up sexual signs with healthcare suppliers (HCPs), associates or members of the family, it’s typically misunderstood. Kingsberg spoke with HealthyWomen to handle our fears, right our assumptions and make clear this under-discussed matter.

And the subject ought to be mentioned, Kingsberg stated, as a result of the most important fantasy about vaginal atrophy is that ladies should endure by way of it. “GSM can be treated effectively,” Kingsberg stated. “This doesn’t have to signal the end of your sex life.”

What is GSM or vaginal atrophy?

The time period vaginal atrophy was modified to GSM as a result of it might probably have an effect on the entire pelvic space, together with the vulva, clitoris, vagina, bladder and urethra. The situation describes the modifications that happen in any of those areas due to lack of the hormone estrogen that occurs throughout menopause. Estrogen helps our sexual and vaginal well being.

What is the reason for GSM?

GSM is brought on by the lack of estrogen at menopause. The drop in estrogen causes vaginal tissue to turn out to be thinner and vaginal dryness to happen. Lack of estrogen additionally modifications the vaginal pH, inflicting a lower in good micro organism (lactobacilli) and an overgrowth of micro organism that may improve the chance of urinary tract infections. Estrogen additionally impacts a variety of different pelvic features.

What are the signs of GSM?

Not all ladies will develop signs of GSM, but when they do, the signs often seem a number of years after menopause. The situation can have a giant impact on sexual exercise. Many ladies first discover vaginal dryness. This could cause ache and even bleeding throughout sexual exercise. Some ladies expertise modifications in sexual enjoyment and bother having an orgasm. These signs are brought on by:

  • Loss of elasticity (the power of the pores and skin to return to its unique form after being stretched) within the vagina
  • Narrowing or shortening of the vagina
  • Lack of blood circulate to the vagina and clitoris throughout intercourse

Women with GSM could get extra frequent urinary tract infections or, in some circumstances, develop incontinence — the lack to regulate after they urinate.

Can I forestall GSM?

Yes, you possibly can forestall GSM with native hormone remedy (which may be prescribed primarily based on age or early signs) and common stretching of the vulvovaginal tissue by way of common sexual exercise or by utilizing a dilator. If you've gotten signs of GSM and usually are not but postmenopausal, you possibly can focus on these therapy choices along with your healthcare supplier).

What are some therapy choices for GSM?

Evidence-based therapies for GSM embrace:

  • Hormone remedy
    • Systemic hormone remedy is used to deal with vasomotor signs of menopause (scorching flashes and night time sweats) and sometimes will sufficiently deal with GSM. However, for some ladies systemic HT is not going to be ample and native vaginal HT ought to be used.
    • Low dose native hormone therapies embrace a wide range of estrogen supply choices — vaginal lotions, rings, tablets and inserts. The dose of hormones may be very low and will get hormones simply to the vulvovaginal tissues.
  • Moisturizers and lubricants
    • Moisturizers and lubricants don’t deal with the underlying concern — the dearth of estrogen — or the present tissue injury, however they can assist preserve you comfy.
      • Vaginal moisturizers are lotions that you simply apply commonly, two or thrice every week. You don’t use them throughout intercourse.
      • Lubricants could assist with vaginal dryness throughout intercourse. There are various choices to select from. Your greatest guess is to make use of a lubricant with:
        • A pH stage of three.8 to 4.5 (this matches the pH of your vagina)
        • An osmolality (a flowery phrase for what number of particles are within the lube) decrease than 1200 (too excessive and it truly pulls moisture out of the tissue). If the label doesn’t listing this, it’s in all probability too excessive.
        • As few components as doable. The cleaner, the higher!
  • Pelvic ground bodily therapists focus on offering specialised bodily remedy when there may be pelvic ground dysfunction. GSM can lead to ache throughout intercourse and consequently, vaginismus—the involuntary tightening of the pelvic ground muscle mass as a result of anticipatory anxiousness and worry of penetration. Vaginismus is a typical situation for ladies to expertise.
    • Pelvic ground bodily remedy to enhance vaginismus could contain growing consciousness of pelvic muscle mass, studying rest strategies, growing vaginal elasticity and tone, and offering methods to stretch the vaginal opening. Pelvic ground bodily remedy could also be mixed with the usage of vaginal dilators. Vaginal dilators can assist scale back the worry and anxiousness of penetration by step by step stretching the vaginal tissue and selling pelvic ground muscle rest.

Who can I converse with if I feel I've GSM?

If you’re experiencing ache throughout intercourse and suppose you may need GSM, converse with somebody who has experience in treating ladies who're menopausal or postmenopausal. You can go to the North American Menopause Society to seek out an HCP who focuses on menopause-related points like GSM.



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