Genitourinary Syndrome of Menopause

A menopause topic that is not discussed very often is about the urinary and genital changes that occur during menopause, called urogenital symptoms. In this article we are going to talk about sex during menopause.

You may be thinking, but WHEN do you have sex? Do you make time for this specifically or do it at a certain time each week? The years are going by and we haven't had any kind of romantic life (that lasts for more than a furtive 30 seconds) for ages. Oh, and it hurts!

Research has shown 70% of women with the condition called vaginal atrophy that causes painful sex have not sought help about their condition from a doctor. (1) This is a large number of women not getting the help or treatment needed. We believe women shouldn’t feel embarrassed or uncomfortable talking about these symptoms, and so we have written this article to shed light on the common symptoms associated with vaginas and menopause. The urinary symptoms are covered in our article called urinary symptoms and menopause

So what are the main genital symptoms of menopause?

  • Vaginal dryness: This is a common genital symptom and can lead to problems such as vaginal discomfort, itching and pain during sex. (6) Reduction in oestrogen can cause dryness and thinning of the vaginal and urethral tissue, causing vaginal dryness and other symptoms, like UTIs. (7) Before menopause, higher levels of oestrogen draws moisture into vagina. However, after menopause the vagina loses some of its natural lubrication. Vaginal dryness can be treated with vaginal lubricants and moisturisers, but your doctor may prescribe a treatment such as vaginal oestrogen which addresses the root cause. (6)
  • Dyspareunia: This is the fancy word for when you have pain during sex. That's right, pain during sex is so common that there is a word for it! And it is especially common during post-menopause. See our article on menopause stages for more information. Painful sex is associated with vaginal dryness and thinning of the vagina’s skin and can be treated with HRT or a non-hormonal approach such as using a vaginal moisturiser. (4)
  • Libido: A part of your life that can be affected by menopause is your libido. This is your sex drive. Menopause can affect arousal and cause discomfort during sex through vaginal dryness, but changes to your self-body image, moods and energy can also reduce libido. Read our article on libido and menopause for more information. (5)

What is genitourinary syndrome?

The genital symptoms of menopause are known collectively as genitourinary syndrome of menopause (GSM). It was previously called vaginal atrophy or vulvovaginal atrophy and encompasses symptoms such as (1): 

  • Dryness of the vulva and vagina
  • Bleeding from the vulva or vagina
  • Decreased libido
  • Itching and burning of the vagina and vulva
  • Urinary tract infections
  • Incontinence
  • Changes to vaginal discharge and lubrication 

Treatment of GSM

Treatment of urogenital symptoms depends on the specific symptom or collection of symptoms you are experiencing. GSM can be treated by either a hormonal or non hormonal approach. The first approach is non hormonal treatment and could involve using moisturisers, lubricants or making changes to your lifestyle. The second approach is the use of localised hormone treatments, which carries no risk of breast cancer. (3)

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