Vaginal Dryness (Genitourinary Syndrome of Menopause - GSM)
Genitourinary Syndrome of Menopause (GSM), often manifesting as vaginal dryness, involves thinning, drying, and inflammation of vaginal and urinary tissues due to decreased estrogen. This can cause significant discomfort, including itching, burning, soreness, pain during intercourse (dyspareunia), and light bleeding after sex. It can also lead to urinary symptoms like urgency, frequency, and recurrent UTIs. Unlike some other menopause symptoms, GSM often persists or worsens without treatment. Effective management options include over-the-counter moisturizers/lubricants and various forms of local or systemic estrogen therapy.
Management Strategies
- Pelvic floor physical therapy
- Dilators
- Laser therapy (evidence still evolving)
- Over-the-counter vaginal moisturizers (regular use, e.g., Replens, Luvena)
- Over-the-counter vaginal lubricants (use during sexual activity, e.g., K-Y, Astroglide, Sliquid)
- Regular sexual activity (can help maintain tissue health)
- Low-dose vaginal estrogen (creams, tablets/inserts, rings - e.g., Estrace, Vagifem, Estring, Imvexxy)
- Prasterone (Intrarosa - intravaginal DHEA insert)
- Systemic Hormone Replacement Therapy (HRT - pills, patches, gels) - treats GSM but has broader effects/risks
- Ospemifene (Osphena - oral SERM)
Diagnostic Considerations
Diagnosis based on symptoms and pelvic exam. Often underreported due to embarrassment; important to discuss with provider.