Erica Rimlinger has spent her 25-year career writing for clients ranging from nonprofit organizations to corporations, from magazines to America's Most Wanted. She considers it a privilege to learn and share her client's stories.
When she's not writing, reading or spending time with her family in Towson, MD, she's backpacking in the western United States — while making plenty of noise to scare off the bears.
Full BioLearn about our editorial policies
Get the answers to your symptom and treatment questions about genitourinary syndrome of menopause (GSM), formerly known as vaginal atrophy
Medically reviewed by Sheryl Kingsberg, Ph.D.
If you’re over 50 and sex has become less pleasurable, or even painful, you’re not imagining it — and you’re far from alone. According to Sheryl Kingsberg, Ph.D., chief of behavioral medicine in the OB-GYN department at University Hospitals Cleveland Medical Center and a member of HealthyWomen’s Women’s Health Advisory Council, this is probably vaginal atrophy, which means thinning or loss of vaginal tissue. Vaginal atrophy (also sometimes referred to as atrophic vaginitis) is now called genitourinary syndrome of menopause (GSM) because it can affect more than just vaginal tissue — and it’s very common during menopause.
Between 55% and 70% of women experience GSM after menopause. But, because it can be difficult to bring up sexual symptoms with healthcare providers (HCPs), friends or family members, it’s often misunderstood. Kingsberg spoke with HealthyWomen to address our fears, correct our assumptions and shed light on this under-discussed topic.
And the topic should be discussed, Kingsberg said, because the biggest myth about vaginal atrophy is that women have to suffer through it. “GSM can be treated effectively,” Kingsberg said. “This doesn’t have to signal the end of your sex life.”
The term vaginal atrophy was changed to GSM because it can affect the whole pelvic area, including the vulva, clitoris, vagina, bladder and urethra. The condition describes the changes that occur in any of these areas because of loss of the hormone estrogen that happens during menopause. Estrogen supports our sexual and vaginal health.
GSM is caused by the loss of estrogen at menopause. The drop in estrogen causes vaginal tissue to become thinner and vaginal dryness to occur. Lack of estrogen also changes the vaginal pH, causing a decrease in good bacteria (lactobacilli) and an overgrowth of bacteria that can increase the risk of urinary tract infections. Estrogen also affects a wide range of other pelvic functions.
Not all women will develop symptoms of GSM, but if they do, the symptoms usually appear a few years after menopause. The condition can have a big effect on sexual activity. Many women first notice vaginal dryness. This can cause pain or even bleeding during sexual activity. Some women experience changes in sexual enjoyment and trouble having an orgasm. These symptoms are caused by:
Women with GSM may get more frequent urinary tract infections or, in some cases, develop incontinence — the inability to control when they urinate.
Yes, you can prevent GSM with local hormone therapy (which can be prescribed based on age or early symptoms) and regular stretching of the vulvovaginal tissue through regular sexual activity or by using a dilator. If you have symptoms of GSM and are not yet postmenopausal, you can discuss these treatment options with your healthcare provider).
Evidence-based treatments for GSM include:
If you’re experiencing pain during sex and think you might have GSM, speak with someone who has expertise in treating women who are menopausal or postmenopausal. You can visit the North American Menopause Society to find an HCP who specializes in menopause-related issues like GSM.
