What happens to the vagina in midlife?

What happens to the vagina in midlife?

Genitourinary Syndrome of Menopause, or GSM, previously known as vulvovaginal atrophy, atrophic vaginitis, or urogenital atrophy, is a condition caused by the lack of estrogen during menopause. The term GSM was introduced in 2014 by a consensus of the International Society for the Study of Women's Sexual Health (ISSWSH) and the North American Menopause Society (NAMS now menopause society). This chronic and progressive condition encompasses a wide range of signs and symptoms that can significantly impact a woman's quality of life.

  • Reduced lubrication
  • Painful intercourse
  • Loss of libido and arousal
  • Urinary urgency, stress or urge incontinence, recurrent urinary tract infections

The lack of estrogen during menopause leads to hormonal and anatomical changes in the genitourinary tract. One of the most bothersome symptoms of GSM is vaginal dryness, which can cause discomfort and pain during intercourse, also known as dyspareunia. Reduced lubrication is another common symptom, contributing to sexual difficulties and decreased sexual pleasure.

Interestingly, GSM-like symptoms may also be present in 15% of premenopausal women due to a hypoestrogenic state. However, the majority of women experiencing GSM are of older age, with 50-70% of postmenopausal women being symptomatic to some degree.

Despite its high prevalence, GSM remains underdiagnosed, partly due to the reluctance among women to seek help, often due to embarrassment or the belief that it's a normal part of aging. Additionally, many healthcare providers do not ask about sexual health.

The impact of GSM on a woman's life cannot be understated. The discomfort and pain associated with GSM can significantly affect sexual intimacy and overall well-being.

Thankfully, there are treatments available to alleviate GSM symptoms. Non-hormonal therapies, such as lubricants and moisturizers, are often considered first-line treatments. These products can provide relief and improve vaginal comfort. Hormonal therapy with local estrogen products is considered the "gold standard" treatment for GSM. Local estrogen can help restore the vaginal tissue, improving lubrication and reducing discomfort during intercourse.

There are alternative treatment options, such as selective estrogen receptor modulators (SERMs) and laser technologies. However, further research is needed to determine their efficacy and suitability for everyday clinical practice.

It is essential that we create a safe and supportive environment for women to discuss GSM-related concerns openly. Raising awareness and educating women about GSM is crucial to ensure timely diagnosis and appropriate management.

If you're experiencing any of the symptoms associated with GSM, I encourage you to reach out to your healthcare provider. Remember, you don't have to suffer in silence, and effective treatments are available to help improve your quality of life.


In the DFW area, schedule an appointment at Sky Women’s Health.

Request an appointment online or call 817-915-9803.