F@#% You Genitourinary Syndrome of Menopause
This post is for everyone who owns a vagina or knows someone who does.
Vaginal dryness and pain is a real thing that happens as people age. It can lead to distressing and debilitating symptoms such as painful sexual penetration, urinary symptoms, and poor self-image. Yet it is underdiagnosed, undertreated, and RARELY discussed in health care settings or in personal conversations with friends and family.
Are you experiencing this?.....Probably. Did anyone prepare you for this?......Probably not.
Talking about vaginal health is taboo in our culture which results in poor health outcomes and decreased quality of life.
Several recent studies found that up to 87% of vagina owners experience this condition, now known as Genitourinary Syndrome of Menopause (GSM) yet only one in 10 health care providers inquire about it and only 40% of symptomatic patients initiate concerns during appointments. Yes, that is right. 87%. Which means more people suffer from this than don’t. This means it is likely happening to you or will happen to you at some point if you are lucky enough to own a vagina.
But many feel it is a normal consequence of aging and they just need to deal with it. Many are just too ashamed to even think about bringing it up with their health care provider (so thank you so much for overcoming shame and reading this article).
The symptoms of GSM include vaginal dryness, pain and dyspareunia (painful sexual penetration), vaginal burning and itching as well as urinary symptoms such as urinary frequency, pain with peeing, and more frequent urinary tract infections.
A decline in estrogen levels which occurs in menopause and the transition leading up to it (known as perimenopause) is largely responsible for GSM. In addition, similar symptoms can happen after childbirth or when breastfeeding when estrogen levels are low, and if using estrogen-blocking medications. Low estrogen states cause decreased vaginal secretions, thinning of the vaginal walls, shortening of the vagina, and increased inflammation. People also have estrogen receptors in the bladder, so decreased amounts of estrogen can lead to urinary difficulties. In addition, vaginal pH increases in menopause leading to a lower production of lactobacilli which maintains a healthy vaginal microbiome.
Okay, so we know what causes it. But can it be treated? And the answer is GSM IS treatable and the treatment will change your life.
So what are the best treatments? In the 2020 North American Menopause Society’s revised position statement, they recommend the following treatments:
The use of nonhormonal, over the counter lubricants to be used with every sexual activity. There are water, oil, and silicone based lubes. I encourage people to select brands that have biosimilar vaginal pH (~4.5) and osmolarity (<4) to decrease irritation and infection.
Regular use of long-acting vaginal moisturizers that can be used two or more times a week. Again choose products that contain a similar pH and osmolarity to the vaginal microbiome. I personally recommend products that contain Hyaluronic Acid as it has been shown to be more effective than other moisturizers.
Low dose vaginal estrogen is an acceptable and safe option for many, yet is only prescribed to about 15% of the people who need it. There are many misconceptions about vaginal estrogen that need to be demystified. It rarely enters the bloodstream, decreasing systemic absorption. Numerous studies have proved its safety. It may be contraindicated in some people with a history of estrogen receptor cancers, so people with a cancer history should consult their oncologist.
Other options include vaginal DHEA inserts or oral ospemifene. When estrogen therapy is not effective or in some other situations these are great options.
Transdermal and oral hormone therapy are possible treatments for women who have dyspareunia due to GSM and have vasomotor symptoms of menopause like hot flashes and night sweats. I have found this treatment to be less effective than local vaginal treatment for GSM but it is an option.
Pelvic floor exercises and the use of vaginal trainers should be considered to help with GSM. A pelvic floor physical therapist can provide this service.
Menopause is a normal life transition, just like puberty. But unlike puberty, menopause is a time where people will spend at least a third or more of their lives. Our patriarchal culture views it as a flawed and pathological time, and we vagina owners have been conditioned to believe that. We need to rise up and demand the same health care and anticipatory guidance for menopause-related conditions as for every other life occurring event. GSM, while a normal and common condition, can be and should be treated to help improve not only the quality of life but to prevent further health problems that can arise from it.
So let’s lift the veil of shame and yell from the rooftop: F@%* You GSM, you are not going to dictate my life. Vaginal health is essential for overall health. You have options. You do not need to suffer in silence.
Susan Kamin is a certified nurse midwife and a certified sexuality counselor. After many years of helping people give birth and be born, she is now providing personalized integrative well body care at Lifecycle Women's Health in Readfield and Brunswick, Maine. She sees people across the lifespan with a focus on care during midlife/menopause and sexual health. She enjoys sharing her wisdom in the hopes of helping people find pleasure, knowledge, and empowerment in their bodies as they go through all of life's transitions.
