Vaginal Dryness & Genitourinary Syndrome of Menopause (GSM)

What is GSM?

Genitourinary syndrome of menopause describes changes in the vulva, vagina, urethra and bladder caused by declining estrogen. Tissues become thinner, drier, less elastic and more fragile. Unlike hot flashes, which often fade with time, GSM tends to progress without treatment.

Symptoms include vaginal dryness, burning or itching, pain with intercourse, light bleeding after sex, urinary urgency, frequent urination, and recurrent urinary tract infections. Many women never mention these symptoms because they assume nothing can be done or feel embarrassed. It is a common, treatable medical condition.

Evaluation

A visit includes a history of symptoms, sexual health, and urinary concerns, along with a gentle exam to assess tissue health and rule out infections, skin conditions such as lichen sclerosus, or other causes of irritation. Urinalysis may be checked for urinary symptoms.

Treatment options

First-line options include regular vaginal moisturizers and high-quality lubricants for intimacy. For most women, low-dose vaginal estrogen — available as a cream, tablet, or ring — is highly effective and acts locally with minimal absorption into the bloodstream. It is considered safe for most women, including many who cannot use systemic hormone therapy.

Other prescription options include vaginal DHEA (prasterone) and ospemifene, an oral medication. Pelvic floor physical therapy can help with pain, tightness or urinary leakage. Vaginal estrogen has also been shown to reduce recurrent urinary tract infections in postmenopausal women.

• Vaginal moisturizers & lubricants
• Low-dose vaginal estradiol
• Vaginal DHEA (prasterone)
• Ospemifene
• Pelvic floor physical therapy referrals

What results to expect

Improvement typically begins within a few weeks, with full tissue restoration by about three months. Because GSM is chronic, ongoing low-dose maintenance is usually recommended to keep tissues healthy and comfortable.

Talking about intimacy without awkwardness

Pain with sex can affect relationships, self-esteem and quality of life. Jennifer's decades of women's health experience mean these conversations happen frankly and kindly. Your comfort matters, and it is a legitimate reason to make an appointment.

Preparing for your visit

Coming prepared helps you get the most from an appointment about vaginal dryness and GSM. Note when symptoms began, which products you have tried (lubricants, moisturizers, soaps), and any urinary symptoms or recent infections. Avoid douching or using new vaginal products for a couple of days before your exam. If you are a breast cancer survivor, bring the name of your oncology team so care can be coordinated.

JennWell Women's Health is located at 11844 Standing Stone Dr., Suite 200 in Gretna, inside Skilled Touch Health and Healing, and welcomes women from Elkhorn, West Omaha, Millard, Papillion, La Vista, Bennington, Lincoln and across Eastern Nebraska. To schedule, call (402) 800-8595 or request an appointment online. If you are unsure whether this service is right for you, a consultation is a no-pressure place to start the conversation and learn your options.