Menopause & Midlife

Genitourinary Syndrome of Menopause (Vaginal Dryness): Symptoms and Treatment

By the Find Her Doctor editorial team · Updated November 1, 2026 · 5 min read

Genitourinary syndrome of menopause (GSM) is the medical name for vaginal dryness, burning, pain with sex and urinary symptoms caused by low estrogen after menopause. It's very common. Unlike hot flashes, it usually doesn't fade on its own and tends to get worse over time, but it responds well to moisturizers, lubricants and low-dose vaginal estrogen.

Here's the frustrating part: many people live with it for years because they're embarrassed to bring it up, or they assume it's just what getting older feels like. It doesn't have to be. Below are the questions people actually want to ask, answered plainly.

"What is actually happening down there?"

Estrogen keeps the tissues of the vagina, vulva, urethra and bladder thick, stretchy and moist. When estrogen drops, those tissues get thinner, drier and more fragile. The vaginal environment changes too, which can affect the healthy bacteria that live there.

GSM used to be called vaginal atrophy or atrophic vaginitis. The Menopause Society and the International Society for the Study of Women's Sexual Health adopted the newer name because the urinary tract is affected too, not just the vagina.

"Is this what I have?"

Vaginal and vulvar symptoms

• Dryness, sometimes enough that sitting or wiping feels raw
• Burning, itching or irritation
• Pain or bleeding with sex
• Less natural lubrication when you're aroused
• Discharge or a change in odor

Urinary symptoms

• Needing to pee urgently or often
• Burning when you pee
• Recurrent urinary tract infections (UTIs)
• Leaking urine

A common story: someone gets three or four "UTIs" a year after menopause, each treated with antibiotics, and nobody connects it to vaginal tissue changes until a gynecologist does.

Symptoms can start in perimenopause and often show up or worsen in the years after your last period. They can also happen while breastfeeding, with some birth control or cancer treatments, and after the ovaries are removed.

"What happens at the appointment?"

Usually a conversation and a pelvic exam. The clinician may see that the vaginal tissue looks pale, thin or less elastic. If the speculum is uncomfortable, say so; a smaller one can be used. Sometimes they'll do a urine test or vaginal swab to rule out infection.

They'll also check for skin conditions such as lichen sclerosus, which can cause similar itching but needs different treatment.

"What actually helps?"

Start here: moisturizers and lubricants

These are the first step for mild symptoms, and people often mix them up.

• Moisturizers go in every two or three days, on a schedule, whether or not you're having sex. Think of them like face lotion for vaginal tissue.
• Lubricants are for sex. Water-based and silicone-based options are easy to find. If you're sensitive, skip anything with fragrance or "warming" ingredients.

The most effective option: low-dose vaginal estrogen

The Menopause Society and ACOG consider low-dose vaginal estrogen highly effective and safe for most people. It goes straight to the tissue, with very little absorbed into your bloodstream, and it can also cut down on recurrent UTIs.

The most common worry is "Isn't estrogen risky?" The low-dose vaginal form is very different from the systemic hormone therapy in the headlines. Our vaginal estrogen safety guide goes through it.

Other prescriptions

• Prasterone (vaginal DHEA) is an insert that the vaginal tissue converts to small amounts of estrogen and androgen locally.
• Ospemifene is a daily pill that acts like estrogen on vaginal tissue. It's not for people with a history of breast cancer or blood clots.

Dilators and pelvic floor therapy

If sex has hurt for a while, the pelvic floor muscles often tighten in anticipation, which makes it hurt more. Pelvic floor physical therapy and dilators can break that cycle, especially combined with vaginal estrogen.

"How long until I feel better?"

Consistency matters more than anything else.

• Lubricants help right away.
• Moisturizers may take a few weeks of regular use.
• Vaginal estrogen often helps within a few weeks, with the full benefit often taking up to 12 weeks.
• Prasterone and ospemifene also take several weeks.

GSM is long-term, so symptoms usually come back if you stop. Many people stay on a maintenance routine for years. Set a phone reminder; the most common reason treatment "stops working" is that it stopped being used.

"What about those vaginal laser treatments?"

Laser and other energy-based devices are heavily marketed, often at a high out-of-pocket price. The Menopause Society and ACOG say the evidence isn't strong enough to recommend them, and the FDA has warned about marketing these devices for vaginal "rejuvenation." Try the proven options first.

"I had breast cancer. What can I use?"

Dryness can be especially severe after breast cancer treatment, particularly with aromatase inhibitors. Non-hormonal moisturizers and lubricants come first. ACOG guidance notes that low-dose vaginal estrogen may be considered for persistent symptoms after a discussion with your oncology team. Bring your oncologist into the decision rather than deciding on your own.

"Sex hurts and it's affecting my relationship."

Pain leads to avoiding intimacy, and that can strain a relationship and how you feel about yourself. Things that help:

• Talk with your partner about what hurts and what feels good.
• Take more time for arousal, which increases natural lubrication.
• Use plenty of lubricant, even after you start treatment.
• Try positions that let you control depth and pace.
• Widen the definition. Intimacy isn't only intercourse.
• Consider sex therapy or counseling if anxiety about pain has become part of the problem.

Your clinician has heard all of this many times. Sexual health is a normal part of menopause care.

"Can I prevent it?"

You can't stop the hormonal change, but early treatment helps keep tissue healthier. Regular sexual activity or vaginal stimulation may help maintain blood flow and elasticity. Skipping harsh soaps, douches and scented products cuts down on irritation.

When to see a doctor

See a gynecologist, urogynecologist or women's health nurse practitioner if:

• Dryness, burning or pain with sex are affecting your life
• You have recurrent UTIs or urinary urgency
• You notice any bleeding after menopause, including after sex. This always needs evaluation; see postmenopausal bleeding.
• You have itching with white patches or skin changes on the vulva
• Over-the-counter products aren't enough

Find care in New York

If you're in a Medicare plan, ask the pharmacy about coverage for your vaginal estrogen before filling it; prices vary a lot by plan and form. Search the directory for gynecologists and urogynecologists across New York City, Long Island and the Hudson Valley who treat GSM and bladder symptoms, or browse providers who take Medicare.

Frequently asked questions

Sources

• The Menopause Society — 2020 Genitourinary Syndrome of Menopause Position Statement
• ACOG — Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer (Clinical Consensus)
• ACOG — Management of Menopausal Symptoms (Practice Bulletin 141)
• American Urological Association / SUFU / AUGS — Recurrent Uncomplicated UTI in Women Guideline

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.