Symptoms and causes


With moderate to severe genitourinary syndrome of menopause (GSM), you may experience the following vaginal and urinary signs and symptoms:

  • Vaginal dryness
  • Vaginal burning
  • Vaginal discharge
  • Genital itching
  • Burning with urination
  • Urgency with urination
  • More urinary tract infections
  • Urinary incontinence
  • Light bleeding after intercourse
  • Discomfort with intercourse
  • Decreased vaginal lubrication during sexual activity
  • Shortening and tightening of the vaginal canal

When to see a doctor

By some estimates, nearly half of postmenopausal women experience GSM, although few seek treatment. Many women resign themselves to the symptoms or are embarrassed to discuss them with their doctor.

Make an appointment to see your doctor if you experience painful intercourse that's not resolved by using a vaginal moisturizer (Replens, Vagisil Feminine Moisturizer, others) or water-based lubricant (glycerin-free versions of Astroglide, K-Y Intrigue, others). Also make an appointment if you have vaginal symptoms, such as unusual bleeding, discharge, burning or soreness.


Genitourinary syndrome of menopause (GSM) is caused by a decrease in estrogen production. Less estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.

A drop in estrogen levels may occur:

  • After menopause
  • During the years leading up to menopause (perimenopause)
  • After surgical removal of both ovaries (surgical menopause)
  • After pelvic radiation therapy for cancer
  • After chemotherapy for cancer
  • As a side effect of breast cancer hormonal treatment

GSM signs and symptoms may begin to bother you during the years leading up to menopause, or it may not become a problem until several years into menopause. Although the condition is common, not all menopausal women experience GSM. Regular sexual activity, with or without a partner, can help you maintain healthy vaginal tissues.

Risk factors

Certain factors may contribute to genitourinary syndrome of menopause (GSM), such as:

  • Smoking. Cigarette smoking affects your blood circulation, resulting in the vagina and other tissues not getting enough oxygen. Smoking also reduces the effects of naturally occurring estrogens in your body. In addition, women who smoke typically experience an earlier menopause.
  • No vaginal births. Researchers have observed that women who have never given birth vaginally are more likely to develop GSM than women who have had vaginal deliveries.
  • No sexual activity. Sexual activity, with or without a partner, increases blood flow and makes your vaginal tissues more elastic.


Genitourinary syndrome of menopause (GSM) increases your risk of:

  • Vaginal infections. Changes in the acid balance of your vagina makes vaginal infections (vaginitis) more likely.
  • Urinary problems. Urinary changes associated with GSM can contribute to urinary problems. You might experience increased frequency or urgency of urination or burning with urination. Some women experience more urinary tract infections or incontinence.
April 23, 2016
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