Genitourinary Syndrome of Menopause

By: Red Hot Mamas

Published: June 8, 2017

Contributed by Dr. Verna Brooks-McKenzie- Red Hot Mamas Medical Expert

Menopause is a normal natural event which occurs during the transition from the reproductive years to post menopause as a result of loss of ovarian follicular function usually due to aging. Surgical menopause is the result of removal of both ovaries. Classic symptoms are hot flashes, night sweats and sleep disorder.

Genitourinary syndrome of menopause (GSM) unlike the term  vulvo vaginal atrophy, refers to the signs and symptoms affecting all the genito pelvic anatomic structures such as the mons pubis, labia majora and minora, clitoris, vestibule, introitus (vaginal opening), vagina, urethra and bladder. The symptoms progress, do not resolve without treatment and may have an adverse effects on sexual function resulting in relationship discord. Many women do not report their symptoms because of embarrassment and some view them as an inevitable part of aging.


  • Loss of / sparse pubic hair
  • Thinning of vulvar skin
  • Mons pubis, labia majora and minora decrease in size
  • Fusion of labia minora (in elderly sexually inactive women)
  • Receding  clitoris (may affect orgasm)
  • Loss of vaginal rugae (folds)
  • Vaginal shortening
  • Thinning of vaginal epithelium (lining)
  • Shortening of urethra


  • Dyspareunia (painful sex, especially on penetration)
  • Lack of vaginal lubrication
  • Genital dryness
  • Burning, irritation in vagina
  • Recurrent urinary tract infection
  • Incontinence
  • Frequency of urination


Education about the cause is important. Vaginal Estrogen (creams, vaginal ring, tablet) is most effective. For mild symptoms vaginal moisturizers inserted into the vagina  to provide hydration can be used. Lubricants used during sex, vaginal dilators and having regular sex are other options. Ospemifene (non estrogen) taken orally is FDA approved for the treatment of moderate to severe GSM.

Dr. Verna Brooks McKenzie is an Obstetrician and Gynecologist and is Certified by the North American Menopause Society as a Menopause Practitioner. She has over 30 years of experience in training , lecturing and public speaking. She is an advocate for women’s health and is a board member for Red Hot Mamas.