cartoon of woman saying no to sex

GSM: What It Is, How It Affects Sex, and What You Can Do to Treat It

May 7, 2024

Do the hormone changes of menopause mean it’s time to kiss sex goodbye?

As estrogen levels dip, women can experience symptoms such as hot flashes, anxiety, mood swings, and sleeplessness.

And after those symptoms pass, many women experience vaginal dryness, burning and itching in and around the vagina, a straw-colored vaginal discharge, vaginal pain during sexual intercourse (think cut glass or barbed wire), an urge to urinate more often, and more frequent urinary tract infections. Often, women seek medical attention for what they think is a yeast infection or urinary tract infection.

These symptoms, caused by thinning of the tissue that lines the vaginal area and urinary tract, are called the genitourinary syndrome of menopause (GSM).

According to the Menopause Society, up to 84% of postmenopausal women experience GSM, which can significantly affect sexual health and quality of life. For women who are not sexually active, GSM can also affect activities of daily living.

Because sexual health isn’t always discussed at doctor visits, many women may not know that GSM causes their symptoms—and that treatment options are available.

“It’s a troublesome concern for women in their late 50s and 60s, who are done with menopause and don’t understand why, years later, they are suddenly no longer able to have sexual relations with their partner,” says Mary Rosser, MD, PhD, director of Integrated Women’s Health at Columbia University Irving Medical Center.

We sat down with Dr. Rosser to learn more about how women can manage GSM and better communicate with their partners.

How Do You Treat GSM?

For some women with GSM, symptoms may be manageable without any treatment. But for most, treatment may be needed to make sexual activity more comfortable.

Over-the-counter personal lubricants and moisturizers are the most popular treatment options.

Personalized lubricants are used right before a sexual encounter to reduce discomfort during intercourse. In a randomized trial, personal lubricants relieved vaginal dryness and pain without side effects in women with GSM. However, some lubricants contain additional ingredients, such as capsaicin, menthol, or glycerin, to create a warming sensation and should not be used by people who are sensitive to those ingredients.

Vaginal suppositories or inserts that contain hyaluronic acid bring moisture to the surface of the vaginal lining. These products may be used once or twice a week, not at the time of a sexual encounter.

And there are also home remedies that can restore moisture, Dr. Rosser says. “Moisturizing the vulva after menopause, like you moisturize your face and the rest of your body, can also work.” Natural oils found in your pantry—like olive, avocado, sesame, or coconut oil—may work just as well as more expensive products and can be applied liberally after bathing.

The Menopause Society also recommends using vaginal dilators, doing Kegel exercises, pelvic floor physical therapy, and even yoga to stretch vaginal tissue and strengthen the pelvic floor, making sexual intercourse more comfortable. Regular sex and self-stimulation increase blood flow to the vagina, which will help keep vaginal tissue healthy.

Experts consider low-dose estrogen suppositories, creams, and rings to be the best way to treat vaginal dryness and pain during sex. These prescription treatments can address vulva and vaginal dryness and urinary symptoms without significantly raising the amount of estrogen in the bloodstream. The most common side effect of low-dose estrogen is vaginal discharge.

How to Talk About GSM

For people who haven’t found an effective way to manage GSM, its symptoms can lead many people to avoid sex entirely, even to the point where they won’t talk about it with their partner. This can lead to misunderstandings and tension. Rosser assures patients that GSM is normal and encourages them to engage in an open conversation with their partner about their symptoms.

“For many older people, sex and GSM can be a taboo topic. Partners think they are no longer desired, and women with GSM worry that their partner is going to find sex elsewhere,” says Dr. Rosser. “Nevertheless, it’s important to let their partner know that this is a normal part of aging. Menopause does not eliminate attraction to her partner, and sex can still be enjoyable.”

Dr. Rosser also notes that many older women don’t miss having sex, though they miss the desire for sex that they experienced in their 20s and 30s and still want to experience intimacy.

“Women should ask themselves what they really want. It’s normal for even very healthy relationships to become less sexually exciting over time. And there are many ways to be intimate without intercourse that can be deeply fulfilling.”


Mary Rosser, MD, PhD, director of Integrated Women’s Health at Columbia University Irving Medical Center.