Dryness, discomfort, and GSM
Dryness, stinging, discomfort during sex, sudden urinary infections. It is common, it has a proper name, and it is one of the most treatable parts of the whole transition — yet almost nobody is offered help.
This is the part women are least likely to raise and doctors are least likely to ask about, which is a shame, because it responds well to treatment. If sex has started to hurt, if there is a persistent dryness or stinging, or if you keep getting urinary tract infections you never used to get, this is worth reading — and worth saying out loud to a clinician.
It has a name: GSM
In 2014 a consensus of specialist societies (ISSWSH and what is now The Menopause Society) agreed on a single term: genitourinary syndrome of menopause, or GSM. The name matters. The old phrase, “vaginal atrophy,” was both narrow and grim, and it left out the urinary half of the picture entirely. GSM covers the whole thing: the tissues of the vulva, vagina and urinary tract depend on estrogen, and as estrogen falls they become thinner, drier and less elastic. That is the mechanism behind the dryness, the discomfort, and the new vulnerability to infection.
Why it goes untreated
Two reasons, and neither is good enough. Women are embarrassed to raise it, and appointments are short and often do not get to it. So it is quietly endured — a slow narrowing of comfort and intimacy that gets written off as “just getting older.” Jen Gunter is blunt about this in The Menopause Manifesto: it is not something to put up with, and it does not improve on its own.
What helps
- Non-hormonal options — good vaginal moisturisers used regularly, and lubricants for sex — help many women and are an easy first step.
- Local (vaginal) estrogen is highly effective and works right where it is needed. Because it acts locally, it is a different conversation from whole-body hormone therapy; ask a clinician whether it is right for you.
- Because GSM overlaps with desire and comfort, it is worth reading alongside desire, changed. Pain and dryness dampen wanting; treating them often lifts more than the physical symptom.
How Still Me helps
The hardest part is usually saying the words, and Still Me is a private place to find them first. You can describe what is happening in plain language, without an audience and without flinching, and the doctor-prep session will turn it into something you can hand over or read from — so you do not have to improvise the most awkward sentence of the appointment in the room. If a clinician has waved it off before, when you’re told it’s stress and talking to your doctor will help you go back better armed.
Grounded in the 2014 ISSWSH / Menopause Society (NAMS) consensus that established the term genitourinary syndrome of menopause; and Jen Gunter, The Menopause Manifesto.
This is general information, not medical advice, and Still Me does not diagnose or prescribe. For anything about your own body or treatment, talk to a clinician. If you feel unsafe, contact your local emergency service.