Understanding Vaginal, Vulvar and Bladder Changes in Menopause (GUSM)

by Rosalina Mahendran  MScPT
Pelvic Physiotherapist
updated Jan 21, 2026

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What Is GUSM?

GUSM stands for Genitourinary Syndrome of Menopause. It describes changes to the vagina, vulva, bladder, and pelvic floor that can happen during and after menopause. These changes are caused mainly by lower estrogen levels.

GUSM is very common:

• About 15% of women notice symptoms during the menopause transition
• Up to 80% will have symptoms after menopause
• Symptoms often do not go away on their own without treatment

 

How Menopause Affects Vaginal & Vulvar Tissues

Estrogen is a hormone that helps keep the vaginal and vulvar tissues healthy. It helps with:

• Stretch and flexibility
• Blood flow
• Natural moisture
• Healthy bacteria

As estrogen drops during menopause:

• Tissues can become thinner, drier, and more sensitive
• Blood flow decreases
• Natural moisture decreases
• The vagina becomes less acidic, making infections more likely

The tissues may look paler and may get irritated more easily. Over time, the vagina may become shorter and narrower. This is a normal change and not caused by lack of sex.

 

Common Symptoms of GUSM

• Vaginal dryness (most common)
• Burning or stinging feelings
• Pain with penetration
• Itching of the vagina or vulva
• Discomfort when wiping after using the toilet
• Less natural lubrication
• Changes in smell or discharge
• Lower interest in sex due to pain
• More bladder infections or UTIs
• Bladder urgency or leaking
• Orgasms that feel weaker or take longer

 

How Pelvic Physiotherapy Can Help GUSM?

Pelvic physiotherapy focuses on the muscles and tissues that support the bladder, bowel, and sexual organs.

A pelvic physiotherapist can help by:

• Checking how the pelvic floor muscles are functioning
• Teaching relaxation for tight or painful muscles
• Improving strength for bladder control
• Improving blood flow and tissue comfort
• Helping make sex more comfortable via accommodation (i.e. dilator therapy) 
• Patient Education re: vulvar care and lubricants/vaginal moisturizers 

 

Hormonal & Non-Hormonal Treatment Options for GUSM

Vaginal Estrogen

• Considered the best treatment for GUSM
• Improves tissue health, moisture, and blood flow
• Very low risk and safe for most people
• Options Include: Vaginal cream, Vaginal Ring, Vaginal Tablet 

Vaginal DHEA

• Helps the body make estrogen in the vaginal tissues
• Improves comfort and lubrication

Non-Hormonal Option

• Ospemifene is a pill used for vaginal symptoms
• Vaginal Lubricants 
• Vaginal Moisturizers 

Always talk with your healthcare provider about what is right for you.

Pauz Health   

Many women quietly live with symptoms like vaginal dryness, discomfort with intimacy, irritation, or recurrent urinary symptoms during menopause, often assuming this is just something they have to tolerate.

The good news is effective, safe treatments exist. Low-dose vaginal estrogen is considered first-line therapy for genitourinary syndrome of menopause (GUSM) because it works directly at the vaginal tissue level to restore moisture, improve comfort, and support urinary and sexual health, with minimal absorption into the bloodstream. Vaginal DHEA (prasterone) is another evidence-based option that helps improve tissue health and painful intercourse through local hormone activity within vaginal cells, and may be preferred by women seeking a non-estrogen labeled treatment.

If you’re experiencing these symptoms, you are not alone and help is available. Talking with a menopause-informed clinician can help you understand your options and find a treatment that supports comfort, intimacy, and quality of life.

GUSM (genitourinary syndrome of menopause) does not resolve with time but it is highly treatable.

At PAUZ Health, expert nurse practitioners provide comprehensive menopause hormone assessments and personalized treatment plans to address vaginal dryness, irritation, pain, and urinary symptoms.

Medical management combined with pelvic floor physiotherapy is a powerful, integrated approach to restoring comfort, function, and confidence. Book your PAUZ appointment here.

 

Bladder Health After Menopause

Low estrogen can affect the bladder and increase UTIs.
Helpful strategies may include:

• Vaginal estrogen
• Pelvic physiotherapy
• Certain medications or supplements recommended by your provider

Pelvic physiotherapy can also help with bladder leaks and urgency.

 

Sex, Desire & Menopause

Changes in sexual desire are common with aging and long-term relationships.

Some people may:

• Need more time or stimulation
• Use a vibrator to reach orgasm
• Notice weaker orgasms

These changes are normal but you don’t have to accept them. Strengthening the pelvic floor and reducing pain can help improve sexual enjoyment.

 

You Don’t Have to Live With GUSM

GUSM is common, but it is treatable. With the right care including education, pelvic physiotherapy, and medical support, symptoms can improve.