Vaginal dryness and pain during intercourse: this is not normal — it is treatable

Vaginal dryness, pain during intercourse, sudden urges to urinate, and recurring bladder infections—these are symptoms many women in menopause suffer from in silence. They may feel embarrassed or think it is just "part of the process." But it is treatable. Completely and effectively.

The medical term for this cluster of symptoms is GSM: Genitourinary Syndrome of Menopause. And it is likely the most underestimated consequence of estrogen deficiency.

What is GSM?

GSM encompasses all changes in the genital and urinary regions resulting from declining estrogen levels. Unlike hot flashes—which subside for most women after a few years—GSM worsens progressively without treatment. The longer you wait, the more the tissues atrophy.

Estrogen keeps the mucous membranes of the vagina, urethra, and bladder supple, well-circulated, and moist. With a structural estrogen deficiency, these tissues become thinner, drier, and more fragile.

What are the symptoms of GSM?

Vaginal symptoms:

• Dryness, irritation, and a burning sensation
• Pain or discomfort during intercourse (dyspareunia)
• Minor bleeding after intercourse due to more fragile mucous membranes
• Reduced lubrication during arousal
• Itching or a burning sensation without an infection

Urinary symptoms:

• Sudden, difficult-to-control urges to urinate (urgency)
• Urine leakage when coughing, sneezing, or jumping (stress incontinence)
• Frequent urination
• Painful urination without a detectable infection
• Recurrent bladder infections — the urethra becomes thinner and more vulnerable, making it easier for bacteria to enter

Many women recognize several of these symptoms but do not always link them to menopause. They visit their GP with "bladder infections" or "incontinence," while the underlying cause is hormonal.

Why GSM is progressive — and why early treatment pays off

This is crucial to understand: GSM worsens over time. The longer estrogen is absent, the thinner the vaginal lining becomes. Sex becomes more painful, bladder infections more frequent, and tissue recovery takes longer.

Treating early — at the first signs of dryness or discomfort — prevents the atrophy from becoming severe. And even with advanced GSM, treatment is effective, although recovery takes longer.

Treatment: local estrogen as the gold standard

Local estrogen therapy — applied directly into the vagina — is the most effective treatment for GSM. The forms:

• Vaginal cream with estradiol or estriol — applied with an applicator
• Vaginal suppositories (ovules) with estradiol
• Vaginal ring — inserted once, releases a low, constant dose of estradiol for three months

The major advantage of local treatment: systemic absorption is negligibly small. The hormones work locally on the tissues that need them, without entering the bloodstream in significant amounts. This also makes local estrogen therapy suitable for women for whom systemic MHT is contraindicated — including women with a history of certain types of breast cancer, after consultation with their oncologist.

Systemic MHT provides additional support

Systemic MHT — transdermal estradiol and bioidentical progesterone — also helps with GSM, but less specifically than local treatment. The combination of systemic MHT for general menopausal symptoms and local estrogen therapy for vaginal and urinary symptoms provides the best results.

In case of Menovia we discuss GSM as standard during the intake — even if you don't bring it up yourself. Because we know that shame and discomfort often get in the way of this topic. Read more about our treatment options.

Additional non-hormonal support

In addition to estrogen therapy, there are supportive measures:

• Vaginal moisturizers (hormone-free) — hydrate the mucous membrane daily, regardless of sexual activity. Not the same as lubricant.
• Water-based lubricants — for intercourse, as a supplement to local estrogen
• Pelvic floor exercises — strengthen the pelvic floor and reduce urinary incontinence. A pelvic floor physical therapist can provide guidance with this.
• Regular sexual activity — keeps blood flow to vaginal tissues active. Self-stimulation has this effect as well.

Talk about it — even if it feels difficult

For many women, GSM is a difficult topic to discuss — with their partner, but also with a doctor. Yet it is essential. Pain during intercourse that remains untreated has consequences for relationships, self-image, and quality of life. And recurring bladder infections are not solved with antibiotics — they are solved by addressing the hormonal cause.

You don't have to accept this as something that "just happens." It is treatable. Completely and safely. Schedule an intake and discuss your symptoms.