GSM – Genitourinary Syndrome of Menopause

What is Genitourinary syndrome of menopause (GSM)? GSM is a collection of symptoms and signs due to decrease in estrogen that include genital symptoms (dryness, burning, and irritation), sexual symptoms (lack of lubrication, discomfort or pain, and impaired function), and urinary symptoms (urgency, dysuria, and recurrent urinary tract infections).

How common is GSM? 65-84% of postmenopausal women suffer from some symptoms of GSM.

Will GSM symptoms go away with time? Unlike hot flashes and night sweats that get better with time, GSM continues to progressively worsens and if left untreated, postmenopausal women develop the negative vicious circle of worsening sexual dysfunction and bladder symptoms such as urgency, frequency, and urinary tract infections. Over time, if left untreated, certain chronic changes such as vaginal narrowing and pelvic muscle spasm will set in that become hard to reverse.

What is the main principle for treating GSM? The most important principle is to institute treatment early and maintain it throughout her life.

What can be done for GSM? Estrogen was the only treatment for GSM until a few years back. An oral medications called Osphena has now been approved for pain during sex. Lately, MonaLisa Touch is a new state-of-the-art procedure available for this condition.

How does the MonaLisa Touch work? This is a special laser that delivers precise energy to the vaginal tissue. The DEKA pulse, that is uniquely designed for vaginal tissue, allows for precise delivery of energy in a uniform, accurate and controlled manner that results in stimulation of collagen and a subsequent emergence of new healthier and more youthful tissue, similar to before menopause.

Before MonaLisa treatment

Before MonaLisa Treatment, AUGM

After MonaLisa treatment

After MonaLisa Treatment, AUGM

58-year-old overall healthy postmenopausal patient presents for complaints of urinary urgency and frequency. Patient states that she goes to the bathroom very frequently in the daytime and couple of times at night.

Patient also is complaining of discomfort during intercourse. She went through menopause at the age of 45 when she underwent a hysterectomy and removal of both ovaries. Patient has not been on any hormone treatment. She notices significant vaginal dryness and discomfort during intercourse. Patient states that if she does not use a lubricant, intercourse is impossible. Lubricant just makes sex  “possible” but not enjoyable.

 Presently, because of the discomfort during intercourse, she prefers not to have sex. This has affected her sexual life. She and her husband have been married for over 30 years and enjoyed

pleasurable intimacy over the years. However, after she went through menopause, this has become increasingly difficult due to pain. She now makes excuses so that she does not get into a situation where she has to say no if her husband desirous to have sex. Her husband is very understanding especially as he realizes her discomfort during intercourse. This has also affected her overall well being and her overall relationship with her husband.

Patient is very skeptical about using estrogen because her sister was diagnosed with breast cancer.

This is a classic situation that we see in our office in almost ALL women who are postmenopausal. Almost everyone has some degree of vaginal dryness and has to use some type of lubricant. This is inevitable considering the physiologic changes that happen after cessation of natural hormones after menopause.

To know more about GSM and MonaLisa Touch, please review the information on our website.