After menopause (when menstruation stops), many people develop vaginal dryness and thinning of the tissue of the vagina because of lower estrogen levels, which can result in painful intercourse. This condition is known as genitourinary syndrome of menopause (GSM), or vulvovaginal atrophy.

It is particularly prevalent in people with a breast cancer diagnosis, who often go through early menopause because of chemotherapy, which can suppress the body's ability to produce estrogen. These people can be treated with anti-estrogen therapies to prevent breast cancer from recurring.

Symptoms of GSM

GSM is caused by a drop in estrogen levels, which causes genital and urinary tract tissues to become thinner, less elastic and unable to produce adequate lubrication. This can result in any of the following vulvar, vaginal or urinary symptoms:

• Dryness
• Irritation
• Itching
• Urinary frequency
• Urinary urgency
• Recurrent urinary tract infections (UTIs)
• Painful intercourse
• Vulvar pain

GSM Fast Facts

• Up to 70% of menopausal women* develop GSM.
• Vaginal dryness is the most common symptom of GSM.
• GSM is particularly common in people diagnosed with breast cancer since chemotherapy can suppress their body's ability to produce estrogen, which can cause an earlier menopause.

"Many patients consider vaginal dryness or painful intercourse and pelvic examinations to be a normal part of aging or cancer survivorship, but it doesn't have to be," says Northwestern Medicine Gynecologist Traci A. Kurtzer, MD. "There are a variety of hormonal and non-hormonal treatments for vaginal dryness, and it is important to rule out other causes of pain."

Non-hormonal Treatments

Over-the-counter vaginal lubricants can sometimes help address pain or dryness with intercourse, but many lubricants don't restore natural lubrication or vaginal elasticity. Some over-the-counter vaginal moisturizers can help with natural lubrication, but may not improve elasticity.

While there are a number of prescription treatments available to help manage GSM, CO2 laser treatment performed by a gynecologist is a safe and effective non-hormonal treatment to restore vaginal and vulvar health. It may also help you have more pleasurable sexual activity.

"The CO2 laser treatment is an effective, non-hormonal option to treat the vaginal dryness and sexual pain associated with GSM," says Dr. Kurtzer.

Hormonal Treatments

Prescription vaginal estrogen or steroid hormones (such as DHEA) in the form of a tablet, cream, suppository or vaginal ring are safe for most people to use and can help alleviate symptoms of GSM. However, many people with breast cancer are advised against using, or prefer not to use, hormone treatments because additional estrogen in their body could increase the risk of breast cancer recurring.

If you have a breast cancer diagnosis and are experiencing vaginal dryness, talk to your physician about whether vaginal hormonal treatment is right for you.

Learn more about vaginal health and discomfort, and what type of treatment might be right for you.

*Scientists do not always collect information from participants about gender identity. To avoid misrepresenting the results of this research, we use the same terminology as the study authors.