If you’ve noticed vaginal dryness, discomfort, pain during sex, bladder irritation, or recurrent urinary symptoms since entering perimenopause or menopause, you’re not alone. These symptoms may be caused by Genitourinary Syndrome of Menopause (GSM)—a common condition affecting around 60–75% of women after menopause.
GSM develops as oestrogen levels decline, causing changes to the tissues of the vulva, vagina, urethra and bladder. Unlike hot flushes, these symptoms usually don’t improve over time without treatment and can gradually worsen if left unaddressed.
Common symptoms include:
- Vaginal dryness or reduced natural lubrication
- Burning, itching or irritation
- Pain during intercourse
- Vaginal tightness or discomfort with penetration
- Urinary urgency or frequency
- Burning when passing urine
- Recurrent urinary tract infections
- Reduced sexual comfort and confidence
How can physiotherapy help?
Pelvic health physiotherapy is an important part of managing GSM, particularly when pain, muscle tension or pelvic floor dysfunction contribute to symptoms.
Your assessment may include:
- Education about GSM and the changes that occur during menopause
- Advice on vaginal moisturisers and lubricants
- Assessment of pelvic floor muscle function
- Treatment of overactive or painful pelvic floor muscles
- Vaginal dilator therapy where appropriate
- Strategies to improve comfort during intimacy
- Bladder and bowel management advice
- Exercise and lifestyle recommendations to support pelvic health
Treatment is always individualised and designed around your goals and comfort.
Other treatment options
Many women benefit from combining physiotherapy with medical treatment.
Depending on your symptoms, your GP or menopause specialist may recommend:
- Non-hormonal vaginal moisturisers and lubricants, which can improve comfort and reduce friction.
- Low-dose vaginal oestrogen, available as creams, pessaries, tablets or rings. These treatments act locally to restore the health, thickness and elasticity of vaginal tissues and are considered safe and highly effective for most women.
- Other prescription options, such as vaginal DHEA (prasterone) or ospemifene, may be suitable for some women depending on their medical history.
If you have a history of breast cancer or other hormone-sensitive conditions, treatment decisions should be made in collaboration with your GP, menopause clinician or oncologist.
What about vaginal laser therapy?
Vaginal laser therapy has been studied as a possible treatment for GSM. While some women report improvement, current evidence is still evolving, and larger, high-quality studies are needed to confirm its long-term safety and effectiveness. At present, professional menopause societies generally recommend established treatments, including vaginal moisturisers, vaginal oestrogen where appropriate, and pelvic health physiotherapy, as first-line management.
You don’t have to put up with these symptoms
Many women assume that vaginal dryness, bladder symptoms or painful sex are an inevitable part of ageing—but effective treatments are available.
If GSM is affecting your comfort, confidence or quality of life, we’d be happy to assess your symptoms and work alongside your GP or menopause specialist to develop a personalised treatment plan.
