Let’s Talk About It: Vaginal Dryness, Discomfort, and the “Taboo” Symptoms of Menopause
- WA Menopause Clinic
- Apr 24
- 3 min read
Let’s Talk About It: Vaginal Dryness, Discomfort, and the “Taboo” Symptoms of Menopause
If you're feeling dryness, discomfort, pain during sex, or frequent urges to wee—especially after menopause—you are not alone. In fact, between 40% and 90% of menopausal women experience what we now call Genitourinary Syndrome of Menopause (GSM) [5–9]. Yet, many women never bring it up with their doctor.
Why? Sometimes it’s embarrassment. Sometimes it’s the mistaken belief that it’s just “normal ageing.” But here’s what you need to know:👉 GSM is common, it’s treatable, and you do not need to suffer in silence.
So, What Is GSM?
GSM is the medical term adopted in 2014 to better describe the genital and urinary changes that occur during and after menopause [2]. Previously known as vulvovaginal atrophy (VVA) or atrophic vaginitis, the term GSM acknowledges that symptoms extend beyond the vagina to the vulva, bladder, and urinary tract.
Symptoms are caused by a decline in estrogen and androgen levels, and unlike hot flushes—which often fade over time—GSM symptoms persist and often worsen as we age [1].
Common Symptoms Include:
Vaginal dryness, irritation, or burning
Painful sex (dyspareunia)
Itching or discomfort of the vulva
Frequent urinary tract infections
Urinary urgency, leakage, or burning (dysuria)
Malodorous or irritating vaginal discharge
In a large US survey of over 3,000 women:
85% reported a loss of intimacy
59% said symptoms reduced sexual enjoyment
47% noted an impact on their relationship
29% said it affected their sleep and overall quality of life [13]
Why Do These Changes Happen?
Estrogen plays a huge role in maintaining vaginal and vulval tissue health. When levels drop:
The vaginal wall becomes thin, less elastic, and more fragile
Lubrication decreases, pH levels rise, and beneficial lactobacilli decline [3]
The vulva loses collagen and pubic hair becomes sparser [2]
The urethra and bladder can become more sensitive, contributing to urinary symptoms [4]
These are real, physical changes. They are not “in your head,” and they are not something you just need to accept.
What Can You Do About It?
🌿 1. General Vulval Care
Small changes can make a big difference:
Avoid scented products, douches, tight clothing, or prolonged moisture (e.g., in wet swimwear)
Wash with plain water or gentle soap substitutes
Use a bland emollient like petroleum jelly as a barrier
Try diluted bicarb soda rinses for itching (½ tsp in 1L water) [13]
💧 2. Moisturisers and Lubricants
Vaginal moisturisers (e.g., polycarbophil gel or hyaluronic acid 0.2%) restore hydration [13–15]
Silicone-based lubricants last longer than water-based ones [16]
Oil-based options can be helpful but aren’t compatible with latex condoms
💊 3. Vaginal Oestrogen
Oestriol or oestradiol creams, tablets, or ovules are low dose, safe, and PBS-listed in Australia
Can be used long term (twice weekly) with minimal systemic absorption—no need for progestogen [17]
Safe in most women and even helps reduce urinary infections [18]
⚠ For breast cancer survivors, vaginal oestrogens may still be used, but only after discussion with an oncologist. Oestriol is generally preferred due to its lower potency [19].
🧬 4. DHEA (Prasterone) Vaginal Pessaries
Available in Australia for moderate to severe vaginal dryness
Improves pH, tissue integrity, and reduces painful sex [20, 21]
Not approved for breast cancer survivors
🚫 5. What About Laser?
A recent high-quality RCT in Australia found no long-term benefit for vaginal laser therapy in GSM [22].
You Deserve Comfort and Confidence
This isn't just about sex. It’s about feeling comfortable in your own skin, confident in your body, and free to enjoy your life without irritation, pain, or embarrassment.
If you’re experiencing symptoms, don’t wait. Let’s talk. At WA Menopause Clinic, we take GSM seriously. We’re here to listen, support, and help you find relief with evidence-based treatments tailored to your needs.
References
Bachmann G. Maturitas 1995;22(Suppl): S1-S5
Portman DJ, Gass ML. J Sex Med. 2014
Naumova I, Castelo-Branco C. Int J Womens Health. 2018
Ptak M et al. Int J Environ Res Public Health. 2017
Nappi RE et al. Climacteric. 2016
Nappi RE, Kokot-Kierepa M. Maturitas. 2010
Kingsberg SA et al. J Sex Med. 2017
Nappi RE et al. Gynecol Endocrinol. 2019
Alvisi S et al. Medicina. 2019
Worsley R et al. Menopause. 2016
Gartoulla P et al. Menopause. 2015
Notelovitz M. Int J Gynaecol Obstet. 1997
NAMS. Menopause. 2013
Nachtigall LE. Fertil Steril. 1994
Stute P. Arch Gynecol Obstet. 2013
Hickey M et al. Breast Cancer Res Treat. 2016
Simunić V et al. Int J Gynaecol Obstet. 2003
Rozenberg S et al. Int J Fertil Womens Med. 2004
RANZCOG Clinical Guidelines (C-Gyn 15)
Archer DF et al. Menopause. 2015
Labrie F et al. Maturitas. 2015
Li FG et al. JAMA. 2021
Comments