Sexual Health & GSM

Sexual health matters at every stage of life — and in midlife, almost no one is immune from the changes. As estrogen and androgens decline through perimenopause and after menopause, the tissues of the vulva, vagina, urethra, and bladder all change. Almost every postmenopausal woman not on local or systemic estrogen will experience some degree of Genitourinary Syndrome of Menopause (GSM) — vaginal dryness, burning, pain with sex, urinary urgency, recurrent UTIs, and more. And it doesn’t resolve on its own. GSM is progressive if untreated — which is why early, preventive treatment is recommended, even for women who aren’t currently sexually active.

The changes you may notice extend beyond the genitourinary tract: decreased desire (libido), difficulty with arousal or orgasm, less intense orgasms, decreased sensation, pelvic floor pain, body-image shifts, and the fatigue and sleep disruption that ride along with menopause itself. These changes are common, often treatable, and not a personal failure.

Sexual health is biopsychosocial

Most women benefit from layered treatment, not a single intervention. The handout breaks the picture into four interconnected layers:

• Biologic — hormones, blood flow, tissue health, pelvic floor
• Psychologic — stress, mood, beliefs, past experiences
• Social and relational — partner dynamics, communication, time, safety
• Behavioral — sleep, movement, intentional intimacy, pleasure

What’s in this guide

Our Sexual Health & GSM patient handout is a three-page reference covering:

• The common sexual changes that come with perimenopause and menopause — and why they’re not in your head
• A clear explanation of GSM, its symptoms, and why it deserves early, proactive treatment
• The four-layer biopsychosocial framework for sexual health
• Foundational lifestyle and behavioral strategies — including the case for regular genital stimulation as preventive care
• Psychological and relationship-based therapies (CBT, sex therapy, AASECT-certified providers)
• Vaginal estrogen — the gold-standard local therapy — how it differs from systemic HRT, and notes on use in patients with breast cancer history
• Vaginal moisturizers and lubricants — what to look for, what to avoid
• Pelvic floor physical therapy, dilator therapy, and the devices with evidence behind them
• Testosterone therapy for hypoactive sexual desire disorder (HSDD)
• The two FDA-approved medications for HSDD: flibanserin (Addyi) and bremelanotide (Vyleesi)
• When to see a clinician with menopause or sexual medicine expertise
• A curated reading list including You Are Not Broken by Kelly Casperson MD, Come As You Are by Emily Nagoski PhD, plus podcasts and apps
• Six peer-reviewed clinical references behind every recommendation

The bottom line

You are not broken — and you are not alone. Sexual changes in menopause are common and treatable, GSM should be treated early and proactively, and pleasure and stimulation are part of preventive care.

Download the full PDF below.