What Happens to Your Vagina During Menopause?
Understanding Vaginal Aging, GSM, and Treatment Options
Menopause causes real, physical changes in the vagina, known as Genitourinary Syndrome of Menopause (GSM). Symptoms like dryness, painful sex, and urinary issues are common but treatable. First-line therapies include vaginal estrogen, DHEA, and hormone replacement, while non-hormonal options like laser and RF treatments offer effective relief for many women. You don’t have to suffer—safe, physician-led treatments can restore comfort, intimacy, and confidence.
Let’s break down what GSM is, why it matters, and treatment options.
What Is GSM?
Genitourinary Syndrome of Menopause (GSM) describes the vaginal and urinary changes that occur due to declining estrogen during menopause and perimenopause.
Common Vaginal Symptoms of GSM:
- Vaginal dryness
- Burning or irritation
- Pain with sex (dyspareunia)
- Decreased elasticity and tone
Urinary Symptoms of GSM:
- Increased urgency or frequency
- Pain or burning with urination
- Recurring urinary tract infections (UTIs)
These symptoms are often progressive—and they don’t go away without treatment.
How Is GSM Diagnosed?
GSM is a clinical diagnosis based on your symptoms and sexual history. It may also include a physical exam or pH testing, but the most important factor is how you feel.
Your doctor may ask:
- Are you experiencing vaginal dryness or discomfort?
- Has your sex life changed due to pain or irritation?
- Are you having urinary issues like urgency or frequent infections?
Treatments for Vaginal Aging and GSM
1. Vaginal Estrogen
Considered the first-line treatment for GSM by AUA guidelines. It’s applied locally, doesn’t significantly raise systemic hormone levels, and provides direct relief from dryness, irritation, and thinning tissues.
2. Vaginal DHEA (Prasterone)
A non-estrogen option approved for painful sex and dryness. Especially helpful for women avoiding estrogen-based treatments.
3. Systemic Hormone Replacement Therapy (HRT)
Estrogen therapy can help with full-body menopause symptoms, including some vaginal changes. However, many still need local vaginal treatment for complete relief.
What If You Can’t Use Hormones?
Some women prefer non-hormonal or non-pharmaceutical options. That’s where regenerative vaginal rejuvenation therapies come in.
🔬 Vaginal Laser Treatments (CO₂ & Er:YAG)
These lasers stimulate collagen production, improve blood flow, and enhance lubrication, tone, and elasticity. Clinical studies show measurable improvement in vaginal health and sexual comfort.
🌡️ Radiofrequency (RF) Therapy
Uses gentle, controlled heat to tighten tissue, boost collagen, and improve symptoms like dryness, urinary leakage, and painful intercourse.
What Does the Research Say?
While AUA guidelines still label vaginal lasers and RF treatments as “experimental,” many studies demonstrate positive outcomes:
| Study | Year | Treatment | Participants | Findings |
| Salvatore et al. | 2015 | CO₂ Laser | 50 | Improved vaginal health index and pain |
| Pitsouni et al. | 2016 | Er:YAG Laser | 45 | Better GSM symptoms and vaginal pH |
| Sokol et al. | 2017 | RF Therapy | 40 | Relief of dryness, urinary issues, and pain |
*More studies are ongoing—but real-world results are promising, especially when therapies are physician-directed.
My Recommendation
At RevitalyzeMD, we take an evidence-based, patient-centered approach to sexual wellness and hormone care. We offer:
- Bioidentical hormone replacement
- Vaginal estrogen and DHEA
- Non-surgical vaginal laser and RF treatments
These options are safe, effective, and performed by an experienced physician who understands the physical and emotional effects of menopause.
Schedule Your Consultation
Menopause doesn’t have to mean discomfort, painful sex, or declining intimacy. Whether you’re in perimenopause, post-menopause, or experiencing early symptoms, you have real, proven options.
Ready to learn more about vaginal rejuvenation or hormone therapy? Schedule a private consultation with Dr. Debra Durst at RevitalyzeMD in Knoxville, TN. We specialize in regenerative medicine for women’s health, and we’re here to help. Let’s talk about your goals and help you feel like yourself again.
FAQS
Is vaginal dryness normal after 40 or 50?
Yes, vaginal dryness is common during perimenopause and menopause due to hormonal changes. However, just because it’s common doesn’t mean you have to live with it. Treatments like vaginal estrogen, DHEA, and laser therapy can safely restore comfort and intimacy.
What are non-hormonal treatments for vaginal aging?
Non-hormonal treatments include vaginal laser therapy (such as CO₂ or Er:YAG lasers) and radiofrequency (RF) therapy. These technologies stimulate collagen production and improve tissue health, helping to reduce dryness, improve elasticity, and even relieve urinary symptoms—without hormones or surgery.
Is vaginal laser therapy safe?
Yes, when performed by a trained and experienced physician, vaginal laser therapy is considered safe. While the American Urological Association still classifies it as experimental, multiple peer-reviewed studies show significant improvements in GSM symptoms with minimal side effects.
Can hormone therapy help with vaginal symptoms?
Absolutely. Hormone replacement therapy (HRT) can help with systemic menopause symptoms like hot flashes and mood changes. However, local vaginal estrogen or DHEA is often more effective for vaginal dryness and discomfort. Many women benefit from combining both.
How do I know which treatment is right for me?
The best treatment depends on your symptoms, medical history, hormone status, and personal preferences. At RevitalyzeMD, we customize care using labs, symptoms, and your goals—whether that includes hormones, regenerative therapy, or a combination.