Genitourinary Syndrome of Menopause Can Seriously Mess With Your Vulva (SELF)

Tier 1: Established: peer-reviewed research or government health authority
Publisher: SELF · Published: April 9, 2026 · Accessed: August 8, 2026

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Genitourinary syndrome of menopause (GSM) is a newer term, introduced in 2014, for a range of vulvovaginal, sexual, and urinary tract symptoms that can happen when estrogen levels decline in perimenopause.
GSM affects as many as 27% to 84% of menopausal women, yet only about 7% of women with it are receiving treatment; without care it tends to get worse rather than go away.
With declining estrogen, vulvovaginal tissue becomes more fragile and prone to tearing, thinning, and dryness; postmenopausal tissue has fewer cell layers, which is what causes the shrinkage noticeable in the vulva.
Labia minora may start to fuse together or become paler in color, and the clitoral hood can get smaller; GSM also includes vaginal dryness, itching or irritation, pain during sex, decreased libido, recurrent UTIs, and urinary urgency or discomfort.
Shrinking labia provide less protective barrier around the urethra, and vaginal pH and microbiome changes can allow more harmful bacteria, both raising urinary tract infection risk; treatments include vaginal estrogen, moisturizers, and lubricants.