--- title: "How Genitourinary Syndrome of Menopause (GSM) Can Affect Libido even in your late 30's and early to mid 40's" entity: "blog" canonical_url: "https://www.dramytung.com/blog/how-genitourinary-syndrome-of-menopause-gsm-can-affect-libido-in-your-30s-and-40s" markdown_url: "https://www.dramytung.com/llms/blog/how-genitourinary-syndrome-of-menopause-gsm-can-affect-libido-in-your-30s-and-40s" lastmod: "2025-08-04T10:00:00.000Z" --- Genitourinary Syndrome of Menopause (GSM) If you're in your late 30's or early or mid 40's and you've noticed a drop in your sexual desire, you're not alone things. For many women, changes in libido can begin well before menopause and can start during the [menopausal transition (also known as the perimenopausal years)](/blog/understanding-menopause-symptoms-stages-and-what-to-expect). The reason symptoms can start much earlier then expected, is due to the role estrogen has and how it can drastically fluctuate during this transitional time of almost a decade. One of the lesser-known contributors is something called Genitourinary Syndrome of Menopause (GSM). # What Is GSM? [Genitourinary Syndrome of Menopause (GSM)](/blog/low-libido-in-perimenopause-understanding-causes-and-solutions) refers to a collection of symptoms caused by declining estrogen levels that affect the vagina, vulva, bladder, and urinary tract. It's also known by its previous name, vulvovaginal atrophy (VVA) or "vaginal atrophy". You can read the menopause society's latest Menonote on GSM released in 2025 [here](https://files.hivecdn.com/e2b53ad4-7da3-4eb7-8433-cbe94b97238a/MenoNote-GSM.pdf). “GSM includes genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria, and recurrent infections.” - (The North American Menopause Society, 2014) While GSM and symptoms associated with the loss of estrogen such as vaginal dryness, is more common in the postmenopausal years, symptoms of GSM can begin well before a women loses her period. This can mean symptoms can often begin much earlier then women often expect. These changes can creep in subtly, leading to discomfort during intimacy that gradually chips away at desire. # How GSM Affects Libido When sex becomes physically uncomfortable or painful, it’s no surprise that desire will fade. Women often describe a cycle where discomfort leads to avoidance, and avoidance leads to feeling disconnected from their sexuality. Let's discuss some specific ways GSM can impact libido: # 1. Vaginal Dryness and Discomfort Declining estrogen causes the vaginal lining to thin and lose elasticity, while natural lubrication decreases. “Estrogen deficiency leads to epithelial thinning, decreased blood flow, and reduced secretions, resulting in vaginal dryness and irritation.” (Santoro et al., 2016) This dryness can make arousal more difficult and intercourse uncomfortable—or even painful (a condition called dyspareunia ). # 2. Decreased Sensation As estrogen levels drop, so does blood flow to the vulva and clitoris, which may lead to reduced sensation and slower arousal. What used to feel good might now feel muted or even numb, making it harder to feel connected or responsive during intimacy. # 3. Changes in Urinary Function Bladder symptoms are part of GSM, too. Increased urgency, frequency, and discomfort can all contribute to feeling less at ease in your body—especially during sex. Recurrent urinary tract infections (UTIs) can also add to the avoidance of intimacy. # 4. Emotional and Psychological Impacts When physical intimacy becomes challenging, many women start to feel self-conscious, frustrated, or distant from their partner. This can create a feedback loop where emotional stress further suppresses desire. “Sexual desire is influenced not only by physical health, but also by emotional connection, body image, and psychological well-being.” (Brotto et al., 2010) # How Common Is GSM in Perimenopause? GSM affects around 50% of postmenopausal women. Despite its prevalence, GSM is often underdiagnosed and undertreated. Many women assume their symptoms are just "normal aging" or feel too embarrassed to bring them up. “A significant number of women report GSM symptoms during the perimenopausal years, particularly those with early or rapid declines in estrogen.” (Simon et al., 2013) # How Is GSM Diagnosed? If you’re experiencing symptoms like vaginal dryness, irritation, burning, discomfort during sex, or urinary changes, talk to your healthcare provider. Diagnosis is usually based on symptoms and a physical exam. Sometimes a vaginal pH test or hormone level check can help rule out other causes. Treatment Options for GSM-Related Low Libido Addressing the physical symptoms of GSM often leads to improvements in sexual desire. Here are some of the most common and effective options: # 1. Local Estrogen Therapy [Low-dose estrogen](/blog/low-libido-in-perimenopause-understanding-causes-and-solutions) applied directly to the vagina is the gold standard for treating GSM. It helps restore thickness, elasticity, and moisture to the vaginal tissue. Vaginal estrogen requires a prescription from your primary care provider. Forms include: - Vaginal creams e.g. Estrace or Premarin vaginal cream (0.5-1 g placed in vagina daily for 2 wk, then 2-3 times/wk generic available), Compounded Estriol Vaginal Cream (0.5-1g is inserted for 2 wk and then 2x a week) can be an option for some women - Vaginal tablets e.g. [Vagifem](https://www.novocare.com/womens-health/vagifem.html) (Vagifem® 10 mcg estradiol vaginal inserts, inserted 14 days and then twice a week), Imvexxy (estradiol softgel insert placed in vagina daily for 2 wk, then twice/wk: 4 µg, 10 µg). - Vaginal rings e.g. "[Estring](https://www.estring.com/)" (Estring is inserted by your primary care provider and is a small, flexible estradiol ring placed in vagina and changed every 3 mo: 7.5 µg/d). “Local estrogen therapy is highly effective in treating symptoms of GSM and is associated with improvements in sexual function.” (The Menopause Society, 2022) Local estrogen has minimal systemic absorption, making it safe for most women, even those who can't use systemic hormone therapy. # 2. Vaginal Moisturizers and Lubricants Regular use of [non-hormonal vaginal moisturizers](/blog/low-libido-in-perimenopause-understanding-causes-and-solutions) can improve hydration and comfort. Water-based lubricants can be used during sex to ease friction and enhance sensation. Hyaluronic acid based vaginal moisturizers are helpful to keep the tissue moist and are used away from intercourse. Whereas lubricants are recommended prior to intercourse. They can both be very helpful in reducing pain and friction for many women during different times during the menopausal transition. Some of the brands I often recommend to my patients are: [Good Clean Love](http://www.goodcleanlove.com) (vaginal moisturizer and lubricant options), [Gynatrof](http://www.gynatrof.com) (vaginal moisturizer), are both great options. Look for products that are: - Fragrance-free - Paraben-free - pH-balanced for vaginal use “Moisturizers used several times per week can help maintain vaginal elasticity and reduce dryness-related discomfort.” (Parish et al., 2019) # 3. Laser and Energy-Based Therapies Newer options like fractional CO2 lasers or radiofrequency treatments stimulate collagen production and improve vaginal tissue quality. These are still being studied but show potential promise for GSM-related symptoms. # 4. Pelvic Floor Therapy Tight or weak pelvic floor muscles can contribute to discomfort during sex. Working with a pelvic floor physiotherapist can improve strength, coordination, and comfort. Look for a therapist who has a focus in working with women in the perimenopausal and menopausal years. # 5. Adaptogenic and Botanical Support Some herbs may support hormone balance, mood, and sexual function: - [Ashwagandha](/blog/discover-the-benefits-of-ashwagandha-root-extract-for-women-with-mild-perimenopausal-symptoms): Traditionally used to reduce stress and support libido - Maca root: May enhance energy and sexual desire - Tribulus terrestris: May support androgen levels As always, speak with a licensed naturopathic doctor before starting any herbal treatments. # 6. Psychosexual Therapy and Mindfulness Addressing the emotional and psychological aspects of libido is essential. Mindfulness-based sex therapy, cognitive behavioural therapy (CBT), and relationship counselling can all be helpful. “Mindfulness-based interventions improve sexual satisfaction, arousal, and desire in women with distressing sexual symptoms.” (Brotto et al., 2012) # Whole-Body Approach for Libido and GSM When GSM symptoms are addressed effectively, many women notice that their libido starts to return. The key is recognizing that physical, hormonal, and emotional factors are all connected. A comprehensive approach might include: - Local estrogen or non-hormonal therapies - Lubricants and vaginal moisturizers - Pelvic floor therapy - Herbal and nutritional support - Psychosexual or relationship counselling # Don't be afraid to ask for help If you’ve been experiencing symptoms that are interfering with your comfort, confidence, or relationships, don’t wait. GSM is treatable, and addressing it early can make a big difference in how you feel—physically and emotionally. I offer free discovery calls for women navigating these transitions and you can book [here](https://dramytung.janeapp.com/#/free-discovery-call). To your best health, Dr. Amy Tung, ND Naturopathic Doctor | Menopause Society Certified Practitioner # References North American Menopause Society (NAMS). (2022). Position Statement on the Treatment of Genitourinary Syndrome of Menopause. Santoro, N., Epperson, C. N., & Mathews, S. B. (2016). Menopausal symptoms and their management. Endocrinology and Metabolism Clinics, 44(3), 497–515. Brotto, L. A., et al. (2010). A mindfulness-based group psychoeducational intervention targeting sexual arousal disorder in women. Journal of Sexual Medicine, 5(7), 1646–1659. Parish, S. J., et al. (2019). The role of nonhormonal vaginal moisturizers and lubricants in managing GSM. Climacteric, 22(3), 228–235. Simon, J. A., et al. (2013). Perimenopausal and postmenopausal GSM symptoms: A review of current literature. Journal of Women's Health, 22(5), 389–395.