12/03/2025
Evidence update!
Are you familiar with the AUA/SUFU/AUGS guideline on Genitourinary Syndrome of Menopause (GSM)?
Here are 5 takeaways regarding s*xual function:
1️⃣ Sexual symptoms are a core component of GSM
Sexual-health problems such as decreased lubrication/arousal, increased pain with in*******se (dyspareunia), and delayed or diminished or***ms are explicitly recognized as part of GSM.
🗨️ This means when you’re working with patients, s*xual function must be part of the assessment, and not just urinary or vaginal atrophy symptoms.
2️⃣ GSM s*xual symptoms don’t tend to resolve without treatment
Unlike vasomotor symptoms of menopause (hot flashes, night sweats) that may reduce over time, or with medical treatment, GSM-related s*xual problems tend to persist or worsen unless addressed.
🗨️ For your clinical practice, this underscores the importance of early screening, approaching patients with a trauma-informed care lens, and referring to a s*x therapist or counselor as appropriate.
3️⃣ There is strong evidence that low-dose local vaginal estrogen improves s*xual health outcomes
Local (vaginal) low-dose estrogen therapy has the most robust evidence base for improving GSM symptoms, including s*xual discomfort and dyspareunia.
🗨️ As a pelvic health specialist, this supports recommending or collaborating with prescribing practitioners on vaginal estrogen therapies when appropriate (and safe) for improving patient s*xual outcomes, including those patients who are on systemic estrogen therapy.
4️⃣ Emerging evidence supports vaginal DHEA (dehydroepiandrosterone) for s*xual function
The guideline mentions that vaginal DHEA has been shown to improve s*xual function, decrease vaginal pH, and improve vaginal epithelial anatomy.
🗨️ Pelvic PTs should educate and collaborate with prescribing practitioners on vaginal DHEA when appropriate, including for those patients who are on systemic estrogen therapy.
5️⃣ Shared decision-making and addressing s*xual wellness beyond anatomy are essential
This guideline emphasizes the importance of shared decision-making with respect to a patient's s*xual goals, preferences, psychological context, and overall quality of life.
🗨️ Clinicians need to consider the whole person and not just the physical/tissue changes that occur with GSM care.
References:
Kaufman, M. R., Ackerman, A. L., Amin, K. A., Coffey, M., Danan, E., Faubion, S. S., Hardart, A., Goldstein, I., Ippolito, G. M., Northington, G. M., Powell, C. R., Rubin, R. S., Westney, O. L., Wilson, T. S., & Lee, U. J. (2025). Executive Summary: The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. Urogynecology (Philadelphia, Pa.), 31(11), 1005–1014. https://doi.org/10.1097/SPV.0000000000001753
