Dryness, irritation, infections and discomfort. They're more common than you might think — and they deserve a place in the menopause conversation.
When we talk about menopause, we talk about hot flashes. Night sweats. Sleepless nights. Mood swings. Brain fog.
But what about the vulva?
For something that affects so many women, intimate discomfort is still surprisingly absent from the conversation.
There's even a medical term for the changes that can happen to your intimate health during perimenopause, menopause and beyond: Genitourinary Syndrome of Menopause, or GSM.
Never heard of it? You're not alone.
And that's exactly why we need to talk about it.
FIRST THINGS FIRST. WHAT IS GSM?
GSM is a medical term describing changes to the vulva, vagina and urinary tract associated with declining estrogen and other hormonal changes during perimenopause and after menopause.
Estrogen does more than regulate your menstrual cycle. It also helps maintain the thickness, elasticity, moisture and overall health of vaginal and vulvar tissues.
As estrogen levels fluctuate and eventually decline, these tissues can become thinner, drier, less elastic and more sensitive. Vaginal lubrication may decrease, and changes in vaginal pH and the microbiome can also occur.
The result? A range of symptoms that can affect everyday comfort, intimacy and quality of life.
And no, it's not just about vaginal dryness.
HOW COMMON IS GSM?
GSM affects more than half of postmenopausal women in some studies.
Research commonly estimates that around 40–60% of postmenopausal women experience genitourinary symptoms, with some studies reporting even higher numbers.
But here's something important: the true extent of the problem is difficult to measure.
Many women never mention their intimate symptoms to a healthcare professional. Some don't seek help at all. Others assume that dryness, irritation or discomfort is simply an inevitable part of getting older.
And unless someone asks, the subject may never come up.
The British Menopause Society highlights this reluctance to discuss symptoms as an important contributor to underdiagnosis and undertreatment.
In other words, the women we know about may not tell the whole story.
If something is this common, why are we still so uncomfortable talking about it?
IT'S NOT JUST DRYNESS. HERE'S WHAT GSM CAN FEEL LIKE.
GSM doesn't look or feel the same for everyone. Some women experience mild discomfort, while others develop symptoms that significantly affect their daily lives.
Common symptoms and associated changes include:
- Dryness: A feeling of dryness or tightness around the vulva or inside the vagina.
- Burning and irritation: Sensitive tissues that may sting, itch or feel uncomfortable.
- Increased sensitivity: Everyday things like underwear, wiping or friction may become uncomfortable.
- Pain during sex: Reduced lubrication and changes in tissue elasticity can make penetration painful.
- Urinary symptoms: Increased urgency, discomfort when urinating and recurrent urinary tract infections.
- Increased vulnerability to certain infections: Hormonal changes can alter the vaginal environment, and GSM is associated with an increased risk of recurrent urinary tract infections.
- Changes in vaginal odor: Changes in vaginal pH and the microbiome may affect vaginal odor. However, a new, strong or unpleasant smell is not a defining symptom of GSM and may indicate an infection that needs medical attention.
Not everyone experiences all these symptoms, and some women experience none at all.
It's also important to remember that these symptoms can have other causes, including infections and skin conditions. New or persistent discomfort should never automatically be assumed to be menopause-related.
WAIT. CAN THIS START DURING PERIMENOPAUSE?
Yes.
And this is something we wish more women knew.
You don't have to have reached menopause to experience changes in your intimate health.
During perimenopause — the transitional years leading up to menopause — estrogen levels can fluctuate significantly. For some women, these changes may already affect vaginal lubrication, tissue comfort and sexual health.
You might still be having regular periods. You might not be experiencing hot flashes. You might not even have considered that you're in perimenopause.
Yet your vulva may already be telling a different story.
For many women, GSM symptoms become more noticeable after menopause, when estrogen levels remain consistently lower.
Unlike hot flashes, which often improve over time, GSM tends to persist and may worsen without appropriate treatment.
Menopause isn't a single moment. And neither are its effects on your body.
THE VULVA IS NOT THE VAGINA. AND THE DIFFERENCE MATTERS.
Let's clear something up.
The vulva refers to the external genital area, including the labia, clitoris and vaginal opening.
The vagina is the internal canal.
Both can be affected by hormonal changes, but their needs aren't necessarily the same.
Vaginal dryness and changes to the internal vaginal environment are important aspects of GSM. But the external vulvar tissues can also become dry, fragile and more sensitive.
That means discomfort isn't limited to sex.
It can happen when you're walking, exercising, wearing certain underwear or simply going about your day.
And yet, intimate health is still so often discussed only in relation to sexual activity.
Your vulva deserves care and attention whether you're having sex or not.
WHAT CAN YOU DO ABOUT GSM?
First, know that you don't have to simply put up with it.
There are effective treatments and ways to manage symptoms. The right approach depends on the type and severity of your discomfort.
1. SUPPORT YOUR SKIN'S NATURAL BARRIER
When vulvar skin becomes dry and sensitive, gentle care becomes especially important.
Our advice? Skip the foam.
Foaming cleansers, soaps and products containing potentially irritating surfactants can aggravate already sensitive vulvar skin. When dryness and irritation are an issue, it's worth leaving foaming products out of your intimate-care routine and choosing a gentler approach.
The vulva doesn't need aggressive cleansing. In fact, overcleansing can make discomfort worse.
This is why we developed ME NO PAUSE Cleansing ´Moisturizing Oil, specifically with the changing needs of the vulva during perimenopause, menopause and beyond in mind.
This fragrance-free, oil-based cleanser is enriched with macadamia oil, oat oil and bisabolol — ingredients selected for their nourishing, skin-conditioning and soothing properties.
Designed to cleanse gently while helping to maintain the skin's natural moisture barrier, it offers a caring alternative to traditional foaming cleansers when the vulva needs a little extra attention.
For extra care, our Lip Balm provides a soothing, protective layer that helps lock in moisture, reduce moisture loss and protect delicate vulvar skin from friction. Especially beneficial when the skin feels dry, sensitive or easily irritated, it helps keep the vulva soft, comfortable and protected throughout the day.
2. DON'T UNDERESTIMATE THE IMPORTANCE OF LUBRICATION
Changes in natural lubrication can make intimacy uncomfortable, even when you're fully aroused.
And let's be clear: arousal and lubrication aren't the same thing.
Using a suitable lubricant can help reduce friction, protect delicate tissues from friction-related irritation and make intimacy more comfortable.
Our water-based lubricant Wet Lips combines hydrating hyaluronic acid with prebiotics designed to support a balanced intimate microbiome. Its pH-balanced formula provides smooth, comfortable glide while helping to reduce friction — especially when natural lubrication needs a little extra support.
3. KNOW WHEN SKINCARE ISN'T ENOUGH
This is important.
While gentle intimate skincare, moisturizers and lubricants can help relieve certain symptoms, they cannot reverse the underlying hormonal changes associated with GSM.
For women experiencing persistent symptoms, local vaginal estrogen is an established, evidence-based treatment that can improve vaginal tissue health and relieve discomfort.
Other medical treatment options are also available.
According to NICE guidelines, non-hormonal moisturizers and lubricants may be used alone or alongside vaginal estrogen. The most appropriate treatment should be discussed with a healthcare professional, particularly if you have a history of hormone-sensitive cancer.
If you're experiencing persistent burning, pain, recurrent urinary problems, unusual discharge, changes in odor or bleeding, seek medical advice rather than assuming it's GSM.
You deserve proper care, not guesswork.
WHY WE NEED TO TALK ABOUT IT
We've come a long way in opening up the menopause conversation.
We're talking more about hormones, mental health, sleep and the changes women experience in midlife.
And that's progress.
But intimate health still seems to be one of the last subjects we're comfortable bringing into the open.
Perhaps because many of us grew up without even learning the correct word for our vulva.
Perhaps because vaginal dryness is still treated as something embarrassing.
Or perhaps because women's intimate discomfort has been normalized for far too long.
Whatever the reason, it's time to change the conversation.
GSM is common. It's real. And it can affect much more than your sex life.
Discomfort shouldn't be something women are simply expected to live with.
ME NO PAUSE. BECAUSE YOUR INTIMATE HEALTH MATTERS AT EVERY STAGE.
Let's make vulvar health part of the menopause conversation.
Not just this month. Every month.
SOURCES & FURTHER READING
-
British Menopause Society (2025). Genitourinary Syndrome of Menopause (GSM). Consensus statement, reviewed November 2025.
https://thebms.org.uk/publications/consensus-statements/genitourinary-syndrome-of-menopause-gsm/ -
NICE (2024). Menopause: Identification and Management (NG23). Updated clinical recommendations on genitourinary symptoms.
https://www.nice.org.uk/guidance/ng23/chapter/Recommendations -
International Menopause Society (2025). Recommendations and Key Messages on Women's Midlife Health and Menopause.
https://doi.org/10.1080/13697137.2025.2585487 -
NICE (2024). Managing genitourinary symptoms (network meta-analyses). Evidence review supporting guideline NG23.
https://pubmed.ncbi.nlm.nih.gov/39637093/
