Genitourinary Syndrome of Menopause (GSM)
Geniotourinary syndrome of menopause is a relatively new term in what used to be called vulvovaginal atrophy, atrophic vaginitis or urogenital atrophy. A lack of estrogen that naturally occurs in the menopausal transition contributes to vaginal dryness, painful sex and reduced lubrication. Not fun! While this is very common in menopause, it also occurs in low estrogen times of life, like postpartum or after prolonged use of hormonal birth control.
The Importance of Sexual Health
Sex and orgasm are rarely discussed, yet they play a crucial role in overall well-being. Good sexual energy is healthy! Regular sexual activity and orgasm:
Decreases pain
Decreases stress
Decreases depression
Decreases the risk of cancer
Decreases the risk of heart disease
Twice weekly intercourse decreases the risk of heart attack by 50%
Decreases the risk of ulcers
Increases the sense of well being
Increases longevity
Increases self esteem and happiness
Increases joy
Increases immune system function
Increases tissue health and bladder function
Improves sleep
Pelvic Floor Physical Therapy: A Detective’s Approach
As pelvic floor physical therapists, it is our job to act like detectives: identifying where the issue lies and, just as importantly, why it exists.
Understanding Menopause
What is menopause? Menopause is defined as the final cessation of periods and occurs, on average, between ages 42 and 58 and reflects the end of the reproductive years. The time before menopause is considered perimenopause where periods can become irregular and symptoms can range from hot flashes, vaginal or sexual symptoms, sleep and mood changes. Musculoskeletal issues like more joint pain, muscle pain, overuse injuries and tendinopathies are also more common. In this time period and beyond, vaginal dryness, decreased libido, bladder symptoms, decreased orgasm intensity and quality are common.
Female Sexual Dysfunction
In a study of perimenopausal women (Journal of sexual medicine 2016 McCool), female sexual dysfunction was 41%, which is quite high! Female sexual dysfunction can be categorized into issues with desire, arousal, orgasm and/or pain:
Desire disorders: lack of sexual desire or interest in intercourse
Arousal disorders: inability to become physically aroused or excited during intercourse
Orgasm disorders: inability to or delay in orgasm (or decreased quality of orgasm)
Pain disorders: pain during intercourse
Some of these elements are intertwined. When pain occurs during arousal or intercourse due to pelvic floor muscle pain, sexual desire naturally declines.
Comprehensive Assessment at RVA Holistic PT
Part of our assessment at RVA Holistic PT is figuring out the WHY by assessing:
The vulva
The pelvic floor muscles
The whole person in front of us
The Vulvar Tissues
Part of our comprehensive pelvic floor exam is looking at the vulvar tissues for signs of low estrogen and atrophy like a small clitoris, clitoral phimosis (clitoral adhesions), decreased labial size, pale color of the vulva, dryness and potential irritation or abrasions. As one may expect, vulvar dryness and atrophy can make intercourse uncomfortable, painful and reduce the quality and intensity of orgasm. The tissues around the urethral sphincter can atrophy and contribute to leaking and incontinence.
Low estrogen states are a common finding in our detective work! We find this in the perimenopause, menopause, postpartum, breastfeeding person… as well as on occasion with women who have been on hormonal contraceptives for some time. When we find vulvar changes we suspect have to do with low estrogen status, we often collaborate with a patient’s referring provider who may choose to suggest a topical estrogen, estrogen-testosterone or an estrogen-mimicing cream.
The Pelvic Floor Muscles
In menopause, we lose muscle mass and our fast twitch muscle fibers in ALL of our muscles– including our pelvic floor! Our job is to assess if there is weakness in the pelvic floor and if so, is it the right side or left? Is it the front part of the pelvic floor supporting the bladder OR the back part supporting our bowels? Is it the deep part of our pelvic floor or the more outer part that supports our sphincters?
We also assess if the pelvic floor is actually tight. Just like we hold stress in tension in our shoulders or neck (or TMJ/ jaw!), some of us hold tension in our hips and pelvic floor. Tight muscles are often painful and WEAK. Our detective work teases out if this is the case for you, and if so, kegels can make your pain and leaking worse.
The Whole Person in Front of Us
Ah, this is so important! Sexual dysfunction is complex. Sometimes it is due to local tissues in a low estrogen state or local muscles that are tense, tight and painful. Other times, it may have to do with a high stress lifestyle, an unhappy work or home environment, poor sleep, inflammatory dietary choices or constipation. We look at the body not only head-to-toe but also consider the woman’s mind-body-spirit.
There are many current therapies that now are out there to address some of the muscle and vulvar changes that are associated with menopause and contribute to pain, incontinence/ leaking and decreased orgasm.
Current therapies include:
Medical
Hormone support, prescribed by your doctor, can be immensely helpful
Platelet Rich Plasma (PRP)
Vaginal lasers
Herbal supplements
Peptides
Vaginal procedures
Physical
Our specialized pelvic health therapy team are experts in improving lifestyle factors, improving muscle function and assessing the root causes of nerve function, hormonal function locally at the vestibule/ vulva and muscle function. I cannot state how important a highly skilled pelvic floor therapist is in your health and well being in this time of life
Understanding Shockwave Therapy
Shockwave: at our West End office, we now offer Gainswave shockwave for the treatment of female sexual dysfunction (as well as Erectile Dysfunction in men).
What is shockwave?
Shockwave has been approved since 2000 for various musculoskeletal conditions
Shockwave has been well studied in erectile dysfunction and has shows beneficial effects; Naturally, it is less studied in female sexual dysfunction (as is the history of women’s health)
The erectile function of the female clitoris is similar to the male, so we extrapolate some of the beneficial effects of shockwave on ED to the female pelvic floor and clitoris
Studied in men: chronic pelvic pain and chronic prostatitis (chronic pelvic pain in men) in the international journal of molecular science 2016 showed
Improved angigenisis (blood flow formation)
Promoted tissue healing
Inhibited inflammation and pain
Differentiated stem cells
Stimulated nerve regeneration
Stimulated muscle regeneration
This innovative treatment has no downtime and no side effects and has been very well researched in male erectile dysfunction.
Want to Learn More?
Explore our other blogs on:
If you would like to see us in person at our Fan District or West End office or virtually from anywhere, we would love to be your personal detective.
References
Rothschild, Carey E. PT, DPT1; Collingwood, Tara Gidus MS, RDN, CSSD, LDN, ASCM-CPT2. Maximizing Running Participation and Performance Through Menopause. Journal of Women's & Pelvic Health Physical Therapy 47(2):p 133-143, April/June 2023. | DOI: 10.1097/JWH.0000000000000276
Vetrovsky T, Steffl M, Stastny P, Tufano JJ. The Efficacy and Safety of Lower-Limb Plyometric Training in Older Adults: A Systematic Review. Sports Med. 2019 Jan;49(1):113-131. doi: 10.1007/s40279-018-1018-x. PMID: 30387072; PMCID: PMC6349785.
Yoon S, Lee D, Bang J. Perimenopausal arthralgia in the shoulder. Menopause. 2018; 25 (1): 98-101. doi: 10.1097/GME.0000000000000944.
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