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non-hormonal treatments for GSM

There Are Several Options For Non-Hormonal Treatments for GSM.

Some include hormones, while others do not.

Today we will review some non-hormone treatment options. As always, consult with your physician to help you make the best decisions regarding your health.

Review: What is GSM?

As we discussed in a previous post, genitourinary syndrome of menopause (GSM) is a relatively new term that describes the different genital, sexual, and urinary signs and symptoms that can occur during menopause.

Here is a table that outlines the different signs and symptoms of GSM, originally printed in Portman, 2014:

GSMchart

Non-Hormonal Treatments of GSM

Use it or Lose it: Maintain Sexual Activity

Maintaining some regularity in your sexual activity, including partnered sex or masturbation, will stimulate vaginal, vulvar, and genital tissues and help maintain sexual function. Use of dilators, vibrators, and penetrative sex will stimulate and stretch the vulvar and vaginal tissues to maintain function. Sexual arousal will increase circulation to the genital tissues, and orgasm will help circulate blood and lymphatic fluid out of the pelvic bowl also.

Lubricants and Moisturizers

Lubricants can be used as needed for sexual activity to increase comfort and pleasure. Check out our prior blog post on lubes to help you choose a lube that won’t damage your tissues.

Lube can:

  • Be used for penetrative and non-penetrative sex, masturbation, and sex toy play
  • Improve lubrication, pleasure, and moisture
  • Decrease friction and discomfort
  • Decrease failure of sexual barriers (IF COMPATIBLE, more on that later)
  • Takes some pressure off the body to “perform” and create enough moisture
  • Makes sexual activities possible for many folks

Common types of lubricants: oil, water-based, and silicone

Water-based lubes

Ideal for people with sensitive skin or vaginal irritation and are safe to use with condoms and sex toys. However make sure your lube has proper osmolality and pH level (read below). Water-based lubes tend to get "sticky" and you may need to re-apply if you are engaging in sex for a long time.

Silicone-based lube

Very slippery and long lasting and is safe to use with condoms. However, silicone-based lubes cannot be used with silicone sex toys, as they can damage the toy. Silicone-based lubes may be more difficult to wash off skin than water-based and may stain sheets, so keep that in mind.

Oil-based lube

We like to recommend organic coconut oil. Oil based lubes are slippery and last longer than water-based lubes. However, oil based lubes are not compatible with latex condoms, as they make the condoms easier to break. Like silicone-based lube, oil-based can stain sheets and be harder to wash off than water-based lube.

Vaginal Moisturizers

Long-term vaginal moisturizers are designed to be used daily or every few days on a regular basis to maintain vulvar and vaginal moisture. These moisturizers are designed to mimic normal vaginal secretions. Read our blog on the importance of picking the right pH and osmolality of lubricants and moisturizers to make sure your lube/moisturizer is not damaging your tissues.

Check out this chart published by the World Health Organization (WHO) listing brand names of lubricants and moisturizers and the pH levels and osmolalities of each product.

Topical lidocaine

Consult with your doctor to see if a genital-safe lidocaine gel or ointment could help with your pain with sex. Lidocaine temporarily numbs whatever it comes in contact, so it may help reduce pain at the opening of the vagina. However, be aware that lidocaine may affect the sensation of your partner as well.

Pelvic Floor Therapy

Pelvic floor therapy can help with common menopausal pelvic health issues including urinary incontinence, bowel issues, pain with sex, and pelvic pain.

Urinary Incontinence

Losing urine when with coughing, sneezing, and laughing is known as stress urinary incontinence. It is common to hear stories about this, as well as “overactive bladders” and “nervous bladders” which lose urine on the way to the bathroom and with strong urge.

Between 12.8 to 46% of women deal with urinary incontinence during their lifetime, with an increase during and after menopause. This is due to: a reduction of elasticity in the genital tissues, thinning in the tissues lining the urethra (the tube that empties urine from the bladder, and reduced muscular strength in the pelvic floor, the group of muscles that supports your pelvis and keeps your “holes” closed.

How Pelvic Floor Therapy Can Help with Urinary Incontinence

Pelvic floor therapy can help you train your pelvic floor muscles, increasing the strength of the muscles. A pelvic floor therapist can will also correct muscle incoordination that can lead to leakage.

Bowel Issues

The research is inconclusive as to whether or not menopause directly causes or worsens constipation, diarrhea, and Irritable Bowl Syndrome (IBS). However it is clear that stress tension, and anxiety all affect bowel health and regularity.

How Pelvic Floor Therapy Can Help with Bowel Issues

A pelvic health therapist can help you with neuromuscular re-education, biofeedback, and self care techniques such as abdominal massage that can regulate the GI system and promote regularity.

Pelvic Pain and Painful Sex

According to Minkin et al. 77% of women with menopause report vaginal dryness, and about 40% report pain with sexual intercourse and touch to the genitals.

When sex is painful, this can trigger anxiety about sex. This anxiety then triggers a new cycle of sexual problems: muscle guarding, decreased lubrication, and pelvic floor tension.

How Pelvic Floor Therapy Can Help with Pelvic Pain and Painful Sex

A pelvic floor therapist can help break the muscle tension cycle with manual therapy and teaching you self-treatment to maintain gains at home. By releasing pelvic floor tension, you free pelvic floor muscles, allowing for pain free sex. Pelvic floor therapists can also screen for musculoskeletal dysfunction in the spine, hips and pelvis; educate about sexual ergonomics and help you find positions that reduce pain during intercourse. Pelvic floor therapists can also provide you with self care programs which can reduce dryness and irritation in the tissues of the vulva, labia, and vaginal canal.

Photobiomodulation

This year, there has been some research published by Lanzafame et al. showing that photobiomodulation, a type of light therapy using light-emitting diodes (LEDs) or supraluminous diodes (SLDs) with red and near-infrared radiation (NIR) light can be effective in the treatment of vaginal tissue laxity.

The research suggests that PBMT stimulates collagen and elastin production in the vaginal tissue and supporting urethrovaginal sphincter and urethra, which may help with symptoms of GSM. At Femina PT, we have several light therapy machines that can be used for photobiomodulation therapy.

Give the therapists at Femina Physical Therapy a call today!

 

References

Kim, H. K., Kang, S. Y., Chung, Y. J., Kim, J. H., & Kim, M. R. (2015). The Recent Review of the Genitourinary Syndrome of Menopause. Journal of menopausal medicine, 21(2), 65–71. doi:10.6118/jmm.2015.21.2.65

Portman DJ, Gass ML. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and the North American Menopause Society. Menopause. 2014;21:1063–1068. [PubMed] []

Faubion, Stephanie S. et al. (2017). Genitourinary Syndrome of Menopause: Management Strategies for the Clinician. Mayo Clinic Proceedings, Volume 92, Issue 12, 1842 – 1849. Accessed from https://www.mayoclinicproceedings.org/article/S0025-6196(17)30639-0/fulltext

Nappi RE, Kokot-Kierepa M. Women's voices in the menopause: results from an international survey on vaginal atrophy. Maturitas. 2010;67:233–238. [PubMed] [Google Scholar]

Levine KB, Williams RE, Hartmann KE. Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women. Menopause. 2008;15:661–666. [PubMed] []

Robinson D, Cardozo LD. The role of estrogens in female lower urinary tract dysfunction. Urology. 2003;62:45–51. [PubMed] [Google Scholar]

Callan, N. G. L., Mitchell, E. S., Heitkemper, M. M., & Woods, N. F. (2018). Constipation and diarrhea during the menopause transition and early postmenopause. Menopause, 25(6), 615–624. doi:10.1097/gme.0000000000001057

Castellani, D., Saldutto, P., Galica, V., Pace, G., Biferi, D., Paradiso Galatioto, G., & Vicentini, C. (2015). Low-Dose Intravaginal Estriol and Pelvic Floor Rehabilitation in Post-Menopausal Stress Urinary Incontinence. Urologia Internationalis, 95(4), 417–421. doi:10.1159/000381989

Maltais ML, Desroches J, Dionne IJ. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact. 2009;9(4):186-97

Minkin, M. J., Reiter, S., & Maamari, R. (2015). Prevalence of postmenopausal symptoms in North America and Europe. Menopause, 22(11), 1231–1238. doi:10.1097/gme.0000000000000464

Mehta, R. S., & Staller, K. (2018). Menopausal transition and bowel disturbances. Menopause, 25(6), 589–590. doi:10.1097/gme.0000000000001110

Lanzafame, R. J., de la Torre, S., & Leibaschoff, G. H. (2019). The Rationale for Photobiomodulation Therapy of Vaginal Tissue for Treatment of Genitourinary Syndrome of Menopause: An Analysis of Its Mechanism of Action, and Current Clinical Outcomes. Photobiomodulation, photomedicine, and laser surgery, 37(7), 395–407. doi:10.1089/photob.2019.4618

**This information is for educational purposes only and is not intended to replace the advice of your doctor.

What Our Patients Have to Say

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Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

Read more: Testimonial by Jamie M.

Testimonial by T.C.

While pregnant with my twins, Heather took care with keeping me on my feet and pain free. She saved my back, my sanity and the holidays! I would recommend her to every “mom” looking to stay on her feet during pregnancy and post-partum.

-- T.C.

Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

Read more: Testimonial by R.M., Age 40

Testimonial by A.M.

Months after giving birth, it was difficult for me to go from a sitting or lying position up to a full standing position without feeling that I had to remain hunched over until a bit of time had passed to get fully upright. However, after taking Heather’s course, I learned exercises to get my body back to normal. She also showed me correct ways to lift and carry my son as well as put him in/take him out of the carseat and stroller. This class was really beneficial and Heather is a wonderful teacher who made me feel very comfortable.

-- A.M.

Testimonial by Y.L. (mom of 2)

After having my second baby via C-section I searched for months to try to find help for my lower back pain and separated abdominal muscles. I finally came across Heather Jeffcoat via a mommy blog. I reached out to her via email and set my first appointment. My first appointment went amazing … she listened to what my symptoms, check my separation and explained to me in detail what the next steps would be. Not only did my abdominal separation go from 3 to about 1 -1/2 but my back has pain has significantly reduced. I’m personally recommending all my mommy friends to Heather!

Y.L. (mom of 2)

Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

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