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Vaginal Atrophy & Genitourinary Syndrome of Menopause (GSM) Treatment in Naples & Marco Island

If you have been experiencing vaginal dryness, painful intercourse, increased urinary urgency, recurrent UTIs that turn out to be sterile, or a general change in vulvar and vaginal comfort — and you are in perimenopause, menopause, or postmenopause — you may have what is now called Genitourinary Syndrome of Menopause (GSM). The older term was 'vaginal atrophy.' The new term reflects a more accurate understanding: the same hormonal change affects vulvar, vaginal, urethral, and bladder tissue all together, and treatment addresses all of it. This page describes what GSM is, why it is so undertreated, and what modern treatment looks like.

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What GSM actually is.

Estrogen has receptors throughout the vulvar, vaginal, urethral, and bladder tissue. When estrogen declines — as it does in perimenopause, menopause, postmenopause, after surgical menopause, during certain cancer treatments, and during breastfeeding — these tissues thin, lose elasticity, lose lubrication, and become more vulnerable to
irritation and infection. The result is a syndrome rather than a single complaint. Vaginal dryness, painful intercourse, vulvar discomfort, urinary urgency, urinary frequency, post-coital UTIs, and a general feeling that 'something has changed down there' often appear together. They share an underlying mechanism — loss of estrogen-mediated tissue health — and
they respond to the same family of treatments.

Why it was renamed.

The term 'vaginal atrophy' captured part of the picture but missed the urinary component. It also carried an implied message that the change was simply something to endure rather than treat. The newer term — Genitourinary Syndrome of Menopause — was introduced in 2014 by the major menopause societies to reflect a more accurate, more treatable, and less stigmatizing framework.

Common GSM symptoms.

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Vaginal Symptoms

  • Dryness

  • Burning

  • Irritation

  • Decreased Lubrication

  • Decreased Elasticity

  • Discomfort with daily activities or intercourse

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Vulvar symptoms

  • Thinning of labia

  • Decreased fat pad

  • Paler tissue

  • Sensitivity, itching

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Urinary Symptoms

  • Urgency

  • Frequency

  • Nocturia

  • Dysuria without infection

  • Recurrent UTIs

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Sexual symptoms

  • Painful intercourse (dyspareunia)

  • Decreased arousal

  • Post-coital pain or soreness

Why GSM is so undertreated.

Several factors converge. Many women feel uncomfortable bringing up vulvar, vaginal, or sexual symptoms with their physician. Many physicians do not ask about them. The symptoms are sometimes attributed to other causes (recurrent infections, dermatologic conditions) without considering GSM. And cultural messaging has long suggested that these changes are a normal part of aging to be accepted rather than treated. The result is that GSM has been called the most undertreated condition in women's health. Effective, low-risk treatment exists. Most affected women never receive it.

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If you've been told your symptoms are "just part of getting older" or that your labs are "normal" despite how you feel, you are not alone. Read our full piece on why perimenopause is so often missed →

How GSM is diagnosed.

Diagnosis is clinical. A focused history clarifies the symptom pattern, timing, and impact. The exam (when appropriate and consented) confirms physical findings — thinning of vulvar and vaginal tissue, decreased rugae, paler appearance, friability, narrowing of the introitus. Labs are not required for the diagnosis.

GSM / Vaginal Atrophy — Treatment Options

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Vaginal Estrogen

  • Cornerstone of GSM treatment

  • Restores vaginal tissue health locally

  • Minimal systemic absorption

  • Symptom relief typically begins within weeks

  • Full benefit over a few months

  • Forms available:

    • ​Cream

    • Tablet (insert)

    • Ring (every 3 months)

  • ​One of the most effective and best-tolerated treatments in women's health

  • ​Often used alongside systemic hormone therapy
      as part of a broader perimenopausal plan

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Vaginal DHEA (Prasterone / Intrarosa)

  • Daily vaginal insert at bedtime

  • Locally converted to estrogen and androgen within vaginal cells

  • Particularly useful when vaginal estrogen is not preferred

  • FDA-approved for moderate-to-severe dyspareunia due to GSM

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Ospemifene
Oral SERM for painful intercourse

  • Selective Estrogen Receptor Modulator (SERM)

  •  

    FDA-approved for moderate-to-severe dyspareunia due to GSM

  • Tissue-specific effects without systemic estrogen exposure

  • Useful for patients who prefer oral over vaginal route

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Non-Hormonal Options

  • Hyaluronic acid-based vaginal moisturizers (used regularly)

  •  

    Vaginal lubricants — water-based or silicone (used as needed)

  • Appropriate for women who cannot use hormonal treatments

  • Often used alongside hormonal therapies for added relief

  • Available over the counter

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Special Consideration: Breast Cancer History

  • Low-dose vaginal estrogen now considered reasonable for many women with breast cancer history

  • Decision made in coordination with the patient's oncology team

  • Vaginal DHEA and ospemifene are additional options

  • Non-hormonal options always available

  • Modern guidance has moved away from blanket prohibition toward individualized risk-benefit discussion

Realistic expectations.

GSM is highly treatable. Most women see meaningful improvement within weeks of starting an appropriate treatment, with continued improvement over a few months. Many describe the change as restorative — returning to a baseline of comfort they did not realize they had lost. Treatment is typically continued long-term, since the underlying estrogen deficiency does not resolve on its own. The risk-benefit profile of low-dose vaginal estrogen is favorable for extended use.

Our approach.

At Timeless Interventional of Naples, Dr. Chaturani Ranasinghe, MD, treats GSM as part of her broader pelvic and hormone practice. The consultation is unhurried, focused on understanding the impact of symptoms on your life, and explicit about treatment options across the hormonal and non-hormonal spectrum. We coordinate with oncology teams when relevant.

Schedule a consultation

Call to schedule a consultation or book online.

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