Lesson 1.1: When Sex Hurts — Understanding GSM and the Silence Around It
Lesson 1.1: When Sex Hurts — Understanding GSM and the Silence Around It (Copy)
IN THIS LESSON
Experiencing estrogen loss can feel like being dropped into a crash course you never signed up for—one that reshapes your body, emotions, and relationships in unexpected ways. Falling estrogen levels result in a host of uncomfortable symptoms: hot flashes, difficulty sleeping, weight gain, anxiety and depression. These are the symptoms we know to expect, even if we’d much rather not. But there are other symptoms that come with estrogen loss that are far less openly discussed.
Estrogen loss doesn’t just alter mood, sleep, and energy — it can fundamentally change the way sex feels. For many people, one of the most distressing outcomes is a condition called the Genitourinary Syndrome of Menopause, or GSM — something incredibly common but rarely talked about, even in medical settings. You may not have heard of GSM before, but it’s a condition that affects the vast majority of people after estrogen loss.
This lesson unpacks the biological reality of estrogen loss, explores common and lesser-known symptoms, and lays out where to go from here.
What is GSM?
GSM is a clinical term that describes a collection of symptoms caused by low estrogen levels affecting the vulva, vagina, urinary tract, and other surrounding tissues. The vast majority of people with unaddressed low estrogen will experience GSM (84%). It’s a progressive, chronic condition — meaning it doesn’t get better on its own and tends to worsen over time if left untreated.
Let’s talk about how estrogen impacts genital and urinary health. Once we understand that, it’s easy to see the impact that estrogen loss can have.
Estrogen plays a vital role in maintaining the structure, elasticity, thickness, and moisture of vaginal and vulvar tissue. It also helps regulate the health of the urinary tract.
When estrogen levels drop — due to natural menopause, induced menopause (surgical or medical), postpartum shifts, or certain hormonal treatments — these tissues become thinner, drier, less elastic, and more fragile.
As a result, people may experience:
Vaginal dryness
Burning or irritation
Itching
Pain during or after sex
Incontinence
Frequent UTIs
The Disconnect Between Prevalence and Awareness
We talk so openly about hot flashes and night sweats, but sexual health is whispered about if at all. It may not be surprising given the pressures and expectations of society, but it’s long overdue that we break the silence.
Even though GSM affects a large percentage of people experiencing estrogen loss, few are told about it — and even fewer are offered treatment. This silence can make it feel like what you’re going through is unusual, shameful, or your fault. It’s not.
The Pain Is Real
Sexual pain can feel confusing or isolating — especially when it arrives suddenly. People describe it as “shredding,” “burning,” “raw,” “ripping,” or even like “razor blades,” to borrow Halle Berry’s words.
It may be startling at first, but it’s important to name the pain that has so often gone unnamed and start the process of addressing it.
Treating GSM
The good news? You’re already in the right place. You and your Corla Health specialist are hard at work addressing and reversing the negative impacts of GSM on your sexual health. We’re so glad you’re here and are getting help. Keep working with your specialist as we tackle the physical impacts of estrogen loss on your body.
Now that we understand the impact that estrogen loss has on our sexual health, and we’re working to address that… how do we manage everything else?
The rest of this course will focus on addressing libido, navigating partner relationships, and reclaiming your own sense of sexuality.