Restoration Health Collective

Evidence update!

Are you familiar with the AUA/SUFU/AUGS guideline on Genitourinary Syndrome of Menopause (GSM)?

Here are 5 takeaways regarding s*xual function:
1️⃣ Sexual symptoms are a core component of GSM
Sexual-health problems such as decreased lubrication/arousal, increased pain with in*******se (dyspareunia), and delayed or diminished or***ms are explicitly recognized as part of GSM.
🗨️ This means when you’re working with patients, s*xual function must be part of the assessment, and not just urinary or vaginal atrophy symptoms.

2️⃣ GSM s*xual symptoms don’t tend to resolve without treatment
Unlike vasomotor symptoms of menopause (hot flashes, night sweats) that may reduce over time, or with medical treatment, GSM-related s*xual problems tend to persist or worsen unless addressed.
🗨️ For your clinical practice, this underscores the importance of early screening, approaching patients with a trauma-informed care lens, and referring to a s*x therapist or counselor as appropriate.

3️⃣ There is strong evidence that low-dose local vaginal estrogen improves s*xual health outcomes
Local (vaginal) low-dose estrogen therapy has the most robust evidence base for improving GSM symptoms, including s*xual discomfort and dyspareunia.
🗨️ As a pelvic health specialist, this supports recommending or collaborating with prescribing practitioners on vaginal estrogen therapies when appropriate (and safe) for improving patient s*xual outcomes, including those patients who are on systemic estrogen therapy.

4️⃣ Emerging evidence supports vaginal DHEA (dehydroepiandrosterone) for s*xual function
The guideline mentions that vaginal DHEA has been shown to improve s*xual function, decrease vaginal pH, and improve vaginal epithelial anatomy.
🗨️ Pelvic PTs should educate and collaborate with prescribing practitioners on vaginal DHEA when appropriate, including for those patients who are on systemic estrogen therapy.

5️⃣ Shared decision-making and addressing s*xual wellness beyond anatomy are essential
This guideline emphasizes the importance of shared decision-making with respect to a patient's s*xual goals, preferences, psychological context, and overall quality of life.
🗨️ Clinicians need to consider the whole person and not just the physical/tissue changes that occur with GSM care.

References:
Kaufman, M. R., Ackerman, A. L., Amin, K. A., Coffey, M., Danan, E., Faubion, S. S., Hardart, A., Goldstein, I., Ippolito, G. M., Northington, G. M., Powell, C. R., Rubin, R. S., Westney, O. L., Wilson, T. S., & Lee, U. J. (2025). Executive Summary: The AUA/SUFU/AUGS Guideline on Genitourinary Syndrome of Menopause. Urogynecology (Philadelphia, Pa.), 31(11), 1005–1014. https://doi.org/10.1097/SPV.0000000000001753

Last call this fabulous baby wearing event!

Last call for registration! The HELD event is this Friday and I’m so excited to learn and share. Thrilled to collaborate wih the Center for Babywearing Studies, learn from Restoration Health Collective and of course shout out to the the PT that is always a good sport for the projects I rope her into (Juliana, I’m talking to you!)

Registration closes tomorrow!