Empowering Healing: The Vital Role of Pelvic Floor Physical Therapy for Genitourinary Syndrome of Menopause”

Pelvic floor physical therapy (PFPT) plays a critical role in the treatment of pelvic and genitourinary symptoms and can dramatically improve the quality of life for individuals with those symptoms. One essential, but sometimes overlooked, aspect of successful PFPT is the comprehensive collection of a focused medical history and the active involvement of the patient in their care. This foundation allows for accurate diagnosis, individualized treatment planning, and better long-term outcomes—especially in patients with Genitourinary Syndrome of Menopause (GSM). 

Genitourinary Syndrome of Menopause is a constellation of symptoms resulting from decreased estrogen levels affecting the vulva, vagina, urethra, and bladder. While GSM is commonly associated with menopause, it is not exclusive to postmenopausal women. An estimated 27–85% of women experience symptoms consistent with GSM at some point, and it can also affect: 

• Women over 40 

• Breastfeeding women 

• Women with primary ovarian insufficiency 

• Those undergoing chemotherapy or radiation 

• Women on oral contraceptives 

• Individuals who are surgically menopausal 

• People undergoing gender-affirming hormone treatment 

Because of its broad prevalence and impact, GSM deserves proactive and comprehensive management, starting with a focused and sensitive medical history. 

A thorough medical history is the cornerstone of effective PFPT. It allows clinicians to differentiate between GSM and other pelvic floor disorders and tailor interventions to the individual’s symptoms, experiences, and goals. A focused history should explore the following key areas: 

1. Vaginal and Vulvar Symptoms 

Many patients are hesitant to discuss genital symptoms unless prompted. Direct but empathetic questioning can help uncover important signs of GSM, such as: 

• Vaginal, vulvar, or vestibular dryness 

• Irritation, burning, or itching 

• Pain with intercourse (dyspareunia) 

• Spotting or bleeding after intercourse 

• Fissures or microtears during sexual activity 

These symptoms can drastically reduce sexual satisfaction, self-esteem, and overall well-being.  

2. Urinary Symptoms 

The genitourinary component of GSM often goes hand-in-hand with pelvic floor dysfunction. Relevant questions include: 

• Do you experience urinary leaking (incontinence)? 

• Is there frequent nighttime urination (nocturia)? 

• Do you feel a constant urge to urinate? 

• Have you had recurrent urinary tract infections? 

• Do you have pain, stinging, or burning with urination? 

Such symptoms are frequently underreported but can significantly impair daily functioning and confidence. 

3. Symptom Duration, Severity, and Quality of Life Impact 

Understanding the timeline and intensity of symptoms helps in identifying chronicity and urgency.  

• How long have you been experiencing these symptoms? 

• How severe are they on a day-to-day basis? 

• How do these symptoms affect your personal life, relationships, work, and emotional health? 

This line of questioning fosters shared understanding and begins the process of collaborative care planning. 

Many medications can contribute to or worsen vaginal dryness and urinary symptoms. During the medical history, clinicians should inquire about: 

• Oral contraceptives 

• Antidepressants (SSRIs, SNRIs) 

• Antihistamines 

• Chemotherapy drugs 

• Hormone-blocking therapies (e.g., for breast or prostate cancer) 

Even lifestyle factors like smoking and low fluid intake can exacerbate pelvic floor symptoms. By identifying and adjusting these factors, PFPT can be made more effective and sustainable. 

Sexual function is a critical but often neglected aspect of pelvic health. Patients should be given the opportunity to discuss concerns such as: 

• Changes in libido or desire 

• Difficulty with arousal or maintaining arousal 

• Reduced genital sensation or numbness 

• Altered orgasmic response or inability to climax 

• Psychological factors like anxiety, trauma, or relationship stress 

These discussions must be handled with sensitivity, confidentiality, and respect. Understanding the emotional and relational dimensions of GSM can greatly enhance the success of physical therapy and overall care. 

Certain medical conditions and treatments are known to influence pelvic and genitourinary health. A full history should include: 

• Lichen sclerosis or other dermatologic vulvar conditions 

• History of pelvic or genital radiation or chemotherapy therapy 

• Diabetes or metabolic syndrome 

• Endocrine disorders such as thyroid disease 

• Gender-affirming hormone treatment 

• Autoimmune diseases 

These conditions can influence tissue health, hormonal balance, and nerve function—key components of pelvic floor integrity. Knowledge of these factors allows therapists to adapt treatment techniques and anticipate complications. 

Beyond collecting information, one of the most powerful tools in pelvic floor therapy is empowering the patient to take an active role in their treatment. Informed patients are more likely to adhere to treatment plans, report changes or concerns early, and maintain long-term wellness routines. 

Strategies to Promote Engagement: 

• Educate the patient on anatomy, GSM, and pelvic floor function 

• Collaborate on goal setting 

• Involve the patient in tracking symptoms and progress 

• Provide written resources and self-care tools 

• Reassess and adjust the plan as symptoms evolve 

When patients understand the “why” behind exercises, behavioral modifications, and lifestyle recommendations, they are more motivated and consistent. 

Pelvic floor physical therapy is not a one-size-fits-all approach. A personalized treatment plan begins with a comprehensive, empathetic medical history and thrives on meaningful patient engagement. For individuals with GSM—whether they are menopausal, breastfeeding, recovering from cancer treatment, or on hormone therapy—a detailed understanding of symptoms, underlying conditions, and quality-of-life concerns is critical. 

By listening carefully, asking the right questions, and involving patients in every step of their care, clinicians can provide more effective, respectful, and empowering pelvic floor therapy.  

References: 

1. 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. 

2. American Urological Association. Clinical Practice Guidelines on GSM and Pelvic Floor Health. 2025. 

3. Kingsberg SA, et al. The Role of the Clinician in Addressing GSM. Journal of Women’s Health. 2017. 

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Disclaimer: This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.