Genitourinary Syndrome of Menopause (GSM) encompasses a range of symptoms resulting from decreased estrogen and androgen levels, affecting the urinary and genital systems. The 2025 AUA/SUFU/AUGS Guideline emphasizes a patient-centered approach, integrating both medical and non-pharmacological interventions. Pelvic floor physical therapy (PFPT) emerges as a pivotal component in managing GSM, addressing the musculoskeletal and functional aspects of the syndrome.
Understanding GSM and Its Impact
GSM symptoms include vaginal dryness, irritation, dyspareunia (pain during intercourse), urinary urgency, frequency, and recurrent urinary tract infections. These symptoms can significantly affect quality of life, sexual function, and emotional well-being. The guideline recommends symptom-based diagnosis and emphasizes shared decision-making in treatment planning.
Pelvic Floor Physical Therapy: A Non-Hormonal Intervention
PFPT offers a non-pharmacological approach to managing GSM symptoms, focusing on:
- Muscle Strengthening: Addressing pelvic floor muscle atrophy to improve support for pelvic organs and alleviate urinary symptoms.
- Tissue Mobilization: Enhancing tissue flexibility and reducing discomfort through manual therapy techniques.
- Pain Management: Utilizing relaxation techniques and biofeedback to manage pain associated with GSM.
- Sexual Function Improvement: Facilitating increased blood flow and muscle tone to enhance sexual comfort and response.
Complementing Medical Treatments
While local low-dose vaginal estrogen therapy is recommended as a first-line treatment for GSM, PFPT serves as a valuable adjunct, especially for individuals who:
- Prefer Non-Hormonal Options: Those seeking alternatives to hormone therapy can benefit from PFPT’s non-invasive approach.
- Have Contraindications: Individuals with a history of estrogen-dependent cancers may opt for PFPT in consultation with their healthcare providers.
- Desire Comprehensive Care: Combining PFPT with medical treatments can address both the structural and functional components of GSM.
Implementing PFPT in GSM Management
A typical PFPT program for GSM may include:
- Initial Assessment: Evaluating pelvic floor muscle function, identifying areas of tension or weakness, and discussing symptom history.
- Customized Exercises: Developing a tailored exercise regimen focusing on strengthening, relaxation, and coordination of pelvic floor muscles.
- Education: Providing information on lifestyle modifications, bladder training, and strategies to manage symptoms.
- Ongoing Support: Regular follow-ups to monitor progress, adjust treatment plans, and address emerging concerns.
Conclusion
Integrating pelvic floor physical therapy into the management of Genitourinary Syndrome of Menopause offers a holistic approach to symptom relief and improved quality of life. By addressing the musculoskeletal components of GSM, PFPT complements medical treatments and empowers individuals to take an active role in their care. Collaboration between patients, physical therapists, and healthcare providers is essential to develop personalized, effective treatment strategies.
