Table 2. Anatomical and pathophysiological changes caused by GSM.

GSM: genitourinary syndrome of menopause

Pathophysiology of GSM

Loss of labial and vulval thickness

Decreased collagen, elasticity, and blood flow

Reduced vaginal discharge

Reduced pubic hair, subcutaneous fat of labia majora

Reduced labia minora and hymenal remnants

Decreased vaginal cells glucogen => change vaginal microbiome => increased pH

Decreased pelvic floor strength and control

Dry and thin epithelium

Short and narrow vagina

Prolapse (vaginal vault, pelvic organs, urethral)

Decreased bladder capacity and sensation

Vaginal hypersensitivity or decreased feeling