When Intimacy Hurts: Dyspareunia in Genitourinary Syndrome of Menopause - A Review of Treatment Options

Abstract

Dyspareunia, defined as pain during or immediately after sexual intercourse, is one of the most common and troublesome symptoms of Genitourinary syndrome of menopause (GSM), affecting a significant number of perimenopausal and postmenopausal women. This paper aims to review and systematize knowledge on pharmacological and non-pharmacological methods of treating this condition, the main cause of which is atrophy of the vulvar and vaginal tissues resulting from estrogen deficiency. An analysis of the available literature indicates that local estrogen therapy remains the gold standard for alleviating symptoms, as it effectively restores the elasticity and lubrication of the epithelium. As alternative therapeutic options, particularly important for patients with contraindications to estrogens, the use of prasterone (DHEA) and oral ospemifene (SERM) is discussed. The paper also presents the role of non-hormonal methods, such as commonly used lubricants and moisturizers as first-line therapy, and hyaluronic acid injections. Attention was also paid to modern laser therapy, which, despite its promising regenerative effects, has not yet been fully approved by scientific societies due to the lack of long-term safety data. The conclusions of the paper emphasise the need for individualised therapy, taking into account the patient's medical history and preferences, which is key to improving the quality of sexual life for women during menopause.