Painful Sex, Dryness, or UTIs? It Might Be Low Estrogen
By Kate Layman, ARNP, CNM. Founder, Mother Love Wellness
As a Certified Nurse Midwife and founder of Mother Love Wellness, I’ve cared for women in hospitals, birth centers, homes, and now in my own practice supporting women through postpartum and perimenopause. Frequently, I hear the same quiet concern:
“I think something is wrong… but maybe this is just normal?”
If you’re experiencing vaginal dryness, burning, painful sex, recurrent UTIs, or urinary urgency — whether you’re breastfeeding or navigating midlife — I want you to hear this clearly:
It’s common.
It’s physiologic.
And it’s treatable.
Genitourinary Syndrome of Menopause (GSM) and Genitourinary Syndrome of Lactation (GSL)
Let’s talk about two conditions that don’t get nearly enough attention: Genitourinary Syndrome of Menopause (GSM) and Genitourinary Syndrome of Lactation (GSL).
What Is GSM?
Genitourinary Syndrome of Menopause (GSM) is the term used to describe the collection of vulvar, vaginal, and urinary symptoms caused by low estrogen levels.
Common symptoms include:
- Vaginal dryness, itching, or burning
- Pain with sex
- Decreased lubrication
- Recurrent urinary tract infections
- Urinary urgency or frequency
- Pain with urination
- Diminished arousal or orgasm
These symptoms occur because estrogen plays a critical role in maintaining vaginal tissue thickness, elasticity, blood flow, lubrication, and urinary tract support.
When estrogen declines — during perimenopause and menopause — tissue becomes thinner, more fragile, and less resilient.
Untreated GSM doesn’t just affect comfort. It can increase risk for recurrent UTIs and long-term tissue changes. Early recognition matters.
What Is GSL?
Now here’s what many postpartum women are never told:
When you are breastfeeding, prolactin levels rise to support milk production. That hormonal shift suppresses ovarian estrogen production. In other words — lactating women are also in a low-estrogen state. We actually refer to postpartum as a “mini-menopause”.
Genitourinary Syndrome of Lactation (GSL) presents almost identically to GSM:
- Vaginal dryness
- Painful sex
- Burning or irritation
- Urinary frequency
- Recurrent UTIs
The difference? Instead of happening at midlife, it happens after you have had a baby.
Because postpartum discomfort is expected, many women assume these symptoms are simply part of recovery. They aren’t warned that low estrogen may be contributing.
But here’s what I tell my patients: just because something is common doesn’t mean you have to live with it.
Low estrogen states are physiologic. But chronic discomfort, painful sex, and recurrent infections are not something you simply have to tolerate. We are long overdue for conversations that normalize vaginal health across the lifespan.
Why This Matters
Pain with intimacy affects relationships and identity.
Recurrent UTIs affect daily life.
Burning and irritation affect confidence and mental health.
Postpartum women are frequently left navigating painful sex alone.
Similarly, midlife women are told dryness is inevitable — as though comfort and pleasure are optional.
They aren’t.
You deserve tissue that feels healthy, resilient, and comfortable — at every stage of life.
How Is It Diagnosed?
It starts with a conversation.
A thorough evaluation should include:
- A detailed symptom history
- A careful vulvar and vaginal exam
- Assessment for other causes (infection, dermatologic conditions, inflammatory disorders)
- Biopsy if symptoms don’t respond as expected
My clinical management emphasizes individualized care, early diagnosis, and patient education to prevent long-term vulvar changes .
If you feel like your concerns are being dismissed, seek a clinician trained in menopause medicine, sexual medicine, or pelvic health. You deserve a provider who understands this physiology.
Treatment: Local Hormones Are the Gold Standard
The first-line treatment for both GSM and GSL is local vaginal hormone therapy.
This is different from systemic (whole-body) hormone therapy. Local treatment acts directly on the vaginal and urinary tissues.
I often use vaginal hormone cream or inserts.
For most women, these therapies are safe and highly effective. One important exception: women actively being treated for breast cancer should consult their oncology team before initiating local estrogen.
Cost can be a barrier, but discount programs like GoodRx or Cost Plus Drugs often make these treatments accessible.
Supportive Care Still Matters
Hormones restore tissue health — but supportive care strengthens the foundation.
- Avoid scented products and harsh soaps
- Wear breathable cotton underwear
- Use vulvar moisturizers regularly
- Use lubrication during intimacy
- Address pelvic floor tension with physical therapy
This is not about “fixing” your body.
It’s about honoring the hormonal season you’re in and giving your tissues what they need.
The Bigger Picture
Whether you’ve just had a baby or navigating perimenopause, your body is adapting to major hormonal shifts.
Low estrogen states are physiologic.
But chronic discomfort, painful sex, and recurrent infections are not something you simply have to tolerate.
We are long overdue for conversations that normalize vaginal health across the lifespan.
At Mother Love Wellness, my mission is simple: nurture you so you can nurture others. That includes your pelvic health, your comfort, and your intimacy.
Let’s Keep the Conversation Going
These symptoms were not “just part of aging” or “just postpartum”.
You deserve informed care.
You deserve comfort.
And you deserve to feel supported in every hormonal season of your life.
If you would like to connect and learn more, reach out to me at motherlovewellness.com
About the author. Kate Layman, ARNP, CNM, is the founder of Mother Love Wellness and a Certified Nurse Midwife with over two decades of experience supporting women on their journey into motherhood. Her career spans diverse settings — including home births, birth centers, hospitals, and virtual care — giving her a comprehensive perspective on women’s health.
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