Genitourinary syndrome of lactation: a new perspective on postpartum and lactation-related genitourinary symptoms

Sara Perelmuter; Ramzy Burns; Katie Shearer; Raeven Grant; Anantha Soogoor; Soyoun Jun; Janine Alexis Meurer; Jill Krapf; Rachel Rubin

doi:10.1093/sxmrev/qeae034

Genitourinary syndrome of lactation: a new perspective on postpartum and lactation-related genitourinary symptoms

Sex Med Rev. 2024 May 16:qeae034. doi: 10.1093/sxmrev/qeae034. Online ahead of print.

Authors

Sara Perelmuter¹, Ramzy Burns², Katie Shearer³, Raeven Grant⁴, Anantha Soogoor⁵, Soyoun Jun⁶, Janine Alexis Meurer⁷, Jill Krapf⁸, Rachel Rubin⁹

Affiliations

¹ Weill Cornell Medical College, New York, NY 10021, United States.
² Department of Urology, Indiana University, Indianapolis, IN 47405, United States.
³ University of Tennessee Health Science Center, Memphis, TN 38163, United States.
⁴ David Geffen School of Medicine, University of California, Los Angeles, CA 90095, United States.
⁵ College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, United States.
⁶ Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX 76107, United States.
⁷ Jacobs School of Medicine and Biomedical Sciences, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY 14203, United States.
⁸ Obstetrics and Gynecology, Center for Vulvovaginal Disorders, Washington, DC 20037, United States.
⁹ Department of Urology, Georgetown University, Washington, DC 20007, United States.

PMID: 38757214
DOI: 10.1093/sxmrev/qeae034

Abstract

Background: The genitourinary syndrome of menopause (GSM) is a well-documented condition characterized by a range of genitourinary symptoms in peri- and postmenopausal women. As with GSM, postpartum lactating women experience reduced estrogen and androgen levels. However, there is limited research on the impact of symptoms during the postpartum breastfeeding period.

Objectives: The aim was to review the literature for genitourinary health in the postpartum breastfeeding population and summarize key findings and potential treatments.

Methods: We performed a comprehensive literature review in PubMed, Google Scholar, and Scopus from inception of database to November 2023 using the following keywords individually and in combination: "physiology of postpartum" or "physiology of lactogenesis" or "vulvovaginal health" or "vaginal atrophy" or "vaginal dryness" or "dyspareunia" or "urinary incontinence" or "lactation" or "breastfeeding" or "vaginal estrogen." All identified articles published in English were considered. Relevant studies were extracted, evaluated, and analyzed. The work presented in this article represents a summative review of the identified literature.

Results: During lactation, high levels of prolactin inhibit estrogen and androgen secretion via negative feedback, which leads to an increased prevalence of vulvovaginal atrophy, vaginal dryness, dyspareunia, and urinary incontinence in lactating postpartum women. Despite these highly prevalent and potentially devastating symptoms, there is a lack of consistent screening at postpartum visits and no treatment guidelines available to health care providers.

Conclusion: Postpartum breastfeeding women experience similar physiology and symptoms to the postmenopausal phase, as seen in GSM. We propose the introduction of a novel term to describe the genitourinary changes seen in postpartum breastfeeding individuals: genitourinary syndrome of lactation. The diagnostic use of genitourinary syndrome of lactation will equip health care providers with an all-encompassing term to bring awareness to the symptoms experienced by postpartum breastfeeding individuals and lead to improved screening and treatment for the high numbers of individuals experiencing these genitourinary changes.

Keywords: breastfeeding; dyspareunia; genitourinary syndrome of menopause (GSM); lactation; postpartum; sexual health; vaginal atrophy; vaginal dryness.