GSM (previously called vaginal atrophy) includes genital, sexual, and urinary symptoms associated with menopause. Genital symptoms range from genital dryness to burning, irritation, and/or discharge. Sexual symptoms include decreased vaginal lubrication, low libido, and painful/uncomfortable sex. Urinary symptoms include urinary tract infections (UTIs), increased urinary leaks, and incontinence. All GSM symptoms are caused by a decline in estrogen that leads to a thinning of the vulva-vaginal wall, including the urethra and bladder.