Sara Perelmuter on genitourinary syndrome of lactation in the postpartum period

Despite being a phenomenon observed clinically for decades, the genitourinary consequences of lactation have lacked a unifying framework.¹ Sara Perelmuter, medical student, Weill Cornell University; co-president, Sexual Medicine Research Team (SMRT)², presented data from a cross-sectional survey at the 2026 ISSWSH meeting, aimed at characterizing Genitourinary Syndrome of Lactation (GSL) and addressing the care gaps faced by postpartum individuals.^1,2

What is genitourinary syndrome of lactation?

Perelmuter explained that the concept of GSL emerged from a clinical paradox. While the medical community recognizes that the hypoestrogenic state of menopause leads to Genitourinary Syndrome of Menopause (GSM), the similar hormonal milieu induced by lactation has remained largely unnamed.

“Without a name, the condition tends to remain diffuse, unrecognized, and underdiagnosed,” Perelmuter said. “Symptoms can much more easily be dismissed or attributed to simply a normal postpartum recovery, even when they are severe and persistent. Terminology shapes clinical recognition. By defining that syndrome, we hope to empower clinicians to identify and address the symptoms more proactively and, on the other side, empower patients by validating their experiences and making it clearer that effective treatments do exist.”

Prevalence and the disconnect in care

The survey contained 1,446 respondents with a median age of 36 years, of which 47.65% were exclusively lactating, 14.66% mixed feeding, and 37.69% non-lactating. Findings revealed that vaginal dryness was the most common symptom (exclusive: 100%; non-exclusive: 100%; non-lactating: 78.72%), followed by dyspareunia (57.04%, 50.00%, and 36.33%, respectively).

Additionally, quality of life was significantly impacted, as 76.34% of those exclusively lactating reported difficulty with sexual activity.

Further, a disconnect between the patient's burden and the provider's intervention. Approximately 64% of patients were never asked about symptoms by their provider, and about 29% were offered treatment. Additionally, 60% were unaware that treatments existed.

“Patients reported that they independently sought out treatments themselves, such as over-the-counter products or other forms of therapy and resources outside of routine clinical care,” Perelmuter explained.

Proactive screening for GSL

While patients are experiencing severe symptoms, conversations regarding genitourinary health are not consistently occurring in the clinical setting. Perelmuter emphasized that clinicians must move away from the assumption that these issues are a standard part of postpartum recovery that patients must navigate alone.

“This underscores a need for more proactive screening from the clinician side,” Perelmuter concluded. By incorporating GSL into standard postpartum care algorithms, providers can validate the patient experience and offer effective, lactation-safe treatments that currently remain underutilized.

References:

1. Perelmuter, S; Drian, A; Vereecken, S, et al. Genitourinary Syndrome of Lactation: Patient-Reported Survey of Symptom Burden, Care Gaps, and Treatment Utilization in the Postpartum Period. Abstract. Presented at: ISSWSH. February 12-15, 2026. Long Beach, California.
2. Sexual Medicine Research Team. Accessed March 11, 2026. https://www.sexmedresearchteam.com/