Sara Perelmuter on GSL: Safe treatment options and the call for routine screening

While Genitourinary Syndrome of Lactation (GSL) affects a vast majority of postpartum individuals, a significant education gap remains regarding safe interventions. Sara Perelmuter, medical student, Weill Cornell University; co-president, Sexual Medicine Research Team (SMRT), presented new data at the 2026 ISSWSH meeting emphasizing that GSL symptoms are "predictable consequences" of hormonal physiology rather than unexpected complications.^1,2

Perelmuter provides more details regarding the initial survey findings and the "clinical paradox" of GSL in a previous video published by Contemporary OB/GYN. Click here to watch.³

A major finding in Perelmuter’s research was the disconnect between symptom burden and treatment, as nearly 64% of participants were never asked about genitourinary concerns, and only 28.42% were offered treatment. Additionally, 60.03% were unaware of lactation-compatible therapies.¹

Perelmuter identified several first-line, lactation-safe options. Pelvic floor physical therapy is a non-invasive tool particularly useful for hypertonic pelvic floors, scar tissue, or neuromuscular dysfunction that contributes to dyspareunia.

Secondly, Perelmuter highlighted low-dose vaginal estrogen as a "star of the show" for addressing the hypoestrogenic component of GSL. “We have evidence from populations that suggests that low-dose vaginal estrogen has no systemic absorption, and so it is considered compatible with lactation,” Perelmuter explained. She addressed common fears regarding hormonal exposure, noting that clinical experience indicates local estrogen does not meaningfully affect milk supply or result in clinically significant transfer to breast milk.

“We also have several non-hormonal options that can play a role, such as vaginal moisturizers, lubricants, and things like that,” added Perelmuter. “But interestingly, in our study, pelvic floor physical therapy and vaginal estrogen were the most commonly recommended treatments. So it also just goes to reinforce that these 2 treatments can be effective and are both safe for this population.”

The study previously reported that 100% of exclusively lactating individuals experienced vaginal dryness, yet many were unaware that treatments existed. Perelmuter advocates for a fundamental shift in postpartum care: routine, proactive screening.

“Given the hormonal physiology of lactation and postpartum, these symptoms should not be viewed as unexpected,” Perelmuter said. “I would also like to mention I think there is a broader call to action for education. Many patients in our studies were simply unaware that treatments even existed, let alone that their symptoms had a name that they could verbalize. So I think improving clinician awareness and patient education could dramatically improve postpartum quality of life on both sides of the professionalism and healthcare.”

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/
3. Fitch J. Sara Perelmuter on genitourinary syndrome of lactation in the postpartum period. Contemporary OB/GYN. Published March 10, 2026. Accessed March 13, 2026. https://www.contemporaryobgyn.net/view/sara-perelmuter-on-genitourinary-syndrome-of-lactation-in-the-postpartum-period