There is a pattern I keep seeing in my office.

Moms come in a little embarrassed, almost apologetic about what they are about to say. Dryness, irritation. discomfort during intimacy, urinary urgency that showed up out of nowhere. And almost every single one of them says the same thing: I thought it was just me.

It is not just you and it has a name.

What is Genitourinary Syndrome of Lactation?

GSL is a condition that affects breastfeeding women who are, hormonally speaking, in a temporary menopausal state. During lactation, the body produces high levels of prolactin to sustain milk production, and prolactin actively suppresses estrogen. That hormonal shift is intentional and necessary for breastfeeding. But estrogen does not just regulate your cycle. It maintains the thickness, elasticity, and lubrication of the vaginal and vulvar tissues, supports the health of the urinary tract lining, and plays a direct role in bladder control and pelvic floor function.

When estrogen drops, all of that changes. The vaginal walls thin and lose elasticity. Natural lubrication decreases. The tissues become more fragile and more prone to irritation. The urethra and bladder lining, which also depend on estrogen, become more sensitive, which is why urinary urgency, frequency, and recurrent UTIs are so common in breastfeeding women and so rarely connected back to GSL.

Research suggests that up to 87% of breastfeeding women experience at least one symptom. Dryness and irritation are the most reported, but pain during sex, a feeling of pressure or rawness, and urinary leakage are just as real and just as common. Most women never connect these symptoms to breastfeeding. Most are never told to expect them.

Why does nobody talk about it?

Postpartum care in this country is notoriously rushed. The standard six-week visit is often the only formal checkpoint between birth and the rest of a woman’s life, and in that window, the focus is rarely on how she feels in her own body. Add to that the cultural conditioning that tells women to push through discomfort, normalize it, and move on, and you have a condition that stays invisible simply because no one creates the space to name it.

Even within medicine, GSL is underrecognized. It was only formally defined and named in 2014 by the American College of Obstetricians and Gynecologists, which means there is an entire generation of providers who trained without ever learning to screen for it proactively. A 2019 study published in the Journal of Midwifery and Women’s Health found that fewer than half of postpartum women were asked about genitourinary symptoms at their follow-up visits. The symptoms exist. The conversation just never happens.

What GSL actually feels like? because nobody describes this part…

Every woman experiences it differently, and that is part of why it goes unrecognized for so long. Some women describe a raw, burning sensation that makes wearing underwear uncomfortable. Others notice that intimacy feels completely different, not just less comfortable, but painful in a way that feels wrong and confusing, especially when everything else about postpartum recovery seems on track. Some women develop what feels like a chronic UTI that keeps coming back, not because of an infection, but because the urethral tissue is inflamed and irritated from low estrogen. Others experience urgency, the sudden, overwhelming need to get to the bathroom, that they attribute to having recently been pregnant, when in reality it is a direct symptom of GSL.

If you recognize yourself in any of this, that recognition matters.

The good news

You do not have to wait until you stop breastfeeding to feel better.

Low-dose vaginal estrogen is the most well-studied and effective treatment for GSL. Applied locally as a cream, ring, or suppository, the systemic absorption is minimal, meaning it does not significantly affect breast milk composition or infant estrogen levels, according to current evidence from both the Academy of Breastfeeding Medicine and the American College of Obstetricians and Gynecologists. Most women notice meaningful improvement within four to six weeks of consistent use.

For those who prefer to start with non-hormonal options, vaginal moisturizers used regularly, not just during intimacy, but two to three times per week as a baseline, can restore hydration to the tissue over time. Hyaluronic acid-based formulations have shown results comparable to low-dose estrogen for mild to moderate symptoms in several studies, making them a genuinely effective starting point. Lubricants used during intimacy reduce friction and discomfort in the moment but do not treat the underlying tissue changes the way moisturizers do, both have a role, and they are not interchangeable.

Pelvic floor physical therapy is one of the most underutilized tools in postpartum care. For women experiencing urinary symptoms, pain with intimacy, or a sense of pelvic pressure, a trained pelvic floor therapist can address the muscular and connective tissue changes that GSL accelerates. It is not just for severe cases. It is for any woman who wants to feel like herself again.

Ospemifene, an oral selective estrogen receptor modulator, is another option for women who prefer not to use vaginal estrogen, though it is less commonly used in actively breastfeeding women and worth discussing individually with your physician.

What to do next

If any of this sounds familiar, bring it up at your next appointment. Write it down beforehand if you need to, because the research consistently shows that when women do not name the symptom out loud, it rarely gets addressed. You are not being dramatic. You are not overreacting. You are describing something real that has a clinical name, established treatments, and a physician who is ready to take it seriously.

GSL resolves on its own once breastfeeding ends and estrogen levels recover, but that timeline is different for every woman, and there is no reason to spend months uncomfortable when effective options exist right now.

You deserve to feel good in your body. Not eventually. Now.

You were never imagining it. You just needed someone to finally name it.