Genitourinary Syndrome of Lactation: Patient-Reported Survey of Symptom Burden, Care Gaps, and Treatment Utilization in the Postpartum Period

Objective: To evaluate genitourinary symptoms during lactation and identify barriers to care among postpartum individuals. Methods: We conducted a cross-sectional survey study from March to May 2025 using an anonymous, 30-item online questionnaire. Eligible participants were postpartum individuals up to 24 months after delivery. Exclusion criteria included nulliparity, current pregnancy, prior genitourinary disorders, and incomplete responses. Participants were stratified into exclusive, nonexclusive, and nonlactating groups. Primary outcomes included genitourinary symptoms, treatments offered and utilized, and quality of life scores (0–100). Quantitative data were analyzed using descriptive statistics, chi-square tests, and multinomial logistic regression ( α = 0.05). Qualitative data were assessed using thematic analysis. Results: Of 1,446 respondents (median age 36 years), 47.65% were exclusively lactating, 14.66% were mixed feeding, and 37.69% were nonlactating. Vaginal dryness was the most common symptom (exclusive: 100%; nonexclusive: 100%; nonlactating: 78.72%), followed by dyspareunia (57.04%, 50.00%, and 36.33%). Functional impairments were prevalent with 76.34% of exclusively lactating participants reporting difficulty with sexual activity. Despite symptom burden, 63.81% were never asked about genitourinary concerns, and only 28.42% were offered treatment. Awareness of lactation-compatible therapies was limited (60.03% unaware). Vaginal estrogen and pelvic floor physiotherapy were most commonly recommended, but to fewer than 30% of symptomatic individuals. Lactation status was significantly associated with symptom presence and treatment patterns ( p < 0.001). Themes highlighted severe pain, disrupted intimacy, and lack of provider support. Conclusions: Genitourinary symptoms during lactation are common yet inadequately managed. Care models should incorporate routine screening, provider education on lactation-safe therapies, and improved access to multidisciplinary interventions.