GSM stands for genitourinary syndrome of menopause. A cluster of symptoms caused by declining estrogen in the vaginal and urinary tissues, including dryness, irritation, painful intercourse, urinary urgency, and recurrent UTIs. It is one of the most under-diagnosed conditions in women's health, and one of the most treatable.

Women's Sexual Health & Libido

Q: Will I need a referral?

No. You can come to Nova directly.

Q: Can hormone therapy actually restore libido?

For many women. Yes, partially or fully. Estrogen, progesterone, and a small amount of testosterone, used appropriately, often restore desire, arousal, and the comfort of sex. It is not a guaranteed result for every patient, but it is a real one for many.

Q: Is this conversation going to be awkward?

It can feel awkward going into it. Our patients consistently tell us it stops being awkward almost immediately. This is medicine. And a part of medicine that has been ignored for too long.

Sexual health is an essential part of overall health, yet it’s one of the least discussed aspects of women’s medicine. Pain with intimacy, vaginal dryness, recurrent urinary tract infections, changes in desire, and difficulty with arousal are common—but they are not something you simply have to accept. Pain during intimacy, in particular, is never something you should have to “push through.” At Nova Wellness, we create the time and space for these conversations and offer thoughtful, evidence-based treatment options tailored to each woman.

What We Treat

Many women come to us because they no longer feel like themselves. Some are experiencing pain. Others have noticed changes in desire, arousal, or intimacy that have developed gradually over time. Whatever brings you here, these symptoms are common—and often treatable.

We commonly evaluate and treat:

Pain during intimacy, often related to genitourinary syndrome of menopause (GSM), but not always.
Vaginal dryness, burning, irritation, and recurrent urinary tract infections associated with GSM.
Low desire (low libido) and hypoactive sexual desire disorder (HSDD).
Difficulty with arousal or taking longer to become aroused than before.
Loss of clitoral or vulvar sensation.
Differences in sexual desire between partners, particularly during perimenopause and menopause.
Sexual health concerns after breast cancer treatment, including women with a history of estrogen receptor-positive breast cancer.
Sexual health concerns after pregnancy and childbirth.

If any of these sound familiar, the most important thing to know is this: These symptoms are common. They are real. And in many cases, they are highly treatable.

Why It's So Often Missed

Sexual health is influenced by many interconnected factors. Hormones are certainly important, but so are blood flow, pelvic floor function, sleep, stress, medications, relationship dynamics, mental health, body image, and overall physical health.

That’s why there is rarely a single cause—or a single solution. At Nova Wellness, we take the time to understand what’s contributing to your symptoms so we can build a treatment plan that’s personalized to you.

What Nova Does

Your personalized treatment plan may include:

Hormonal therapies, including vaginal estrogen, systemic hormone therapy, or testosterone therapy when clinically appropriate.
Non-hormonal therapies to improve vaginal comfort, arousal, and sexual function.
Pelvic floor physical therapy referral and coordination when pelvic floor dysfunction contributes to pain or discomfort.
Lifestyle, nutrition, sleep, and stress optimization, recognizing that sexual health is closely connected to overall physical and emotional well-being.
Other individualized therapies, including prescription medications, compounded treatments, or targeted interventions when appropriate.

Dr. Chris Di Giorgio

Dr. Chris Di Giorgio, a board-certified cardiologist and former Chief of Cardiology at Hackensack Meridian Mountainside Medical Center, brings a prevention-focused approach to cardiovascular and metabolic health. His expertise includes insulin resistance, inflammation, cholesterol management, longevity medicine, and identifying cardiovascular risk long before disease develops.

Dr. Jennifer Knight

Women’s health at Nova is led by Dr. Jennifer Knight, a double board-certified physician and certified menopause specialist with advanced training in integrative and longevity medicine. Whether you’re navigating hormonal changes, unexplained symptoms, or simply want to optimize your health, our goal is simple: understand the whole story, identify the root causes, and create a personalized plan that helps you feel your best.

Who This Is For

Women in perimenopause or menopause whose sexual health has changed and want it addressed seriously.
Couples in midlife navigating a desire discrepancy who want clinical help making sense of it.
Women who have been told painful sex is just something they have to live with.
Breast cancer survivors with GSM who have been told they can’t use any form of estrogen. And who deserve a more nuanced conversation.
Women who haven’t brought this up with anyone because no one has made it easy to.

Frequently Asked Questions

Is vaginal estrogen safe?

Yes. For most patients, vaginal estrogen has an exceptionally strong safety profile. It works locally, with minimal systemic absorption. The Menopause Society and current professional guidelines consider vaginal estrogen safe even for many breast cancer survivors. We’ll work through your individual case carefully.

Will I need a referral?

What's "GSM"?

Can hormone therapy actually restore libido?

Is this conversation going to be awkward?

You deserve a sex life that doesn't hurt. And one that you actually want.

If sexual health has been a quiet, untreated part of your life, let’s change that.