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

Abstract Introduction Despite the high prevalence of lactation in the postpartum period, the genitourinary consequences of this physiologic state remain underrecognized. The hypoestrogenic and hypoandrogenic milieu induced by lactation can give rise to genitourinary symptoms such as vaginal dryness, dyspareunia, urinary incontinence, and sexual dysfunction-collectively termed Genitourinary Syndrome of Lactation (GSL). These symptoms mirror aspects of the genitourinary syndrome of menopause but remain largely absent from postpartum care algorithms. Given their substantial impact on sexual health and quality of life, GSL represents an overlooked yet modifiable contributor to postpartum morbidity, warranting attention from providers in sexual medicine, urology, and gynecology. Objective To characterize genitourinary symptoms during lactation, assess quality-of-life impact, and identify gaps in care and treatment access among postpartum individuals. Methods We conducted a cross-sectional survey study from March to May 2025 using an anonymous, 30-item online questionnaire disseminated via social media and postpartum support groups. 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, non-exclusive, and non-lactating groups. Primary outcomes included self-reported 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 of open-text responses. Results Among 1446 respondents (median age 36 years), 47.65% were exclusively lactating, 14.66% mixed feeding, and 37.69% non-lactating. 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). Quality of life was significantly affected; 76.34% of those exclusive lactating reported difficulty with sexual activity. Despite high symptom burden, 63.81% were never asked about genitourinary symptoms by their provider, and 28.42% were offered treatment. Awareness of safe, lactation-compatible therapies was limited; 60.03% were unaware treatments existed. Vaginal estrogen and pelvic floor physiotherapy were the most commonly offered treatments but were recommended to fewer than 30% of symptomatic individuals. Significant associations were observed between lactation status and menstruation onset, symptom presence, and treatment patterns (p < 0.001). Qualitative responses emphasized severe pain, disrupted intimacy, and lack of clinical support. Conclusions Genitourinary symptoms during lactation are common, under-recognized, and insufficiently treated, with significant implications for postpartum quality of life. Clinical care models should incorporate routine screening for genitourinary symptoms, increase provider education on lactation-safe treatments, and improve patient access to multidisciplinary interventions. Disclosure No.