A menopause congress report makes the case for psychological support alongside GSM treatment when fear and sexual pain reinforce each other.
On October 13, 2026, Contemporary OB/GYN reported on a presentation by Sheryl Kingsberg about psychotherapy and genitourinary syndrome of menopause (GSM). At the International Menopause Society’s 20th World Congress on Menopause in Rio de Janeiro, she advocated combining medical and physical care with psychological support when fear and sexual pain reinforce each other.
The model Kingsberg challenged was care built around a single treatment modality. The report discusses vaginal estrogen or other vaginal hormone therapy and pelvic-floor physical therapy as parts of GSM care. Her argument was that addressing a physical contributor does not automatically address fear or avoidance around painful sex.
This updates the focus of care without replacing its physical foundations. A discussion of symptoms can include both what hurts and how the possibility of pain is shaping sexual experience. In Kingsberg’s account, these are interacting parts of the problem rather than competing explanations.
For women in midlife, the distinction matters: being offered psychological support should not mean being sent away from medical care. The proposal is to bring relevant kinds of care together when one intervention leaves other parts of the experience unaddressed.
One finding needs to remain attached to the symptom it actually measured. Contemporary OB/GYN reported a randomized controlled trial involving 140 women with problematic hot flashes and night sweats. At six weeks, women using group CBT or self-help CBT rated those symptoms as less problematic than women receiving no treatment. The result concerns perceived impact rather than a reduction in hot-flash frequency.
That is a useful distinction when reading menopause research. How often a symptom happens and how problematic it feels are different questions. An improvement in the second outcome should not be rewritten as an improvement in the first. Keeping the outcome in view preserves the meaning of the finding without extending it to other symptoms.
That trial was not a trial of painful penetration or GSM. The conference report supplies no GSM-specific treatment-effect estimate for CBT, vaginal hormone therapy or pelvic-floor physical therapy. It also gives no estimate of the prevalence of the fear-pain cycle or how quickly sexual pain might improve. The article is conference coverage rather than a new GSM guideline.
The clinical proposal is to address fear and avoidance alongside physical symptoms. For women reading the news, the distinction keeps a reasonable proposal for broader care separate from a promise about pain relief.
The reported approach offers a way to frame a discussion with qualified care rather than a self-directed treatment plan. Physical symptoms and the fear surrounding penetration can be described together. It can also be useful to keep desire, dryness and pain as separate topics so that a conversation about discomfort does not become only a conversation about libido.
Within the reported approach, questions for a clinical discussion might include:
Another question is what each part of care is meant to address. In the presentation’s model, vaginal treatment addresses GSM while psychological care addresses fear and behavioral responses. Pelvic-floor physical therapy is another part of the proposed multidisciplinary approach. Naming those aims makes the conversation more specific than a broad suggestion to try therapy: it asks what concern the added support is meant to address.
These are questions about the scope of care. They do not require a woman to decide which professional explanation is correct before she asks for help. A clearer view of the different care roles can be useful when the concern crosses medical and psychological boundaries. Decisions about any of these approaches belong with qualified professionals who can assess the symptoms and the woman’s circumstances.
Contemporary OB/GYN also published “Shame, culture, and the barriers to pelvic pain care” on October 13, 2026. For this article, the relevant editorial point is simple: the conversation should make room for the person experiencing the symptoms. Kingsberg’s proposal gives that principle a clinical focus by asking about emotional and behavioral responses alongside physical discomfort.
Kingsberg is chief of the Division of Behavioral Medicine at University Hospitals MacDonald Women’s Hospital/University Hospitals Cleveland Medical Center. She is also a professor at Case Western Reserve University.
As Contemporary OB/GYN reported, she described the role of emotional and behavioral responses this way:
> “if you don’t address how women feel about these symptoms, the catastrophic fear, the behavioral responses, then your treatment just isn’t as effective.”
The point is to avoid an either-or explanation. Sexual pain can have biological contributors while fear and avoidance also deserve care. Psychological support should not make a woman prove that her pain is real or imply that she caused it. It belongs in this discussion as support for a fuller account of the problem.
Kingsberg’s presentation points toward menopause care that joins medical treatment and pelvic-floor care with psychological support when fear and avoidance remain part of persistent sexual pain.
Treating fear around painful sex as a reason to dismiss physical symptoms misses the fuller problem described in this report on menopause care. Refemina connects sexual wellbeing with hormonal change and confidence through research-led editorial guidance for women navigating perimenopause, menopause and the years beyond.
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