Not all women will develop symptoms of GSM, but if they do, the symptoms usually appear a few years after menopause. The condition can have a big effect on sexual activity. Many women first notice vaginal dryness. This can cause pain or even bleeding during sexual activity. Some women experience changes in sexual enjoyment and trouble having an orgasm. These symptoms are caused by: Loss of elasticity (the ability of the skin to go back to its original shape after being stretched) in the vaginaNarrowing or shortening of the vaginaLack of blood flow to the vagina and clitoris during sexWomen with GSM may get more frequent urinary tract infections or, in some cases, develop incontinence — the inability to control when they urinate.