Impact of vulvovaginal health on postmenopausal women: A review of surveys on symptoms of vulvovaginal atrophy

Several recent, large-scale studies have provided valuable insights into patient perspectives on postmenopausal vulvovaginal health. Symptoms of vulvovaginal atrophy, which include dryness, irritation, itching, dysuria, and dyspareunia, can adversely affect interpersonal relationships, quality of life, and sexual function. While approximately half of postmenopausal women report these symptoms, far fewer seek treatment, often because they are uninformed about hypoestrogenic postmenopausal vulvovaginal changes and the availability of safe, effective, and well-tolerated treatments, particularly local vaginal estrogen therapy. Because women hesitate to seek help for symptoms, a proactive approach to conversations about vulvovaginal discomfort would improve diagnosis and treatment

International Society for the Study of Women's Sexual Health (ISSWSH) review of epidemiology and pathophysiology, and a consensus nomenclature and process of care for the management of persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD)

Background Persistent genital arousal disorder (PGAD), a condition of unwanted, unremitting sensations of genital arousal, is associated with a significant, negative psychosocial impact that may include emotional lability, catastrophization, and suicidal ideation. Despite being first reported in 2001, PGAD remains poorly understood. Aim To characterize this complex condition more accurately, review the epidemiology and pathophysiology, and provide new nomenclature and guidance for evidence-based management. Methods A panel of experts reviewed pertinent literature, discussed research and clinical experience, and used a modified Delphi method to reach consensus concerning nomenclature, etiology, and associated factors. Levels of evidence and grades of recommendation were assigned for diagnosis and treatment. Outcomes The nomenclature of PGAD was broadened to include genito-pelvic dysesthesia (GPD), and a new biopsychosocial diagnostic and treatment algorithm for PGAD/GPD was developed

Listening to the voices of women diagnosed with vulvodynia: A model for sexuality education

In the field of human sexuality, a goal is to provide education to populations who face challenges in intimate relationships. The present research addressed the learning needs of women who experience a type of chronic sexual pain that interferes with their ability to be physically intimate. A condition known as “vulvodynia” causes a sensation of severe, prohibitive genital burning in association with any form of vaginal penetration. Women with this condition often view themselves as “abnormal” because of a cultural sexual script that equates coitus with adequate sexual functioning. Women with vulvodynia often have difficulty adapting their behavior and attitudes in a resilient fashion. Previous research suggests that many avoid all physically intimate behaviors, which negatively impacts their emotional well-being. Professional sources suggest that education about physical intimacy is critical for women with vulvodynia, but inadequate education at the time of diagnosis, and factors in women\u27s personal, familial and cultural systems, may contribute to the phenomenon of avoidance. Descriptive research about sexual adaptation and education of women with vulvodynia is lacking in the professional literature. The present study assessed adaptation to vulvodynia through the administration of quantitative questionnaires to 100 women and qualitative interviews with 12 women, all diagnosed with vulvodynia. Quantitative and qualitative analysis resulted in five key findings: (1) at the time of diagnosis, women with vulodynia were infrequently given any relevant sexuality education by healthcare providers; (2) women viewed sexuality education as most useful when it included facts about vulvodynia and partner communication issues; (3) a written sexuality education format was considered most useful; (4) multiple system factors influenced adaptation to vulvodynia, including: women\u27s developmental levels, personal competency, gender role models, support from family members, partners, peers and healthcare providers; (5) resilient adaptation to sexual pain involved the rescripting of initiation patterns and intimate behaviors. The study concluded that sexuality education for women with vulvodynia should include accessible written information that presents accurate facts about the disorder and interpersonal rescripting information

The 2020 genitourinary syndrome of menopause position statement of the North American Menopause Society

Objective: To update and expand the 2013 position statement of The North American Menopause Society (NAMS) on the management of the genitourinary syndrome of menopause (GSM), of which symptomatic vulvovaginal atrophy (VVA) is a component. Methods: A Panel of acknowledged experts in the field of genitourinary health reviewed the literature to evaluate new evidence on vaginal hormone therapies as well as on other management options available or in development for GSM. A search of PubMed was conducted identifying medical literature on VVA and GSM published since the 2013 position statement on the role of pharmacologic and nonpharmacologic treatments for VVA in postmenopausal women. The Panel revised and added recommendations on the basis of current evidence. The Panel's conclusions and recommendations were reviewed and approved by the NAMS Board of Trustees. Results: Genitourinary syndrome of menopause affects approximately 27% to 84% of postmenopausal women and can significantly impair health, sexual function, and quality of life. Genitourinary syndrome of menopause is likely underdiagnosed and undertreated. In most cases, symptoms can be effectively managed. A number of over-the-counter and government-approved prescription therapies available in the United States and Canada demonstrate effectiveness, depending on the severity of symptoms. These include vaginal lubricants and moisturizers, vaginal estrogens and dehydroepiandrosterone (DHEA), systemic hormone therapy, and the estrogen agonist/antagonist ospemifene. Long-term studies on the endometrial safety of vaginal estrogen, vaginal DHEA, and ospemifene are lacking. There are insufficient placebo-controlled trials of energy-based therapies, including laser, to draw conclusions on efficacy and safety or to make treatment recommendations. Conclusions: Clinicians can resolve many distressing genitourinary symptoms and improve sexual health and the quality of life of postmenopausal women by educating women about, diagnosing, and appropriately managing GSM. Choice of therapy depends on the severity of symptoms, the effectiveness and safety of treatments for the individual patient, and patient preference. Nonhormone therapies available without a prescription provide sufficient relief for most women with mild symptoms. Low-dose vaginal estrogens, vaginal DHEA, systemic estrogen therapy, and ospemifene are effective treatments for moderate to severe GSM. When low-dose vaginal estrogen or DHEA or ospemifene is administered, a progestogen is not indicated; however, endometrial safety has not been studied in clinical trials beyond 1 year. There are insufficient data at present to confirm the safety of vaginal estrogen or DHEA or ospemifene in women with breast cancer; management of GSM should consider the woman's needs and the recommendations of her oncologist

The role of androgens in the treatment of genitourinary syndrome of menopause (GSM): International Society for the Study of Women's Sexual Health (ISSWSH) expert consensus panel review

The objective of this consensus document is to broaden the perspective on clinical management of genitourinary syndrome of menopause to include androgens