Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women

Abstract

Vaginal health is an essential component of active and healthy aging in women at midlife and beyond. As a consequence of hormonal deprivation and senescence, the anatomy and function of urogenital tissues are significantly affected and vulvovaginal atrophy (VVA) may occur. In a high proportion of postmenopausal women, progressive and chronic VVA symptoms have a strong impact on sexual function and quality of life. The new definition of genitourinary syndrome of menopause (GSM) comprises genital symptoms (dryness, burning, itching, irritation, bleeding), sexual symptoms (dyspareunia and other sexual dysfunctions) and urinary symptoms (dysuria, frequency, urgency, recurrent urinary infections). Many variables (age, sexual activity and partnership status) influence the clinical impact VVA/GSM symptoms and attitudes of elderly women to consult for receiving effective treatments. Psychosocial factors play a critical role in sexual functioning, but the integrity of the urogenital system is as well important affecting many domains of postmenopausal women's health, including sexual function. Several international surveys have extensively documented the need to improve VVA/GSM management because of the strong impact on women's daily life and on couple's intimacy. Health care providers (HCPs) need to be proactive in the early recognition of VVA/GSM in order to preserve urogenital and sexual longevity, by using hormonal and non-hormonal strategies. The clinical diagnosis is based on genital examination to identify objective signs and on the use of subjective scales to rate most bothersome symptoms (MBS), especially vaginal dryness. Recent studies point to the importance of addressing VVA/GSM as a potential early marker of poor general health in analogy with vasomotor symptoms. Therefore, a standard of VVA/GSM care in elderly women is desirable to enhance physical, emotional and mental well-being.

Quality of Life before and after the Use of Vaginal Estriol in Postmenopausal Women with Lower Urinary Tract Symptoms

“…Assessing health-related quality of life has been the subject of countless studies and publications, mainly starting in the first decade of the 21st century. At a time when technology is overemphasized in Medicine, sustaining and enhancing QoL involves making healthcare more focused on people, and various studies have shown that the QoL of postmenopausal women with LUTS is seriously compromised in several contexts, such as at work, in relationships and their social lives [4] [6] [7]. The literature also suggests that vaginal estriol improves vaginal trophism and reduces LUTS, leading to a positive effect on QoL [9] [17] [18].…”

“…Some women may feel uncomfortable discussing sexual matters, but this becomes necessary due to the high frequency of symptoms related to sex life, affecting nearly 50% of women in the postmenopausal period, negatively affecting their self-esteem and intimacy with their partner, and lowering their QoL [3] [27]. Studies have shown that women who use vaginal estriol have positive effects on their sexual function and QoL [4] [28] [29]. Despite its importance, we decided not to perform a statistical analysis in this domain due to a lack of consistency in the responses we obtained.…”

“…It is estimated that many of these women spend more than one-third of their lives in this period, which is marked by a gradual decrease in the production of sex steroids, especially estrogen [1]. Among other consequences, being deprived of estrogen leads to urogenital atrophy, which is associated with progressive, chronic symptoms such as vaginal dryness, vulvar pruritus, a burning sensation in the genitals, sexual symptoms such as dyspareunia and vaginal bleeding [2], along with symptoms related to lower urinary tract dysfunction, such as urinary urgency, increased daily frequency of urination, urinary incontinence (UI), dysuria and recurrent urinary infections [3] [4].…”

“…The symptoms stemming from vulvovaginal atrophy and the lower urinary tract are currently referred to as the Genitourinary Syndrome of Menopause (GSM) [5]. GSM, which includes urinary symptoms, can have negative repercussions on the quality of life (QoL), which is why it should always be taken into consideration and addressed so that the patient's aging can be as healthy as possible [4] [6] [7].…”

“…Diagnosis of GSM is clinical, based solely on the patient's reported complaints, does not require performing additional examinations, and is confirmed through a careful genital examination, including inspection of the vulva, vestibule, vagina, and urethra in order to detect signs of atrophy, such as dryness, paleness and thinning of the vaginal mucosae. The clinical exam is straightforward and objective and is a useful means of diagnosing GSM, as well as of assessing response to therapy [4].…”