New recommendations suggest every woman should be screened, whether or not they bring it up during an exam.
Genitourinary syndrome of menopause (GSM) is a common affliction, yet many women do not seek treatment — and many physicians do not talk with their patients about it, either.
The North American Menopause Society is hoping to change this. After the organization issued an updated position statement on the condition in 2020, physicians from the Rutgers Robert Wood Johnson Medical School published a positive review of the position, advocating a proactive approach to GSM.
“[GSM] affects up to 50% of women in the peri- and postmenopausal years, and it has been shown to have a very negative effect on their overall quality of life and their sense of well-being,” says review author Nancy A. Phillips, MD, Director, Center for Vulvovaginal Health and associate professor, Department of Obstetrics, Gynecology & Reproductive Sciences at Robert Wood Johnson Medical School. “It’s disruptive to their daily life and disruptive to their sexual health. It can cause further sexual dysfunction such as decreased desire or painful sex.”
More Than Simple Vaginal Dryness
With estrogen loss, many postmenopausal women experience vulvovaginal dryness, but GSM goes beyond a mere need for lubricants during sex. Women with GSM have a combination of symptoms affecting both the genitals and urinary tract, including incontinence, recurrent UTI, painful intercourse and painful or urgent urination.
Diagnosis of GSM is often missed because many patients feel awkward discussing sex or urinary problems with their doctors, which is why Dr. Phillips says it is imperative for physicians to bring up the topic during annual physicals or OB/GYN visits.
“Once [patients] hit 40, it’s especially important to ask about sexual problems and to be specific about it,” Dr. Phillips says. “Ask, ‘Are you having pain with sex? Are you having decreased lubrication? Do you feel dry?’ ... You have to get details about it.”
If a woman says she is no longer sexually active, physicians should follow up with further questioning, as research shows up to 58% of women say they have stopped having sex due to GSM symptoms. A physical exam can rule out other possible sources of vulvovaginal complaints, like infections or skin disorders. And a vaginal pH test can be diagnostic of a lack of estrogen.
“I think this is an essential part of overall women’s health,” Dr. Phillips says. “[More physicians] should recognize the impact that this has on women and that there are both hormonal and nonhormonal treatments available. And the hormonal treatments for vulvovaginal atrophy, especially the local treatments, are very safe and without the negative connotations of systemic estrogen therapy.”