We're Not Doing Enough for the Postmenopausal Vulva and Vagina

madman · Oct 3, 2023

Dr. James Simon discusses the lack of attention given to postmenopausal vulva and vagina health and the evidence-based approach to addressing this issue. He explains the clinical manifestations of hormonal-mediated vestibular denia (VVS) and genital urinary syndrome of menopause (GSM), highlighting their impact on sexual function. Dr. Simon explores the embryology and development of the female vestibule and emphasizes the importance of androgens for its health. He delves into the treatment options available, including hormonal and non-hormonal medications and energy-based devices. The presentation also touches on the prevalence and significance of vulvar and vaginal atrophy (GSM) in postmenopausal women.

Highlights:

Dr. Simon’s disclosures: involvement in drug and device development in women’s health.
Objectives: recognize clinical manifestations of VVS and GSM, understand pathophysiology, appreciate their impact on sexual function, and gain knowledge of evidence-based treatment options.
Importance of androgens for the health, integrity, and toughness of the vestibule.
Treatment options: topical estradiol and testosterone, intravaginal DHEA, systemic estrogen and androgen therapies, fractional CO2 laser.
Embryological development of the female vestibule.
Prevalence and impact of GSM: affects 50% of postmenopausal women, chronic and progressive without treatment, underdiagnosed, and undertreated.
Sexual inactivity in postmenopausal women often due to sexual pain and discomfort associated with GSM.
Symptoms of GSM often unrecognized as menopausal symptoms.
Changes in vaginal pH, epithelium, and biome in postmenopausal women.
Alternative treatments: moisturizers, lubricants, vaginal dilators, and energy-based therapies.
Controversies surrounding CO2 laser treatment for vulvar and vaginal atrophy.
Relationship between GSM and urinary tract infections.
GSM and VVA as preventable and treatable disorders affecting genital urinary health, sexuality, relationships, and quality of life.