Executive Summary
Research findings indicate that brief telephone counseling sustained long-term impact from a sexually transmitted infections/HIV intervention program among African American female adolescents.
• The Centers for Disease Control and Prevention estimates that African American youth continue to be one of the U.S. groups most severely affected by HIV infection. Black youth represent more than half (57%) of all new HIV infections among young people ages 13 to 24.
• Mobile phones represent an important communication avenue for adolescents. Estimates say 75% of people ages 12-17 have a mobile phone, including 58% of 12-year-olds.
It’s time to incorporate new terminology in your discussion of menopause: genitourinary syndrome of menopause (GSM). Developed and endorsed by the North American Menopause Society (NAMS) and the International Society for the Study of Women’s Sexual Health, the term defines "a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder."1-4 The syndrome might include but is not limited to genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria, and recurrent urinary tract infections.
The new terminology is medically accurate, isn’t embarrassing to say, and should help providers and patients more comfortably discuss the changes often associated with menopause, says Margery Gass, MD, NAMS executive director.
Up to now, terms such as "atrophic vaginitis" and "vulvovaginal atrophy." have been used to describe the genital problems women can have when estrogen drops after menopause, notes Gass. With "atrophic vaginitis," the term implies infection or inflammation, which isn’t the main problem. And with "vaginal atrophy," atrophy has negative connotations for midlife women, and the word "vagina" is not a generally accepted term for public discourse or for the media.1-4 Both terms also ignore the urinary symptoms that come along with menopausal genital changes, including urgency, painful urination, and recurring urinary tract infections.
With the new terminology, look for increased communication, research, education, and treatments, much as when the term "impotence" was replaced by erectile dysfunction (ED). "When the stigma associated with the term impotence was removed, the definition of ED refined, and guidelines for assessment and therapy provided, communication between healthcare professionals and patients greatly improved, as did treatment and quality of life," observes the GSM consensus panel.
Regardless of what terminology is used, atrophic genital changes accompanying menopause are common, represent an important cause of sexual dysfunction, and too often are untreated, says Andrew Kaunitz, MD, University of Florida Research Foundation professor and associate chairman of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine — Jacksonville.
"I am hopeful this new terminology will make it easier for women and clinicians to discuss this issue, leading to greater recognition and treatment," says Kaunitz, who serves on the NAMS board of trustees.
Being able to discuss GSM is important, because most menopausal women remain sexually active after menopause. Low hormone levels after menopause result in thinning tissue, loss of elasticity, fewer blood vessels, dryness, and physical changes that can make intercourse painful and the urethra easily irritated if not treated.5 These changes can be problematic for many women. In a study of 94,000 postmenopausal women ages 50-79, 52% reported that they had been sexually active with a partner in the past year.6
In an international survey of women ages 55-65 years in Canada, Finland, Sweden, the United Kingdom, and the United States, 30% of women who reported experiencing vaginal discomfort did not talk to anyone about it, even to partners or friends.7 Vaginal discomfort was defined in the survey as dryness, smarting pain, itching, involuntary urination, or pain in the vagina in connection with touching and/or intercourse.
To get discussions rolling, an article covering the development of the new terminology has been simultaneously released in four medical journals.1-4 Presentations are being made at professional societies such as the Association of Reproductive Health Professionals’ annual conference in Charlotte, NC, says Gass.
Panelists who participated in the consensus panel are developing a tool to help standardize physical examination to look for GSM changes. With such a tool in hand, providers will be able to make diagnoses swiftly and accurately to supply needed treatment.
Remember that terms such as "vaginal atrophy" and "atrophic vaginitis" still might be listed in indications for use in existing approved drugs, notes Gass. These drugs will continue to be used in treatment of GSM, she states.
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Portman DJ, Gass ML; on behalf of the Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Menopause 2014; doi: 10.1097/gme.0000000000000329.
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Portman DJ, Gass ML; on behalf of the Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Maturitas 2014; doi: 10.1016/j.maturitas.2014.07.013.
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Portman DJ, Gass ML; on behalf of the Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. J Sex Med 2014; doi: 10.1111/jsm.12686.
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Portman DJ, Gass ML; on behalf of the Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Climactric 2014; doi:10.3109/13697137.2014.946279.
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Tan O, Bradshaw K, Carr BR. Management of vulvovaginal atrophy-related sexual dysfunction in postmenopausal women: an up-to-date review. Menopause 2012; 19:109-117
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McCall-Hosenfeld JS, Jaramillo SA, Legault C, et al. Correlates of sexual satisfaction among sexually active postmenopausal women in the Women’s Health Initiative Observational Study. J Gen Intern Med 2008; 23:2000-2009.
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Nappi RE, Kokot-Kierepa M. Women’s voices in the menopause: results from an international survey on vaginal atrophy. Maturitas 2010; 67(3):233-238.
