Genitourinary Changes with Aging.
25 Oct 2018-Obstetrics and Gynecology Clinics of North America (Obstet Gynecol Clin North Am)-Vol. 45, Iss: 4, pp 737-750
TL;DR: The epidemiology and impact of genitourinary aging in midlife and older women, namely, vulvovaginal, urinary, and sexual symptoms, are presented.
About: This article is published in Obstetrics and Gynecology Clinics of North America.The article was published on 2018-10-25. It has received 31 citations till now. The article focuses on the topics: Genitourinary system & Sexual dysfunction.
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TL;DR: Health care providers 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.
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.
76 citations
TL;DR: The genitourinary syndrome of menopause (GSM) is a relatively new term for the condition previously known as vulvovaginal atrophy, atrophic vaginitis, or urogenital atrophy characterized by a broad spectrum of signs and symptoms.
Abstract: The genitourinary syndrome of menopause (GSM) is a relatively new term for the condition previously known as vulvovaginal atrophy, atrophic vaginitis, or urogenital atrophy. The term was first introduced in 2014. GSM is a chronic, progressive, vulvovaginal, sexual, and lower urinary tract condition characterized by a broad spectrum of signs and symptoms. Most of these symptoms can be attributed to the lack of estrogen that characterizes menopause. Even though the condition mainly affects postmenopausal women, it is seen in many premenopausal women as well. The hypoestrogenic state results in hormonal and anatomical changes in the genitourinary tract, with vaginal dryness, dyspareunia, and reduced lubrication being the most prevalent and bothersome symptoms. These can have a great impact on the quality of life (QOL) of the affected women, especially those who are sexually active. The primary goal of the treatment of GSM is to achieve the relief of symptoms. First-line treatment consists of non-hormonal therapies such as lubricants and moisturizers, while hormonal therapy with local estrogen products is generally considered the "gold standard''. Newer therapeutic approaches with selective estrogen receptor modulators (SERMs) or laser technologies can be employed as alternative options, but further research is required to investigate the viability and scope of their implementation in day-to-day clinical practice.
37 citations
TL;DR: Evidence supporting physical exercise as a strategy to improve sexual function and quality of sexual life related to menopausal symptoms is limited, and further studies on this topic are needed.
Abstract: During the menopausal period, sexual dysfunction is associated with the development or worsening of psychological conditions, causing deterioration in women’s mental health and quality of life. This systematic review aims to investigate the effects of different exercise programs on sexual function and quality of sexual life related to menopausal symptoms. With this purpose, a systematic literature search was conducted in PubMed, CINAHL, Scopus, Web of Science, and Cochrane Plus. A total of 1787 articles were identified in the initial search and 11 prospective studies (including 8 randomized controlled trials) were finally included. The most commonly recommended training programs are based on exercising pelvic floor muscles, as they seem to have the largest impact on sexual function. Mind–body disciplines also helped in managing menopausal symptoms. However, as far as the most traditional programs were concerned, aerobic exercises showed inconsistent results and resistance training did not seem to convey any benefits. Although positive effects have been found, evidence supporting physical exercise as a strategy to improve sexual function and quality of sexual life related to menopausal symptoms is limited, and further studies on this topic are needed.
32 citations
Cites background from "Genitourinary Changes with Aging."
...In addition, vaginal innervations appear to increase as estrogen decreases [34], which may further condition sexual function....
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TL;DR: Genitourinary syndrome of menopause (GSM) refers to a collection of symptoms resulting from diminished hormonal, primarily estrogenic stimulation to the vulvovaginal or lower urinary tract and may affect up to 50% of postmenopausal women as discussed by the authors.
Abstract: Genitourinary syndrome of menopause (GSM) refers to a collection of symptoms resulting from diminished hormonal, primarily estrogenic stimulation to the vulvovaginal or lower urinary tract and may affect up to 50% of postmenopausal women Symptoms, which are typically progressive and unlikely to resolve spontaneously, may include, but are not limited to, vulvovaginal dryness, burning or irritation, dyspareunia, or urinary symptoms of urgency, dysuria or recurrent urinary tract infection These symptoms are typically progressive and unlikely to resolve spontaneously Diagnosis is clinical Telemedicine may play a role in diagnosis, initiation of treatment, and follow-up of women with GSM Effective treatments include moisturizers and lubricants, local hormonal therapy with estrogen or dehydroepiandrosterone, and oral selective estrogen receptor agonists Laser or radiofrequency procedures, although currently utilized, are being studied to comprehensively understand their overall effectiveness and safety Additionally, the influence and effect of the vaginal microbiome, as well as potential of treatment via its manipulation, is being studied We performed a literature search of PubMed, Google Scholar, and Ovid with search terms of vulvovaginal atrophy and GSM and reviewed major US Society Guidelines to create this narrative review of this topic The literature suggests that healthcare providers can make a significant impact of the health and quality of life of women by being proactive about discussing and providing interventions for GSM A systematic approach with consideration of current guidelines and attention to developing protocols for interventions should be employed
29 citations
TL;DR: It is estimated that 50% of women will suffer a severe form of vulvovaginal atrophy (VVA) related to menopause, and young women may temporarily present this clinical problem while receiving va...
Abstract: It is estimated that 50% of women will suffer a severe form of vulvovaginal atrophy (VVA) related to menopause. Equally, young women may temporarily present this clinical problem while receiving va...
20 citations
References
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TL;DR: The EPIC study is the largest population-based survey to assess prevalence rates of OAB, UI, and other LUTS in five countries and is the first study to evaluate these symptoms simultaneously using the 2002 ICS definitions.
2,275 citations
TL;DR: Men and women who rated their health as being poor were less likely to be sexually active and, among respondents who were sexually active, were more likely to reportSexual problems are frequent among older adults, but these problems are infrequently discussed with physicians.
Abstract: BACKGROUND Despite the aging of the population, little is known about the sexual behaviors and sexual function of older people. METHODS We report the prevalence of sexual activity, behaviors, and problems in a national probability sample of 3005 U.S. adults (1550 women and 1455 men) 57 to 85 years of age, and we describe the association of these variables with age and health status. RESULTS The unweighted survey response rate for this probability sample was 74.8%, and the weighted response rate was 75.5%. The prevalence of sexual activity declined with age (73% among respondents who were 57 to 64 years of age, 53% among respondents who were 65 to 74 years of age, and 26% among respondents who were 75 to 85 years of age); women were significantly less likely than men at all ages to report sexual activity. Among respondents who were sexually active, about half of both men and women reported at least one bothersome sexual problem. The most prevalent sexual problems among women were low desire (43%), difficulty with vaginal lubrication (39%), and inability to climax (34%). Among men, the most prevalent sexual problems were erectile difficulties (37%). Fourteen percent of all men reported using medication or supplements to improve sexual function. Men and women who rated their health as being poor were less likely to be sexually active and, among respondents who were sexually active, were more likely to report sexual problems. A total of 38% of men and 22% of women reported having discussed sex with a physician since the age of 50 years. CONCLUSIONS Many older adults are sexually active. Women are less likely than men to have a spousal or other intimate relationship and to be sexually active. Sexual problems are frequent among older adults, but these problems are infrequently discussed with physicians.
1,866 citations
TL;DR: To determine if urge urinary incontinence is associated with risk of falls and non‐spine fractures in older women, a large number of studies have found that it is not.
Abstract: OBJECTIVE: To determine if urge urinary incontinence is associated with risk of falls and non-spine fractures in older women.
METHODS: Type and frequency of incontinent episodes were assessed by 6049 community-dwelling women using a self-completed questionnaire. Postcards were subsequently mailed every 4 months to inquire about falls and fractures. Incident fractures were confirmed by radiographic report. Logistic and proportional hazard models were used to assess the independent association of urge urinary incontinence and risk of falling or fracture.
RESULTS: The mean age of the women was 78.5 (± 4.6) years. During an average follow-up of 3 years, 55% of women reported falling, and 8.5% reported fractures. One-quarter of the women (1493) reported weekly or more frequent urge incontinence, 19% (1137) reported weekly or more frequent stress incontinence, and 708 (12%) reported both types of incontinence. In multivariate models, weekly or more frequent urge incontinence was associated independently with risk of falling (odds ratio = 1.26; 95% confidence interval (CI), 1.14-1.40) and with non-spine nontraumatic fracture (relative hazard 1.34; 95% CI, 1.06-1.69; P = .02). Stress incontinence was not associated independently with falls or fracture.
CONCLUSIONS: Weekly or more frequent urge incontinence was associated independently with an increased risk of falls and non-spine, nontraumatic fractures in older women. Urinary frequency, nocturia, and rushing to the bathroom to avoid urge incontinent episodes most likely increase the risk of falling, which then results in fractures. Early diagnosis and appropriate treatment of urge incontinence may decrease the risk of fracture. J Am Geriatr Soc 48:721–725, 2000.
532 citations
TL;DR: The term genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing, and publicly acceptable term than vulvovaginal atrophy and was formally endorsed by the respective Boards of NAMS and ISSWSH in 2014.
Abstract: BackgroundIn 2012, the Board of Directors of the International Society for the Study of Women’s Sexual Health (ISSWSH) and the Board of Trustees of The North American Menopause Society (NAMS) acknowledged the need to review current terminology associated with genitourinary tract symptoms rel
473 citations
TL;DR: Menopausal hormone therapy increased the incidence of all types of UI at 1 year among women who were continent at baseline and worsened the characteristics of UI among symptomatic women after 1 year.
Abstract: ContextMenopausal hormone therapy has long been credited with many benefits
beyond the indications of relieving hot flashes, night sweats, and vaginal
dryness, and it is often prescribed to treat urinary incontinence (UI).ObjectiveTo assess the effects of menopausal hormone therapy on the incidence
and severity of symptoms of stress, urge, and mixed UI in healthy postmenopausal
women.Design, Setting, and ParticipantsWomen’s Health Initiative multicenter double-blind, placebo-controlled,
randomized clinical trials of menopausal hormone therapy in 27 347 postmenopausal
women aged 50 to 79 years enrolled between 1993 and 1998, for whom UI symptoms
were known in 23 296 participants at baseline and 1 year.InterventionsWomen were randomized based on hysterectomy status to active treatment
or placebo in either the estrogen plus progestin (E + P) or estrogen alone
trials. The E + P hormones were 0.625 mg/d of conjugated equine estrogen plus
2.5 mg/d of medroxyprogesterone acetate (CEE + MPA); estrogen alone consisted
of 0.625 mg/d of conjugated equine estrogen (CEE). There were 8506 participants
who received CEE + MPA (8102 who received placebo) and 5310 who received CEE
alone (5429 who received placebo).Main Outcome MeasuresIncident UI at 1 year among women without UI at baseline and severity
of UI at 1 year among women who had UI at baseline.ResultsMenopausal hormone therapy increased the incidence of all types of UI
at 1 year among women who were continent at baseline. The risk was highest
for stress UI (CEE + MPA: relative risk [RR], 1.87 [95% confidence interval
{CI}, 1.61-2.18]; CEE alone: RR, 2.15 [95% CI, 1.77-2.62]), followed by mixed
UI (CEE + MPA: RR, 1.49 [95% CI, 1.10-2.01]; CEE alone: RR, 1.79 [95% CI,
1.26-2.53]). The combination of CEE + MPA had no significant effect on developing
urge UI (RR, 1.15; 95% CI, 0.99-1.34), but CEE alone increased the risk (RR,
1.32; 95% CI, 1.10-1.58). Among women experiencing UI at baseline, frequency
worsened in both trials (CEE + MPA: RR, 1.38 [95% CI, 1.28-1.49]; CEE alone:
RR, 1.47 [95% CI, 1.35-1.61]). Amount of UI worsened at 1 year in both trials
(CEE + MPA: RR, 1.20 [95% CI, 1.06-1.36]; CEE alone: RR, 1.59 [95% CI, 1.39-1.82]).
Women receiving menopausal hormone therapy were more likely to report that
UI limited their daily activities (CEE + MPA: RR, 1.18 [95% CI, 1.06-1.32];
CEE alone: RR, 1.29 [95% CI, 1.15-1.45]) and bothered or disturbed them (CEE +
MPA: RR, 1.22 [95% CI, 1.13-1.32]; CEE alone: RR, 1.50 [95% CI, 1.37-1.65])
at 1 year.ConclusionsConjugated equine estrogen alone and CEE + MPA increased the risk of
UI among continent women and worsened the characteristics of UI among symptomatic
women after 1 year. Conjugated equine estrogen with or without progestin should
not be prescribed for the prevention or relief of UI.
441 citations