Genitourinary Syndrome: Difference between revisions
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== Introduction == | == Introduction == | ||
Genitourinary syndrome | Genitourinary syndrome of menopause GSM was first introduced in 2014 as an alternative term for vulvovaginal atrophy, it is a chronic condition affect women after menopause. It is a chronic progressive conditions that describes the changes result from the decrease in estrogen level after menopause on vulvovaginal and lower urinary tract. The majority of women may be affected after menopause but about 15%of women may have symptoms pre-menopause, and may women consider it a normal process with aging process and they do not seek help or consider it a condition that need help so it remains underdiagnosed and they need medical awareness of their conditions<ref name=":2">Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S. The genitourinary syndrome of menopause: an overview of the recent data. Cureus. 2020 Apr 8;12(4).</ref>. | ||
== Mechanism of Injury / Pathological Process == | |||
The vagina, vestibule, urethra, trigone of bladder contain receptors a and b for estrogen. However both receptors can be found in premenopausal women but during menopause only b receptors can be found. So the level of estrogen at urogenital tract will be decreased and will affect on the contractility and elasticity of organs. The stratified squamous vaginal epithelium is estrogen responsive, there will be changes in the vaginal epithelium thickness, blood flow, atrophy of smooth cells of vagina, loss of tissue elasticity, and the vaginal mucosa will be fragile and pallor. The labia minora consists of elastic fibers, dense connective tissue, and erectile tissue, there will be loss in the size of labia minora, decrease in the subcutaneous fat of labia majora, reduction in pubic hair, in addition, there will be a change in microbial environment of the vagina and an increase in vaginal PH<ref name=":0">Mitchell CM, Waetjen LE. Genitourinary changes with aging. Obstetrics and Gynecology Clinics. 2018 Dec 1;45(4):737-50.</ref><ref name=":1">Faubion SS, Sood R, Kapoor E. Genitourinary syndrome of menopause: management strategies for the clinician. InMayo Clinic Proceedings 2017 Dec 1 (Vol. 92, No. 12, pp. 1842-1849). Elsevier.</ref>. | |||
The vagina, vestibule, urethra, trigone of bladder contain receptors a and b for estrogen. However both receptors can be found in premenopausal women but during menopause only b receptors can be found. So the level of estrogen at urogenital tract will be decreased and will affect on the contractility and elasticity of organs. | |||
The stratified squamous vaginal epithelium is estrogen responsive, there will be changes in the vaginal epithelium thickness, blood flow, atrophy of smooth cells of vagina, loss of tissue elasticity, and the vaginal mucosa will be fragile and pallor. | |||
The labia minora consists of elastic fibers, dense connective tissue, and erectile tissue, there will be loss in the size of labia minora, decrease in the subcutaneous fat of labia majora, reduction in pubic hair, in addition, there will be a change in microbial environment of the vagina and an increase in vaginal PH<ref name=":0">Mitchell CM, Waetjen LE. Genitourinary changes with aging. Obstetrics and Gynecology Clinics. 2018 Dec 1;45(4):737-50.</ref><ref name=":1">Faubion SS, Sood R, Kapoor E. Genitourinary syndrome of menopause: management strategies for the clinician. InMayo Clinic Proceedings 2017 Dec 1 (Vol. 92, No. 12, pp. 1842-1849). Elsevier.</ref>. | |||
That cause trauma and irritation during sex. Plus changes at the level of genital system the contractile ability of ureteral sphincter, and contractile coordination of pelvic floor muscle will be decreased<ref name=":0" /><ref name=":1" />. | That cause trauma and irritation during sex. Plus changes at the level of genital system the contractile ability of ureteral sphincter, and contractile coordination of pelvic floor muscle will be decreased<ref name=":0" /><ref name=":1" />. | ||
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== Clinical Presentation == | == Clinical Presentation == | ||
More than 45% of post menopausal women report some types of GSM, those with dryness and painful intercourse are the most common<ref name=":0" />. In about 50% of post-menopausal women the manifestations are mild and non specific and it is not necessary for all GSM symptoms to occur. Irritation, burning, itching of vulva or vagina are common symptoms of GSM, and they are reported in 63.3% of the women with GSM<ref>Genitourinary syndrome of menopause. Prevalence and quality of life in Spanish postmenopausal women. The GENISSE study. Moral E, Delgado JL, Carmona F, et al. ''Climacteric.'' 2018;21:167–173</ref>''.'' Other signs and symptoms includes: | More than 45% of post menopausal women report some types of GSM, those with dryness and painful intercourse are the most common<ref name=":0" />. In about 50% of post-menopausal women the manifestations are mild and non specific and it is not necessary for all GSM symptoms to occur. Irritation, burning, itching of vulva or vagina are common symptoms of GSM, and they are reported in 63.3% of the women with GSM<ref>Genitourinary syndrome of menopause. Prevalence and quality of life in Spanish postmenopausal women. The GENISSE study. Moral E, Delgado JL, Carmona F, et al. ''Climacteric.'' 2018;21:167–173</ref>''.'' Symptoms of GSM appear to have a greater impact on the quality of life (QOL) specially in sexually active women, confidence and intimacy with their partner. Other signs and symptoms includes: | ||
* Vaginal dryness. | * Vaginal dryness. | ||
* Dyspareunia (20% to 59%). | * Dyspareunia (20% to 59%). | ||
* Decrease or loss of arousal, orgasm, or desire. | * [[Female Sexual Health|Decrease or loss of arousal, orgasm, or desire.]] | ||
* Vaginal vault prolapse. | * Vaginal vault prolapse. | ||
* Post coital bleeding. | * Post coital bleeding. | ||
* Incontinence (stress or urge). | * [[Urinary Incontinence|Incontinence]] (stress or urge). | ||
* Recurrent urinary tract infection UTI (8%-11%)<ref name=":0" />. | * Recurrent urinary tract infection UTI (8%-11%)<ref name=":0" />. | ||
* Dysuria (7%- 13%). | * Dysuria (7%- 13%). | ||
| Line 38: | Line 28: | ||
* Idiopathic overactive bladder. | * Idiopathic overactive bladder. | ||
* Interstitial cystitis<ref name=":0" /><ref name=":2" />. | * Interstitial cystitis<ref name=":0" /><ref name=":2" />. | ||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
There is not specific or necessary diagnostic procedures to diagnose GSM and it depends on exclusion of other causes with similar symptoms such as chronic pelvic pain, vulvodynia, or dermatological conditions. | |||
== Outcome Measures == | == Outcome Measures == | ||
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Chronic pelvic pain | Chronic pelvic pain | ||
== References == | == References == | ||
<references /> | <references /> | ||
[[Category:Womens Health]] | |||
[[Category:Pelvic Health]] | |||
[[Category:Pelvis - Conditions]] | |||
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Introduction[edit | edit source]
Genitourinary syndrome of menopause GSM was first introduced in 2014 as an alternative term for vulvovaginal atrophy, it is a chronic condition affect women after menopause. It is a chronic progressive conditions that describes the changes result from the decrease in estrogen level after menopause on vulvovaginal and lower urinary tract. The majority of women may be affected after menopause but about 15%of women may have symptoms pre-menopause, and may women consider it a normal process with aging process and they do not seek help or consider it a condition that need help so it remains underdiagnosed and they need medical awareness of their conditions[1].
Mechanism of Injury / Pathological Process[edit | edit source]
The vagina, vestibule, urethra, trigone of bladder contain receptors a and b for estrogen. However both receptors can be found in premenopausal women but during menopause only b receptors can be found. So the level of estrogen at urogenital tract will be decreased and will affect on the contractility and elasticity of organs. The stratified squamous vaginal epithelium is estrogen responsive, there will be changes in the vaginal epithelium thickness, blood flow, atrophy of smooth cells of vagina, loss of tissue elasticity, and the vaginal mucosa will be fragile and pallor. The labia minora consists of elastic fibers, dense connective tissue, and erectile tissue, there will be loss in the size of labia minora, decrease in the subcutaneous fat of labia majora, reduction in pubic hair, in addition, there will be a change in microbial environment of the vagina and an increase in vaginal PH[2][3].
That cause trauma and irritation during sex. Plus changes at the level of genital system the contractile ability of ureteral sphincter, and contractile coordination of pelvic floor muscle will be decreased[2][3].
Clinical Presentation[edit | edit source]
More than 45% of post menopausal women report some types of GSM, those with dryness and painful intercourse are the most common[2]. In about 50% of post-menopausal women the manifestations are mild and non specific and it is not necessary for all GSM symptoms to occur. Irritation, burning, itching of vulva or vagina are common symptoms of GSM, and they are reported in 63.3% of the women with GSM[4]. Symptoms of GSM appear to have a greater impact on the quality of life (QOL) specially in sexually active women, confidence and intimacy with their partner. Other signs and symptoms includes:
- Vaginal dryness.
- Dyspareunia (20% to 59%).
- Decrease or loss of arousal, orgasm, or desire.
- Vaginal vault prolapse.
- Post coital bleeding.
- Incontinence (stress or urge).
- Recurrent urinary tract infection UTI (8%-11%)[2].
- Dysuria (7%- 13%).
- Urethral prolapse.
- Idiopathic overactive bladder.
- Interstitial cystitis[2][1].
Diagnostic Procedures[edit | edit source]
There is not specific or necessary diagnostic procedures to diagnose GSM and it depends on exclusion of other causes with similar symptoms such as chronic pelvic pain, vulvodynia, or dermatological conditions.
Outcome Measures[edit | edit source]
Vulvovaginal Symptoms Questionnaire.
Day-to-Day Impact of Vaginal Aging (DIVA) Questionnaire[5].
Management / Interventions[edit | edit source]
add text here relating to management approaches to the condition
Differential Diagnosis[edit | edit source]
Dermatological conditions related to vulva; vaginitis, lichen sclerosus, chronic vulvovaginitis, or eczema.
Vulvodynia
Chronic pelvic pain
References[edit | edit source]
- ↑ 1.0 1.1 Angelou K, Grigoriadis T, Diakosavvas M, Zacharakis D, Athanasiou S. The genitourinary syndrome of menopause: an overview of the recent data. Cureus. 2020 Apr 8;12(4).
- ↑ 2.0 2.1 2.2 2.3 2.4 Mitchell CM, Waetjen LE. Genitourinary changes with aging. Obstetrics and Gynecology Clinics. 2018 Dec 1;45(4):737-50.
- ↑ 3.0 3.1 Faubion SS, Sood R, Kapoor E. Genitourinary syndrome of menopause: management strategies for the clinician. InMayo Clinic Proceedings 2017 Dec 1 (Vol. 92, No. 12, pp. 1842-1849). Elsevier.
- ↑ Genitourinary syndrome of menopause. Prevalence and quality of life in Spanish postmenopausal women. The GENISSE study. Moral E, Delgado JL, Carmona F, et al. Climacteric. 2018;21:167–173
- ↑ Huang AJ, Gregorich SE, Kuppermann M, Nakagawa S, Van Den Eeden SK, Brown JS, Richter HE, Walter LC, Thom D, Stewart AL. The day-to-day impact of vaginal aging questionnaire: A multidimensional measure of the impact of vaginal symptoms on functioning and well-being in postmenopausal women. Menopause (New York, NY). 2015 Feb;22(2):144.
