question help

 I was surprised to learn that menopause can cause a woman to have painful intercourse. I knew it can cause vaginal dryness, but I assumed it could be easily solved with an over the counter vaginal lubricant. After watching the video I realized that the solution to that problem may not be as simple and medical advice may be needed.

        Genitourinary syndrome of menopause (GSM) is defined as a condition in which the anatomy and function of urogenital tissues are significantly affected and vulvovaginal atrophy (VVA) may occur as a  consequence of hormonal deprivation and senescence. For a many 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 such as dryness, burning, itching, irritation, bleeding;  sexual symptoms such as dyspareunia and other sexual dysfunctions. It can also include urinary symptoms such dysuria, frequency, urgency, recurrent urinary infections (Nappi, Martini, Cucinella, Martella, Tiranini, Inzoli & Gardella, 2019)

 

     On her video, Dr. Shapiro described some of the treatments to treat GSM. I am particularly interested in the hormone containing cream due to being easy to use. She points out the importance of sexual health and how important it is to the quality of life. That’s why I think that a cream, even though it is a medication, doesn't feel like a medication as much as other treatments would. Therefore, I find it to be the most appealing choice for our female patients. According to research from the Women’s Health Initiative clinical, trials suggest that the risks of combined estrogen/progestin therapy exceed the benefits convinced many postmenopausal women to stop using systemic estrogen therapy. In addition to this, NAMS suggested that an individual benefit–risk profile that considers formulation, route of administration, and timing of therapy should be created for each woman considering hormone therapy (Kagan, Kellogg-Spadt & Parish, 2019) . 

 

    My level of comfort in taking a complete sexual history is yet to be developed. I did have a few chances to see patients who had a sexual related diagnosis at my clinical practice, but I used let my preceptor take the lead. I knew exactly what to ask, but I wasn’t sure how the patient would react to my questions. Currently, I feel more confident about it, especially with female patients. For some reason I feel like male patients will be more open with a male provider, but then I think about the fact that they chose a female for a reason. I guess there is  room for personal improvement in this area and I need to get some education on how to approach the sexual history taking of a male patient.

 

    I found this week’s lessons extremely helpful understanding what our elderly go through. The psychological aspect of sexual health is very important and can affect the mood and overall quality of life of our elderly population. Like I mentioned at the beginning of my post, I was impressed to learn about the profound changes in the female genitalia, pelvic floor and urinary organ due to the lack of sexual hormones. I feel the need to learn more about the treatment options and about the need for reassurance for my female patients.

References 

Kagan, R., Kellogg-Spadt, S., & Parish, S. J. (2019). Practical treatment considerations in the management of genitourinary syndrome of menopause. Drugs & aging, 36(10), 897-908.https://link.springer.com/article/10.1007/s40266-019-00700-w (Links to an external site.)

 

Nappi, R. E., Martini, E., Cucinella, L., Martella, S., Tiranini, L., Inzoli, A., ... & Gardella, B. (2019). Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women. Frontiers in endocrinology, 10, 561.https://scholar.google.com/scholar?hl=en&as_sdt=0%2C33&q=gsm+definition+&btnG=#d=gs_qabs&u=%23p%3DlddkdEE5BZsJ