This Morning’s sessions can be summarised by a quote from Nick Panay’s presentation “VVA is an unmet need and cause of silent suffering”, infact that seems to be an over-riding theme of ISGE 2018 so far. As raised in yesterday’s intracrinology session, women are not talking about their sexual health, and commonly physicians are not asking them.
Rosella Nappi expressed her alarm at how recent data has shown that despite many women suffering from dyspareunia, pain during sex, they continue having sexual activity. The reasons for this are likely multifaceted but a key reason could be sexual expectations by a partner, and as I discussed in my blog post yesterday, unsurprisingly women with a partner have a much higher incidence of distress over sexual dysfunction, and therefore a reduced quality of life.
Let’s talk sexual health
Providing physicians with the right training and tools can enable them to embark on this “proactive approach” of opening sexual health discussions. A tool such as the Decreased Sexual Desire Screener, which has been validated for use by clinicians to assist in HSDD (Hypoactive Sexual Desire Disorder) diagnosis as per the DSM-IV-TR and ISSWSH criteria. The 5 question tool, completed by the patient, suggests primary care doctors should first ask permission to discuss sexual health with the questions – are you sexually active? Are there sexual concerns you wish to discuss?
How to diagnose and classify VVA/GSM
After opening discussions about sexual health, examination appears to be an essential part of diagnosing VVA and a means to exclude other problems, such as lichen sclerosis. To increase understanding of how to classify the condition, the new nomenclature of GSM (Genitourinary Syndrome of Menopause) should be adopted globally, and standardised universally accepted questionnaires developed to correlate severity with quality of life. There are a number of existing tools, some evaluated and others yet to be, but Dr Panay explained that the Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire, relatively new but evaluated, has shown to have good correlations with vaginal and vulvar atrophy and urinary symptoms.
IMS guidelines on managing VVA symptoms are available to download for free from the IMS website. Hormone therapy is frequently discussed but the adverse effects of systemic administration mean that the IMS recommend local estrogen therapy as preferential. However, the armamentarium can be widened by considering every treatment option, including lubricants, pelvic floor therapy etc., therefore, making individualised treatment for the patient easier.
Every woman is different and what works for one may not work for another. But whilst treatment is open to change, what we know for sure is that by improving the peripheral sexual response, sexual quality of life can also be improved.