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Discussing vulvovaginal health at well-woman visits

Contemporary OB/GYN Journal, Vol 64 No 11, Volume 64, Issue 11

Although nearly half of postmenopausal women reported having vulvovaginal symptoms (VVS), only a minority discussed their symptoms during a well-woman visit with a primary care provider or gynecologist, according to recent survey analysis.

Although nearly half of postmenopausal women reported having vulvovaginal symptoms (VVS), only a minority discussed their symptoms during a well-woman visit with a primary care provider or gynecologist, according to a secondary analysis of a 2015 survey of 1,513 postmenopausal women.

“Despite the availability of safe and effective treatments, the Genitourinary Syndrome of Menopause (GSM) commonly affects postmenopausal women and reduces quality of life, yet it is under-recognized and undertreated,” said co-investigator Amanda Clark, MD, MCR, NCMP, an affiliate investigator at the Kaiser Permanente Center for Health Research in Portland, Oregon.

Other studies indicate that VVS affects 39% to 51% of women and that 44% to 67% have discussed their symptoms with a health care professional. In addition, “lower urinary tract symptoms affect 75% of women aged 40 or greater, yet less than a third report having sought treatment,” said Dr. Clark, who shared survey results at The North American Menopause Society (NAMS) Annual Meeting in Chicago in September.

The survey study was part of a larger intervention trial, to test whether or not an educational initiative for clinicians could improve detection and treatment of GSM. Within 1 to 2 weeks of a well woman visit, women aged 55 and older were invited by email to participate in an online survey about their care experience related to GSM at the visit.

Overall, 45% of respondents (680 of 1,513) reported having VVS. However, only 40% of these women reported discussing the symptoms at the well visit. Well visits for symptomatic women occurred both in primary care (76%) and in gynecology (24%). But when well visits occurred in gynecology, 71% of women reported a discussion about VVS, compared to 30% of women who had a well visit by primary care. Perhaps more disturbing, though, is that it was the patient who was more likely to initiate the discussion than the clinician: 59% versus 22%, respectively.“The study results are not surprising, but they provide insight into future directions for improving GSM care,” Dr. Clark told Contemporary OB/GYN. “The fact that primary care doctors are much less likely than gynecologists to initiate a discussion about GSM is not unexpected, because their scope of care is much broader than women’s health. Still, as older women stop having annual gynecologic exams related to contraception and reproductive issues, they may be losing access to needed specialty care for genitourinary symptoms that are so prevalent.”

To improve care for GSM, Dr. Clark said there must be increased  awareness about GSM among primary care clinicians. “Women may need greater access to gynecology and urogynecology care in their postmenopausal years,” she said.

The survey also revealed that when women did have a discussion about VVS with their provider, positive actions were initiated for therapy, including educational handouts, suggestions for over-the-counter (OTC) and prescription therapies, and increased referrals for specialty care.

“Discussions do make a difference,” said Dr. Clark, noting that  clinicians should ask their patients about VVS symptoms when they present for wellness exam, as women report lack of care-seeking behavior for VVS because they are unaware that symptoms are associated with menopause and unaware that there are safe and effective treatment options. 

“GSM is one of the chronic conditions of midlife and older women for which treatment can result in a marked improvement in quality of life, particularly in relieving dryness and pain related to sexual activity,” Dr. Clark said.

In addition to OTC lubricants and moisturizers, GSM can be treated with low-dose vaginal estrogen products; intravaginal prasterone (DHEA); and ospemifene, a selective estrogen receptor modulator (SERM). “All of these options have a good safety profile and minimal systemic absorption,” Dr. Clark said. 


Dr. Clark is a legal consultant for Butler Snow LLC, representing Ethicon, for pelvic mesh litigation.