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JAMA Insights
Women's Health
September 26, 2019

Treatment of Vulvovaginal Atrophy

Author Affiliations
  • 1David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles
JAMA. 2019;322(19):1910-1911. doi:10.1001/jama.2019.15100

Symptoms of vulvar and vaginal atrophy, such as dyspareunia, dryness, burning, and pruritus, affect more than 50% of midlife and older women.1 Previously, the term vulvovaginal atrophy (VVA) was used to refer to these symptoms. However, there is increasing recognition that the loss of estrogen resulting from the cessation of ovarian function may also promote urinary frequency and urgency, prompting a new broader term, genitourinary syndrome of menopause (GSM).1 GSM includes symptomatic VVA as well as lower urinary tract symptoms related to low estrogen levels. GSM symptoms adversely affect quality of life and cause pain during sex, loss of libido, avoidance of intimacy, urinary urgency, dysuria, and recurrent symptomatic urinary tract infections. If left unmanaged, GSM can be progressive and often debilitating, with severe symptoms and anatomic changes sometimes requiring pelvic floor physical therapy and vaginal dilator therapy. Many women who have GSM symptoms are undiagnosed and untreated, and women often do not identify GSM as the cause of their symptoms.

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