Advances in Diagnosing Dyspareunia
Murray A. Freedman, MS, MD
Clinical Professor of Obstetrics and Gynecology
Medical College of Georgia
Augusta, GA
INTRODUCTION
Three major factors adversely affect postmenopausal female sexuality: anatomic and physiologic changes associated with aging, ovarian and adrenal hormonal insufficiency, and partnership issues.1,2 In postmenopausal women, the lack of estrogen stimulation in vaginal and vulvar tissue commonly results in involution of these tissues—commonly referred to as vulvovaginal atrophy (VVA). In the United States, it is estimated that there are 64 million postmenopausal women and that as many as 32 million women have been found to suffer VVA symptoms.3,4 The symptoms may also occur in pre-menopausal women if they exhibit significant hypoestrogenemia (eg, postpartum breastfeeding women). Symptoms of VVA include, but are not limited to, vaginal dryness, irritation, burning, dysuria, dyspareunia, and vaginal discharge.5 Whereas vasomotor symptoms (VMS) associated with menopause diminish over time, VVA is a chronic condition that worsens in the absence of treatment.6 VVA symptoms can adversely affect a woman’s sexual functioning, partnership issues, and her overall quality of life.7,8,9
Dyspareunia Associated with Vulvovaginal Atrophy: Innovations in Counseling, Diagnosis, and Management
This activity is designed to meet the educational needs of the obstetrician and gynecologist, family physician, internal medicine physician, physician assistant, nurse practitioner, and certified nurse midwife.
Supported by an educational grant from:
AMAG Pharmaceuticals Inc.
Activity Information
Expired
Date of Original Release: May 7, 2018
Date Credits Expire: May 7, 2019
EXPIRED
FACULTY
Murray A. Freedman, MS, MD, FACOG, IF
Clinical Professor of Obstetrics
and Gynecology
Medical College of Georgia
Augusta, GA
Sheryl A. Kingsberg, PhD
Professor of Reproductive Biology
and Psychiatry
Case Western Reserve University
School of Medicine
Cleveland, OH
David J. Portman, MD
Director Emeritus, Columbus Center
for Women’s Health Research
Adjunct Instructor of Obstetrics
and Gynecology
Ohio State University
Columbus, OH
Disclosure of Conflicts of Interest:
In accordance with the ACCME Standards for Commercial Support, The Omnia-Prova Education Collaborative (TOPEC) requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. TOPEC resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs.
Faculty
Murray A. Freedman, MS, MD, FACOG, IF Consulting Fees: AMAG Pharmaceuticals; Commercial Interest Speakers Bureau: Valeant Pharmaceuticals; Contracted Research: Procter and Gamble
Sheryl A. Kingsberg, PhD Consulting Fees: AMAG Pharmaceuticals, Emotional Brain, Palatin, Valeant Pharmaceuticals; Commercial Interest Speakers Bureau: AMAG Pharmaceuticals, Palatin, Valeant Pharmaceuticals; Contracted
Research: Palatin
David J. Portman, MD Consulting Fees: AMAG Pharmaceuticals, Palatin, Valeant Pharmaceuticals; Commercial Interest Speakers Bureau: AMAG Pharmaceuticals, Palatin, Valeant Pharmaceuticals; Contracted Research: Endoceutics
Reviewers/Planners/Authors:
Sean T. Barrett has nothing to disclose.
Carole Drexel, PhD, CHCP has nothing to disclose.
Amanda Hilferty has nothing to disclose.
Ashley Rosenthal has nothing to disclose.
Robert Schneider, MSW has nothing to disclose.
LEARNING OBJECTIVES
After participating in this educational activity, participants should be better able to:
- Define vulvovaginal atrophy (VVA), and genitourinary syndrome (GSM) and their impact on post-menopausal dyspareunia
- Identify the factors, both clinician-based and patient-based, that may inhibit diagnosis of dyspareunia
- Describe clinician counseling approaches to facilitate a discussion with patients about their symptoms
- Discuss the benefits and risks of innovative therapeutic interventions indicated for the management of menopause-related dyspareunia
ACCREDITATION AND CREDIT DESIGNATION STATEMENTS:
The Omnia-Prova Education Collaborative, Inc. is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Omnia-Prova Education Collaborative, Inc. designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The posttest and evaluation of this activity may be taken online by visiting www.omniaeducation.com/dyspareunia. CME credit may also be claimed by faxing the posttest/evaluation to 215.358.0556. A copy of the posttest/evaluation may also be mailed to Omnia Education 500 Office Center Drive, Suite 300 Fort Washington, PA 19034.
PROVIDER
Omnia Education has a core focus on women’s health and the ways in which diseases and conditions impact the female patient. That unique focus has transformed the CME learning environment for healthcare professionals nationwide. We impact thousands of clinicians annually, many of whom return each year for clinical updates and connectivity with regional peers.
COMMERCIAL SUPPORT
This activity is supported by an independent educational grant from AMAG Pharmaceuticals Inc.
Disclaimer
The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of TOPEC and Omnia Education. This presentation is not intended to define an exclusive course of patient management; the participant should use his/her clinical judgment, knowledge, experience and diagnostic skills in applying or adopting for professional use any of the information provided herein. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Links to other sites may be provided as additional sources of information. Once you elect to link to a site outside of Omnia Education you are subject to the terms and conditions of use, including copyright and licensing restriction, of that site.
Reproduction Prohibited
Reproduction of this material is not permitted without written permission from the copyright owner.
References
- Freedman M. Vaginal pH, estrogen and genital atrophy. Menopause Manage. 2008;17(4):9-13.
- Freedman MA. Partnership issues and sexuality. Clin Obstet Gynecol. 2009;52(4):656-665.
- Kingsberg SA, Wysocki S, Magnus L, Krychman ML. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) Survey. J Sex Med. 2013;10(7):1790-1799.
- Santoro N, Komi J. Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med. 2009;6(8):2133-2142.
- The North American Menopause Society. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20(9):888-902.
- Minkin MJ. Postmenopausal vulvovaginal atrophy: communication and care. The Clinical Advisor. 2013;16(10):59-65.
- Freedman MA. Quality of life and menopause: the role of estrogen. J Womens Health (Larchmt). 2002;11(8):703-718.
- Freedman M. Perceptions of dyspareunia in postmenopausal women with vulvar and vaginal atrophy: findings from the REVIVE survey. Womens Health (Lond). 2014;10(4):445-454.
- DiBonaventura M, Luo X, Moffatt M, et al. The association between vulvovaginal atrophy symptoms and quality of life among post-menopausal women in the United States and Western Europe. J Womens Health (Larchmt). 2015;24(9):713-722.
- Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause. 2014;21(10):1063-1068.
- American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Gynecology. ACOG Practice Bulletin Number 119: Female sexual dysfunction. Obstet Gynecol. 2011;117(4):996-1007.
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- Gandhi J, Chen A, Dagur G, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016;215(6):704-711.
- Nappi RE, Kingsberg S, Maamari R, Simon J. The CLOSER (Clarifying Vaginal Atrophy’s Impact On Sex and Relationships) survey: implications of vaginal discomfort in postmenopausal women and in male partners. J Sex Med. 2013;10(9):2232-2241.
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- Freedman MA. Genitourinary syndrome of menopause: physical characteristics and prevalence. Poster (#P-21)presented at NAMS Annual Meeting, Orlando FL: October 2016. Available at http://www.menopause.org/docs/default-source/2016-doc/scientific-poster-abstracts.pdf. Accessed February 14, 2018.
- Panda S, Das A, Singh AS, Pala S. Vaginal pH: a marker for meno-pause. J Midlife Health. 2014;5(1):34-37.
- Brotman RM, Shardell MD, Gajer P, et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause. 2014;21(5):450-458.
- Minkin MJ, Guess MK. Diagnosis and treatment of the non-sex-related symptoms of vulvovaginal atrophy. The Female Patient. 2012;37:33-41.
- Bachmann G, Stern L, Ramos J. Female sexual function. In: Gyne-cology and Obstetrics CD-ROM. Philadelphia, PA: Lippincott Williams & Wilkins; 2008: Chapter 99. Available at www.glowm.com/resources/glowm/cd/pages/v6/v6c099.html. Accessed February 14, 2018.
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- Benshushan A, Rojansky N, Chaviv M, et al. Climacteric symptoms in women undergoing risk-reducing bilateral salpingo-oophorectomy. Climacteric. 2009;12(5):404-409.
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Disclosures
Consulting Fees: AMAG Pharmaceuticals; Commercial Interest Speakers Bureau: Valeant Pharmaceuticals; Contracted Research: Procter and Gamble