Genitourinary Syndrome of Menopause
The decline of hormonal activity of the ovaries during menopause has a significant impact on a woman’s body. In particular, the reduction of the quantity of oestrogens means significant changes in the female urogenital system. Genitourinary Syndrome of Menopause (GSM) indeed identifies that set of clinical conditions that impact the intimate system of a woman in menopause.
3 main areas can be identified:
TREATMENT
Vulvo-Vaginal Atrophy
With the reduction of oestrogens, the vulvovaginal mucosa becomes atrophic: it thins out, becomes more frail and dries out, loses trophism and hydration. Among the consequences of this process there is the fact that glycogen, normally found in the epithelial cells of the vaginal mucosa, diminishes. Glycogen is though fundamental for lactobacilli which constitute the main element of the vaginal flora. Only thanks to lactobacilli, indeed, it is possible to maintain a correct acid pH in the vagina, thereby guaranteeing a protection barrier against pathogens. Therefore, atrophy also causes an increase in vaginal pH with a subsequent change in the microbiome in which pathogenic agents may spread.
Vaginal atrophy is a widespread condition, especially among women in menopause (both natural and induced) or after delivery. Atrophy is often a consequence of medical treatments, chemotherapy, radiotherapy or oophorectomy. The vulvovaginal tract is very prone to oestrogen decline, with a series of consequences which interfere negatively on a woman’s quality of life and on couples’ relationships like: Frailty and laxity of the vaginal mucosa, dryness, itching and burning, pain during intercourse (dyspareunia).
TREATMENT
Atrophic Vaginitis
Atrophic vaginitis is an inflammation of the vaginal mucosa, not directly caused by a bacterial or fungal infection. It is the consequence of a reduction at oestrogen level and it can therefore show during menopause, during breastfeeding, when taking medication for the cure of endometriosis and uterine fibroids or following some oncological therapies. The reduced level of oestrogen leads to a reduction in nourishment and hydration of the vaginal and vulvar mucosa which thins out progressively becoming more delicate, irritable and more exposed to traumas. Vaginal dryness, burning, pain during intercourse and continuous ailments (e.g., cystitides and recurring infections) are consequences, often erroneously deemed as inevitable, of atrophic vaginitis.
TREATMENT
Urinary Incontinece
It is among the most common problems in women over 35 years of age, and it seriously compromises the quality of life.
It may be of various types and levels: From strain (involuntary loss of urine which occurs, for example, when laughing, coughing, lifting weights), from urge (strong necessity to urinate accompanied by the inability to wait to reach a restroom), mixed (which shows strain and urgency incontinence together) or from other issues which involve the neurological realm (it appears when the bladder is so full that the internal pressure is stronger than that of the urethra).
The common symptom of any form of incontinence is the involuntary loss of urine. This may occur both through small losses of urine and abundant ones. Nevertheless, the most important symptoms are caused by the person’s psychological distress, given by the ailment which seriously compromises the quality of life and hinder the emotional, relational and social aspects of the individual.
The cause of incontinence in women may be multiple: For example, physical changes stemming from pregnancy, delivery and menopause or a uterus removal procedure (hysterectomy) may trigger the dysfunction.
TREATMENT
Vulvodynia
Vulvodynia is a gynaecological disease characterized by chronic pain of the vulva and the tissues surrounding the vagina opening.
Sometimes this disease may only involve the clitoris, the vagina opening, the urethral orifice, up to the internal organs like the bladder or the entire urethra. The chronic vulvar pain which characterizes the ailment is typically associated with strong burning, dyspareunia (pain during sexual intercourse) and redness; it is seldom accompanied by other lesions which may be observed macroscopically.
The pain in connection with vulvodynia shows, in the majority of case, during intercourse, however it may also show spontaneously, possibly associated with certain movements, when the patient sits or walks. These painful symptoms are not necessarily simply provoked or spontaneous: The patient may show them in both circumstances.
Whilst being a frequently encountered pathology, vulvodynia may have a late diagnosis, besides not being cured during the first years, because underestimated (Note: It is considered as an “invisible” disease) and it is perceived as difficult to manage. It is not by chance that vulvodynia has long been considered as “psychosomatic” or, also, “psychogenic”: In realty, this interpretation is obsolete, as it relates to a disease with solid biological basis which fall within the gynaecological realm, and which may be managed effectively with an adequate therapeutic protocol.
TREATMENT
Cystitides
Cystitis is an inflammation of the bladder. It may cause frequent urinary stimuli, presence and traces of blood in urine, pain when urinating and suprapubic discomfort. It is often debilitating and it affects women most of the time.
There exist various types of cystitides, like for example: Bacterial cystitis, caused by the uncontrolled proliferation of bacteria which normally live in our intestine, but that may climb through the urethra up to the bladder: interstitial cystitis, a chronic inflammation of the bladder with non-identifiable cause, and in which there are no signs of urinary infection, in fact the use of antibiotics does not effect any improvement; post-coital cystitis, referring specifically to an instance of cystitis which occurs 24-72 hours after intercourse.
Treatment of cystitis may vary based on the cause which determines it and may include the use of antibiotics for bacterial infections, changes in lifestyle for less serious forms, surgical procedures in extreme cases.
TREATMENT
Fecal Incontinence
Fecal incontinence consists of the involuntary loss of feces or gas. For the person, it represents a real and social inconvenience which has an impact on the quality of life. In fact, people who are affected by this ailment are often silent about it because they are ashamed or due to prude- related reasons.
This condition may depend on anatomical changes which relate, for example, to a weakening of the pelvic floor or the sphincter muscles, or also damage to the controlling nerves or a reduced storage capacity of the rectum.
Women are more likely to be affected by fecal incontinence compared to men, and this is due to a higher laxity of the pelvic musculature after delivery. The most impacted age groups range from 50 and above, both in men and women.
The adequate treatment depends on the triggering cause of the incontinence, for example the patient may be referred to a purely rehabilitative treatment in case of hypotonia of the pelvic floor or towards surgical therapy in case of prolapses and/or muscular lesions.
