A woman’s body undergoes many significant changes during her lifetime, many of which can have an impact on her sexual health and general well-being. For example, when a woman enters menopause, her estrogen and other steroid hormone levels decline. This can lead to changes in her vulva and vaginal tissues that can lead to vaginal dryness, less vaginal elasticity and burning or pain during intercourse – a condition known as vulvar atrophy (VVA)/the genitourinary syndrome of menopause (GSM) ).
About 50% of postmenopausal women experience VVA/GSM, many of whom may not expect it. Tami Rowen, MD, MS, Ob/Gyn who specializes in sexual medicine at UCSF said:[As providers,] We need to make sure we really learn to talk about GSM with all patients as they approach menopause.” He continued, “It can be very painful and often comes as a big and unwelcome surprise.”
However, when a woman has knowledge of her body, sexual health resources, and the support of a knowledgeable health care provider, she can achieve a satisfying sex life at any age. In addition, sexual medicine specialists continue to create new, innovative tools to help diagnose and manage VVA/GSM symptoms and support patients as they approach and go through menopause, such as the newly named Gynecology.
The Gynogram is a structured 24-item questionnaire that can help providers assess and quantify the level of VVA/GSM-related intercourse pain experienced by a patient and assess its impact on her sexual quality of life.
Originally a 120-item questionnaire, the Gynogram was created and refined by a team of gynecologists, endocrinologists, and psychologists to explore the physical, intrapsychic, relational, and social dimensions of VVA/GSM in relation to a woman’s well-being. The team whittled down the original 120 items to the final 24 items through a series of focus groups in 2017, in which participants rated each question on a scale of 1 (not understood) to 5 (fully understood). Only items with scores of 4–5 were included in the final instrument, and the researchers further narrowed the list by including only two items for each of the 12 factors they wanted to explore (eg, vaginal dryness, sexual self-image, partner conflict, embarrassment , etc.)
Providers then tested the gynecological gynecological screening with 214 sexually active postmenopausal women from seven gynecological outpatient facilities in Italy, 103 of whom had a confirmed VVA diagnosis and 111 without a confirmed VVA diagnosis. The results showed statistically significant differences in all Gynecography factors between the two groups of women, indicating that Gynecology can provide important clinical information about the sexual function of postmenopausal women.
Until now, no other validated instrument has addressed the association between intercourse pain and sexual quality of life in this population in such a systematic, comprehensive manner, which is what makes Gynecological Women unique. According to Dr. Rowan, “[The Gynogram] is a novel new tool that incorporates the biopsychosocial model into the management of GSM. It was developed to address multiple aspects of GSM that are often overlooked by medical providers and this allows them to provide patients with a truly comprehensive report on how GSM is affecting their sexual well-being.”
Dr. Rowen acknowledges that the study has limitations and that widespread adoption of Gynecology is not a foregone conclusion. “This was a relatively small sample of women that may not be generalizable,” she said, “and like all tools, it would really need buy-in from the wider medical community to use.”
However, he sees potential for Gynecology Gynecology, especially in referring patients to specialists. Dr. Rowen said, “This tool could be used by non-sexual medicine providers to screen and refer patients for GSM that is symptomatic and bothersome.”
Article contributed by Tami Rowen, MD, MS.
Resources:
Nappi, RE, Graziottin, A., Mollaioli, D., Limoncin, E., Ciocca, G., Sansone, A., Meriggiola, MC, Becorpi, AM, Maffei, S., Russo, N., & Jannini, EA (2021). The Gynogram: A Multicenter Validation of a New Psychometric Tool for Assessing VVA-Related Synovial Pain and Its Impact on Sexual Quality of Life in Postmenopausal Women. The Journal of Sexual Medicine, 18(5), 955-965. https://www.jsm.jsexmed.org/article/S1743-6095(21)00260-5/fulltext.
