Genitourinary Syndrome of Menopause (GSM), as the name suggests, often appears after menopause and is characterised by vaginal dryness, irritation, flaccidity of the mucous membrane, decreased libido, pain during sexual intercourse, and is associated with urge urinary incontinence.
The main cause is the decrease in female hormones – oestrogen. As oestrogen decreases, the walls of the vagina become thinner, drier, and less elastic, often causing a burning sensation. An imbalance of the vaginal flora may also occur, increasing the risk of vaginal and urinary infections.
All the symptoms characteristic of genitourinary syndrome of the menopause have a significant impact on a woman's quality of life. Symptoms can lead to problems in relationships with partners and loss of intimacy in couples due to the pain that occurs during intercourse.
Symptoms can also limit healthy lifestyle habits, such as exercise, as movement itself can cause discomfort.
Symptoms arising from genitourinary syndrome of the menopause are the second most frequent complaint during menopause after vasomotor symptoms.
In the first instance, if you experience any of these symptoms, you should seek advice from your doctor. Many women consider these complaints, like pain during sexual intercourse or lack of interest in sex, to be inevitable with age and that there is no solution, which is wrong.
Most women these days live more than a third of their lives in menopause, so it makes no sense to live with these symptoms for so long!
The diagnosis is made by identifying the symptoms that are characteristic of this syndrome. If you are already menopausal and suffer from symptoms such as vaginal dryness, pain during sexual intercourse, or urge urinary incontinence, there is a chance that you may be suffering from genitourinary syndrome of the menopause.
Most women will experience a vaginal infection in their lifetime, which is usually characterised by discharge, itchiness, or odour.
The aetiological diagnosis requires an in-depth look at the patient's clinical history (including information on sexual practices and behaviour, menstrual cycles, hygiene habits, and medications), a gynaecological examination, and laboratory tests.
The three conditions most commonly associated with vaginal discharge are bacterial vaginosis, candidiasis, and trichomoniasis. The terms candidiasis and trichomoniasis were adopted due to the presence of inflammation.
The presence of objective signs of vulvar inflammation, in the absence of pathogenic germs identified in laboratory tests, suggests the possibility of mechanical, chemical, allergic, or other non-infectious vulvar irritation (e.g. dermatoses). The discharge can be caused by other physiological and pathological conditions, including cervicitis, atrophic vaginitis, and mucoid cervical ectropion. Psychosexual problems and depression may occur with recurrent episodes of vaginal discharge.
There is an inflammatory condition with long-lasting symptoms and intermittent flare-ups called aerobic vaginitis, which is also characterised by decreased lactobacilli and high pH, where gut-derived aerobic microflora such as Escherichia coli, group B streptococci, and Staphylococcus aureus prevail. There is as of yet no conclusive information on this condition.
Urinary incontinence (UI) is a condition that results from the inability to store and control urine outflow. It is characterised by involuntary urinary leakage that varies considerably in nature, from very slight and occasional leakages to more serious and regular ones. It is women who are most affected by UI. Currently, 33% of women and 16% of men over the age of 40 have symptoms of the disease, according to data from the Portuguese Urology Association.*
Urinary incontinence affects 20% of the Portuguese population over the age of 40, which means that 1 in 5 Portuguese people over the age of 40 suffer from the condition.*
Involuntary urine leakage is extremely common. However, it is a symptom that defines a public health problem and has a considerable social and economic impact. Even the smallest urine leakages have implications on quality of life, having physical, social, sexual, and psychological implications, and causing emotional repercussions.
Sources:
* Portuguese Urology Association and Portuguese Neurourology and Urogynecological Association . Urinary Incontinence. [Online] [cited 2021 Apr 9] Available from: https://www.apurologia.pt/incontinencia/incontinencia_2014/Dossier_Inc_Urinaria_2014.pdf.
In the last decade important discoveries have been made in this area. There are also forms of urinary incontinence that are treated with medication or rehabilitation techniques.
Support material on incontinence: There are lots of support materials for patients suffering from incontinence, from adult nappies with different absorption capacities to pads of various different sizes. There is also underwear that has been specially designed for this purpose. It is washable and reusable, and can be used in the same way as any other piece of underwear.
The prostate is a small chestnut-shaped organ situated just below the bladder, which the urethra passes through. Only men have a prostate and its development is stimulated by testosterone, the male sex hormone.
BPH (Benign Prostatic Hyperplasia) is a disease characterised by an increase in the size of this organ. This is age-related and related to testosterone production.
Benign Prostatic Hyperplasia (BPH) is one of the most common pathological conditions in men over the age of 50 and its prevalence increases progressively with age.
