Endless "vaginal atrophy" insults (2023)

In 2019, when Heather Corinna started a Facebook support group for menopausal and perimenopausal people, one phrase kept repeating itself. Group members read about it on the Internet, heard from doctors and saw it in their medical records. "Everyone reacted badly," said Mx. Corinna is a queer sexuality educator and founder of the sexuality education website Scarleteen.

expression? Vaginal atrophy.

Among the many unfamiliar terms and physical changes people face, "vaginal atrophy" seems to encompass a variety of fears about sex and aging. "I mean, atrophy," said Mx. Corinna, age 53, is non-binary. "I'm getting older and my body has changed. My elbows definitely don't look or act like they used to, but you don't hear anyone talking about my stunted elbows."

Officially, the phrase was removed a few years ago. In 2013, the Menopause Society and the International Association for the Study of Women's Sexual Health convened a panel of medical experts to replace the increasingly outdated term. Stunting "has a negative effect on middle-aged women," they wrote. Furthermore, they add, "vagina" is "not a commonly accepted term in public discourse or the media."

But like Max. Corinna learned that the term continues to circulate in the medical literature, as well as in the health and health care of the menopausal population. In medicine, "atrophy" often refers to the loss or thinning of tissue. In this case, it refers to tissues that are dependent on estrogen and therefore thin and lose elasticity when hormone levels drop during menopause. But the vagina and vulva are not the only parts of the body affected by these hormonal changes. The urethra and bladder also need estrogen to function properly.

For many patients, focusing exclusively on the vagina can sexualize all of their genital symptoms. In fact, problems commonly associated with penetrative intercourse (dryness, irritation, tissue thinning) can also cause discomfort and pain in other daily activities.

dr. Stephanie Faubien, director of the Mayo Clinic's Center for Women's Health, has heard patients say they have a hard time sitting in the car, putting on jeans or wiping themselves after using the bathroom. But since estrogen therapy is often soldmostly forDyspareunia, many patients are not aware that these symptoms can also beresolvedwith vaginal estrogen.

"It's weird to focus only on the sexual part," says Dr. Faubien, medical director of the Menopause Society. "These are not lifestyle drugs like Viagra. They treat more symptoms than just sex-related ones."

Excessive focus on the vagina also obscures the fact that urinary problems (including incontinence, frequent urination, and urinary tract infections) are often associated with menopause. For many, these symptoms can be just as distressing as genital symptoms: urinary tract infections are the cause.15%Elderly people are hospitalized and can cause delirium and even death.

"I spent my 20s and 30s with urinary tract infections and I can't go back to that," said Mx. Corinna is the author of What the Fuck Is This Cool? "Author of the book. Perimenopause, menopause, other insults and you. "If my vulva changes, I have to learn to have sex differently, or I have to sit on a doughnut, I can deal with it. But I can't deal with urinary tract infections all the time. "

In other words, the term "vaginal atrophy" is not only potentially offensive, but also clinically misleading. dr. James Simon, a clinical professor of obstetrics and gynecology at the George Washington University School of Medicine and Health Sciences and a member of the Rethinking Menopause Terminology panel, said millions of women and others going through menopause are undiagnosed and have treatable symptoms. "We think one of the reasons is bad terminology," he said.

In 2014, a group of experts agreed on a new term that incorporates this realization: Genitourinary Menopausal Syndrome, or G.S.M. It's not particularly glamorous, but it brings the urological system to the party, and unlike the concept of vaginal atrophy, "there's no stigma, it's not something women are doing wrong or working on," says Dr. Simon. "It's just a natural aging process with a set of symptoms that could be classified as a syndrome."

There is precedent for renaming genital disorders to make them more palatable to patients. In 1992, the National Institutes of Healthbe replacedThe rationale for the term impotence with erectile dysfunction (ED) is similar: impotence is consideredto disparageAnd imprecisely, it is believed to imply that the condition is primarily psychological, increasing communication barriers between patients and healthcare providers.

However, while ED G.S.M. it is firmly established in both medical and popular vocabulary. I haven't had the same success yet. Vaginal atrophy remains the dominant term used for most estrogen treatments.societyand many service providers. "I don't know if it's common knowledge," said Dr. Faubien, who often has to explain the term to her colleagues.

Even doctors who do not want to subject their patients to this appointment will find it difficult to avoid it. dr. Robin Noble, an ob/gyn in Portland, Maine, tries to focus conversations with patients on specific symptoms like dryness and irritation. However, when prescribing vaginal estrogen, you must still select "vaginal atrophy" from the diagnostic drop-down menu in the hospital's computer system, and patients can see this in their medical records. "I couldn't avoid it completely," he said.

Gynecology ten years agotransferMoving from a male-dominated field to one where service providers are predominantly female. Given this history, it is perhaps not surprising that many terms seem out of date: consider terms such as "ovarian failure",cervical incompetenceguterus until now(Actually).

In the gynecological literature, women between the ages of 15 and 49 are usually classified as "of reproductive age" or "fertile time"Feeling the signs of menopause"The end of the reproductive phase of a woman's life., as the Menopause Society website says, "at the end of their reproductive years, according to the World Health Organization (both are better word choices than the 2015 article: "place of reproductive ability”)

In addition to being ambiguous (there is a big difference between 15 and 49 years old), these terms also imply the assumption that all women will or should have children. This language can be uncomfortable for those who are infertile or choose not to have children and those who don't want to be defined by their own fertility. It also makes some people think they can't get pregnant.perimenopauza;they can.

Defining menopause solely in terms of what happens in the body can be more helpful and less pretentious, says Dr. Judith Joseph, a psychiatrist at NYU Langone Health and a medical board member of the nonprofit Let's Talk Menopause. "Your ovaries are no longer producing eggs," Dr. Joseph tells her patients. "Compared to 'fertile years', that sounds completely different," he said, adding: "You teach people what's going on in their bodies, not what they're capable of."

Of course, the meaning changes over time and depends on who owns the medical record.

Many people consider "vaginal atrophy" to be pejorative because there is no equivalent term for the male genitalia. While the penis and testicles also shrink with age, medicine rarely describes them as such, "so no woman would want that diagnosis," says Dr. Formbean. But testicular atrophy is not something unknown. The term can describe genital atrophy following the use of steroids, prostate cancer treatment, or testosterone-blocking hormones for gender confirmation.

For some doctors, atrophy is a neutral term that has nothing to do with the value and dignity of the patient before them. dr. Kathleen O'Banion, an OB/GYN and professor at Cooper University Hospital in New Jersey, remembers using the term 30 years ago at a conference on estrogen loss and sexual function. During her speech, a sex therapist in the audience raised her hand against her tongue.

dr. O'Banion was taken aback. "I could see she was bothered by the word 'psychiatrist,' but it didn't mean that to me," he said in an email. According to her, "stunt lips are as beautiful as any other and deserve my care and attention."