Newsflash! When it comes to symptoms ‘down there,’ does terminology matter?

Posted by Liz on Aug 29, 2014 in menopause | 2 comments

 

GSM (genitourinary symptoms of menopause) is a new acronym being adopted by the North American Menopause Society (NAMS) and the International Society for the Study of Women’s Sexual Health (ISSWSH) to encourage dialogue between female patients and their doctors. NAMS says that it refers to the genital, sexual and urinary problems that make women and their doctors uncomfortable discussing. “Having a term that doesn’t carry stigma, isn’t embarrassing to say, and is medically accurate could go a long way in helping women get the help they need and allowing them to make smarter healthcare decisions.”

The vagina and surrounding area (e.g. urethra, lower end of the bladder) are estrogen and androgen receptor-rich.  Hence, the decline in estrogen and other sex hormones during menopause can lead to thinning of tissue, loss of elasticity, dryness and physical changes that increase the risk for infection and discomfort.  The issue with current nomenclature is that terms that have traditionally referred to genital problems that occur after menopause aren’t accurate; for example, atrophic vaginitis refers to inflammation and infection, both of which may not be the underlying issue during menopause. Atrophy infers that something is wasting away from disuse, which isn’t always the case; rather, pain and dryness can lower libido significantly. Additionally, previously used terminology pretty much ignores urinary problems like overactive bladder, stress incontinence and recurring urinary tract infections.

Yet, there is another part of this story; the stigma attached to the terms used to describe the issues. I’m not sure that I agree with the organizations’ claim that women are too embarrassed to use the term ‘vagina’ with their physicians; after all, when you are sitting in stirrups and the gynecologist is peering into your vagina and you have a question, do you refer to your privates as ‘vajayjay’ or ‘nether region?’ Perhaps prior generations have trouble using the ‘V’ word but as a child of the 60s and 70s (Our Bodies, Ourselves, anyone?!), I would hope that we would have gotten past the embarrassment by the time we reach menopause.

In a related press release, Dr. Margaret Gass, Executive Director of NAMS is quoted as saying that “GSM will make discussing the problems so much easier, similar to the way ED changed our ability to talk about impotence.”

I question the value in further stigmatizing an inherent and necessary part of the female anatomy. Are we still so archaic that in the 21st Century we need an acronym to avoid discussing sensitive issues?

From where I stand, the greatest benefit from this initiative will be to help women understand why these problems happen, that hormones are at-play. The organizations are also developing a tool to standardize aspects of a physical exam to look specifically for the types of changes that cause these issues in menopause. Those two things are wonderful. But do we need truly need another acronym, one that may actually prevent what I hope will be an evolution in thought and communication and the end to an arbitrary code of ethics?