ABSTRACT
Female sexual dysfunction commonly occurs during the menopause transition and post-menopause due to hormonal, physiologic, and psychosocial factors. Sexuality is important to aging women; however, many are reluctant to seek treatment for their sexual concerns. Clinicians should be adept at managing and treating sexual dysfunction in this population. A multi-dimensional treatment approach that addresses modifiable mental, physical, and psychosocial factors is warranted to improve sexual function and quality of life.
Subject(s)
Quality of Life , Sexual Dysfunction, Physiological , Sexual Dysfunctions, Psychological , Humans , Female , Sexual Dysfunction, Physiological/therapy , Sexual Dysfunction, Physiological/etiology , Sexual Dysfunction, Physiological/diagnosis , Sexual Dysfunctions, Psychological/therapy , Sexual Dysfunctions, Psychological/diagnosis , Postmenopause/physiology , Menopause/physiology , Practice Guidelines as Topic , Middle AgedABSTRACT
IMPORTANCE: Urogenital changes associated with menopause are now classified as genitourinary syndrome of menopause (GSM), which includes symptoms of urgency, frequency, dysuria, and recurrent urinary tract infections for which the recommended treatment is estrogen. However, the association between menopause and urinary symptoms and the efficacy of hormone therapy for these symptoms is uncertain. OBJECTIVE: Our objective was to define the relationship between menopause and urinary symptoms including dysuria, urgency, frequency, recurrent urinary tract infections (UTIs), and urge and stress incontinence by conducting a systematic review of the effects of hormone therapy (HT) for urinary symptoms in perimenopausal and postmenopausal women. EVIDENCE REVIEW: Eligible studies included randomized control trials with perimenopausal and postmenopausal women with a primary or secondary outcome of the following urinary symptoms: dysuria, frequent UTI, urgency, frequency, and incontinence, included at least one treatment arm of estrogen therapy, and were in English. Animal trials, cancer studies and pharmacokinetic studies, secondary analyses, and conference abstracts were excluded. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were searched until April 2022. Two authors reviewed each article with discrepancies resolved through whole group consensus. Data extracted included the following: publication date, country, setting, subject number, follow-up, duration, age, race/ethnicity, study design, inclusion criteria, and main findings. FINDINGS: There is insufficient evidence to confirm that menopause is associated with urinary symptoms. The effect of HT on urinary symptoms depends on type. Systemic HT may cause urinary incontinence or worsen existing urinary symptoms. Vaginal estrogen improves dysuria, frequency, urge and stress incontinence, and recurrent UTI in menopausal women. CONCLUSIONS AND RELEVANCE: Vaginal estrogen improves urinary symptoms and decreases the risk of recurrent UTI in postmenopausal women.
Subject(s)
Urinary Incontinence, Stress , Urinary Incontinence , Female , Humans , Dysuria , Menopause , Estrogens/therapeutic use , Hormone Replacement Therapy , Urinary Incontinence, Stress/drug therapyABSTRACT
Background: Nearly half of U.S. women experienced new or worsening health-related socioeconomic risks (HRSRs) (food, housing, utilities and transportation difficulties, and interpersonal violence) early in the COVID-19 pandemic. We sought to examine racial/ethnic disparities in pandemic-related changes in HRSRs among women. Materials and Methods: We conducted a cross-sectional survey (04/2020) of 3200 women. Pre- and early pandemic HRSRs were described by race/ethnicity. Weighted, multivariable logistic regression models generated odds of incident and worsening HRSRs by race/ethnicity. Results: The majority of Black, East or Southeast (E/SE) Asian, and Hispanic women reported ≥1 prepandemic HRSR (51%-56% vs. 38% of White women, p < 0.001). By April 2020, 68% of Black, E/SE Asian, and Hispanic women and 55% of White women had ≥1 HRSR (p < 0.001). For most HRSRs, the odds of an incident or worsening condition were similar across racial/ethnic groups, except Black, E/SE Asian and Hispanic women had 2-3.6 times the odds of incident transportation difficulties compared with White women. E/SE Asian women also had higher odds of worsening transportation difficulties compared with White women (adjusted odds ratios = 2.5, 95% confidence interval 1.1-5.6). In the early pandemic, 1/19 Hispanic, 1/28 E/SE Asian, 1/36 Black and 1/100 White women had all 5 HRSRs (extreme health-related socioeconomic vulnerability). Conclusions: Prepandemic racial/ethnic disparities in HRSRs persisted and prevalence rates increased for all groups early in the pandemic. Disparities in transportation difficulties widened. White women were much less likely than others to experience extreme health-related socioeconomic vulnerability. An equitable COVID-19 response requires attention to persistent and widening racial/ethnic disparities in HRSRs among women.
Subject(s)
COVID-19 , Ethnicity , Cross-Sectional Studies , Female , Hispanic or Latino , Humans , Pandemics , Racial Groups , SARS-CoV-2 , Socioeconomic Factors , United States/epidemiology , White PeopleABSTRACT
Una mujer de 35 años se presenta a su clíni- ca. Estado: posoperatorio de histerectomía ab- dominal; salpingooforectomía bilateral y pélvica; radiación hace 2 años para la etapa 1, grado 2, de adenocarcinoma endometrial. Ella no tiene evidencia actual de la enfermedad. Tiene un índice de masa corporal de 28, y su historia es significativa para el síndrome de ovario poliquístico.
A 35-year-old woman comes to her clinic. Condition: postoperative abdominal hysterectomy; bilateral and pelvic salpingo-oophorectomy; radiation 2 years ago for stage 1, grade 2, of endometrial adenocarcinoma. She does not have current evidence of the disease. It has a body mass index of 28, and its history is significant for polycystic ovarian syndrome.
