Postmenopausal women who experience problems like vaginal dryness, painful intercourse, or urinary incontinence may want to see a gynecologist instead of a primary care provider for help, a recent study suggests.
That's because gynecologists may be more knowledgeable about what's known as vulvovaginal atrophy, a common but often overlooked condition that can seriously impact women's lives after menopause and lead to avoidance of intimacy, loss of libido, and painful sex.
For the study, researchers asked 90 primary care providers and 29 gynecologists multiple choice questions about how to recognize vulvovaginal atrophy and surveyed participants about how often they assessed patients for these issues and what barriers stopped them from doing this.
Overall, gynecologists got correct answers to knowledge questions about vulvovaginal atrophy 77 percent of the time on average, compared to 63 percent for primary care providers, researchers report in Menopause.
This makes sense, given how much more often gynecologists give women pelvic exams that would show changes in the vulva and vagina and any development of atrophy, and because gynecologists are more familiar with hormones that might be prescribed to relieve some symptoms of vulvovaginal atrophy, said lead study author Dr. Kimberly Vesco of the Kaiser Permanente Center for Health Research Northwest in Portland.
"Before we learned that Pap smears could safely be discontinued at age 65 for most women, gynecologists regularly saw the changes of vulvovaginal atrophy," Vesco said by email. "Also, gynecologists regularly see women with conditions that may require hormone therapy — contraception, endometriosis, menopause, osteoporosis, etc. — and have much more familiarity with hormone therapies compared to primary care doctors."
Primary care providers were less likely to assess women for symptoms, the survey found.
In addition, primary care providers were less confident in their ability to advise patients on symptoms and recommend treatments.
Lack of time and lack of patient education materials about symptoms and treatment were the reasons doctors cited most often as barriers to diagnosing and treating vulvovaginal atrophy.
Women go through menopause when they stop menstruating, which typically happens between ages 45 and 55. As the ovaries curb production of the hormones estrogen and progesterone in the years leading up to menopause and afterward, women can experience symptoms ranging from vaginal dryness to mood swings, joint pain, memory trouble, and insomnia.
"The healthy vagina is lined by cells that are well-hydrated and that release fluid into the vagina, and this encourages the growth of healthy bacteria," said Dr. Susan Davis of Monash University in Melbourne, Australia, who is president of the International Menopause Society.
"When estrogen levels fall at menopause the lining of the vagina changes; the lining cells change and release less fluid," Davis, who wasn't involved in the study, said by email. "So the vagina becomes dryer, less elastic, more fragile, less acidic — even alkaline sometimes, and this allows unhealthy bacteria to grow."
As a result, there's less lubrication and sex can be painful, Davis added. Women might also feel vaginal irritation or itching or experience bacterial infections that may cause unpleasant odor or discharge.
While the study wasn't designed to assess differences in women's symptoms or quality of life based on what type of doctor they saw, the results suggest that physicians need more education about medical issues related to menopause, said Dr. Mary Jane Minkin, a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale Medical School in New Haven, Connecticut.
If doctors don't ask patients about symptoms of menopause, women may not bring it up, Minkin, who wasn't involved in the study, said by email.
"Many women don't think of VVA as a treatable condition, and many do not link it to menopause," Minkin added. "Many women also don't want to think about a condition linked to getting older (we are a youth centric society)."
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