Genitourinary Symptoms of Menopause (GSM) Effects on Sexual Function
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1 Genitourinary Symptoms of Menopause (GSM) Effects on Sexual Function Amanda Clark MD MCR NCMP Urogynecologist Co-authors: Joanna Bulkley PhD, Kate Beadle WHNP, NCMP, Michael Leo PhD, Ashley Stoneburner MS, Kimberly K. Vesco MD MPH Kaiser Center for Health Research Kaiser Permanente Northwest, Obstetrics and Gynecology
2 Funding and Disclosures Sources of Funding: Pfizer Independent Grant for Learning & Change # and the North American Menopause Society Disclosure of Financial Relationships with Commercial Interests: None
3 Background Sexual function after menopause Is adversely affected by vulvovaginal symptoms Is adversely affected by urinary symptoms Most studies focus on sexually active women Less attention on inactive women
4 Objective To describe sexual concerns of postmenopausal women in relation to both vulvovaginal and urinary symptoms for sexually active and inactive women
5 Study Design KPNW Primary Care (8) and GYN (6) Clinics Intervention Randomization Control Education Electronic Tools 1 year Patient-reported Outcomes Online Survey Practice Outcomes -- EMR Query -- GSM Dx & Rx
6 Methods Participants Women 55 years old invitation within 2 weeks of a well woman visit Survey consent, eligibility and data collection conducted using REDCap TM
7 Methods Survey Content Medical history and medications Vulvovaginal and urinary symptoms Sexual symptoms via PISQ-IR Pelvic Organ Prolapse and Incontinence Sexual Function Questionnaire International Urogynecological Association Revised Prolapse, bowel items deleted Urinary items retained, vulvovaginal items created
8 Results Survey Enrollment Eligible patients identified from EMR Valid address available Final survey sample N = 7,578 GYN = 13% PC = 87% N = 5,873 78% 26% GYN = 15% PC = 85% N = 1,533 GYN = 17% PC = 83%
9 RESULTS Demographics Inactive n=716, 48% Active n=815, 52% Age Mean, (Min-Max)*** 67.0 (55-89) 64.0 (55-84) BMI by EMR (mean)*** Race/Ethnicity White Other Overall Health status*** (0=poor, 4=excellent) 92% 6% 91% 8% *** p<.001, **p<.01, *p<.05
10 RESULTS Demographics Marriage/Partner Status*** Married, partnered Single, divorced, widowed Education* High school/ some college College degree Graduate degree Income Level*** $50,000 $50-100,000 > 100,000 *** p<.001, **p<.01, *<.05 Inactive n=716, 48% 45% 55% 49% 28% 22% 42% 39% 11% Active n=815, 52% 87% 13% 44% 27% 28% 24% 48% 23%
11 Results Current Estrogen Use Systemic Vaginal*** Lubricant Use*** Moisturizer Use*** Presence of 1 vaginal symptom** 1 vulvar symptom 1 urinary symptom *** p<.001, **p<.01, *<.05 Inactive n=716, 48% 3% 10% 8% 2% 37% 23% 71% Active n=815, 52% 5% 22% 51% 7% 45% 28% 70%
12 Results Reason given for inactivity (may choose multiple items) Lack of a partner Partner s lack of interest or inability Bladder leaks, urgency, frequency Vulvovaginal dryness, irritation, pain Pain with intercourse Inactive n=716, 48% 47% 55% 7% 26% 24% Active n=815, 52%
13 Results Reason given for inactivity (may choose multiple items) Lack of a partner Partner s lack of interest or inability Bladder leaks, urgency, frequency Vulvovaginal dryness, irritation, pain Pain with intercourse Symptoms during sexual activity Urine leakage Inactive n=716, 48% 47% 55% 7% 26% 24% Active n=815, 52% 7% Vaginal dryness without lubricant use (n=608) Pain/discomfort with vaginal intercourse 64% 45%
14 Inactive n=716, 48% Active n=815, 52% Negative Feelings I feel sexually inferior due to Bladder problems Strongly / Somewhat Agree 4% Strongly / Somewhat Agree Vulvovaginal problems** 11% 18% I feel angry due to impact on my sex life from: 2% 3% Bladder problems 8% 15% Vulvovaginal problems* Avoidance Some/A Lot Some /A Lot I avoid/restrict sexual activity due to fear of: 8% 10% Bladder problems 14% 24% Vulvovaginal problems** Bladder vs. Vulvovaginal **p<.001, *p<0.1 4%
15 CONCLUSIONS In postmenopausal women: Both vulvovaginal and bladder symptoms limit sexual activity Vulvovaginal symptoms are more bothersome Inactive and active women similarly affected Inquiry about the sexual history must not end when a woman reports current sexually inactivity
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