女性健康组织提出“外阴阴道萎缩”新名称

据估计，约有20%~40%的更年期妇女存在不同程度的外阴阴道萎缩，但这一名称并不能恰当描述女性可能出现的相关症状和体征。来自北美绝经学会(NAMS)和国际女性性健康研究协会(ISSWSH)的代表们提出了一个新名称：绝经期生殖泌尿综合征(GSM)。

今年早些时候，这两个组织召开了一场为期两天的会议，以考虑哪些名称比较合适。NAMS执行主任Margery Gass博士介绍，这次会议的目标是确定一个对专业人员、消费者和媒体均适用的全面的描述性术语。


Margery Gass博士

参与者评价了生殖泌尿系统老化的症状和体征，以及可获得的相关数据，以确定新术语应当包括哪些成分，涵盖受影响的解剖学、描述性因素、该疾病导致的问题，以及生命阶段的背景。

Gass博士和哥伦布妇女健康研究中心主任David J. Portman博士，联合主持了这次共识会议。他们在10月份举行的NAMS年会上报告了这次会议得出的结论。

Gass博士指出：“之所以为这一疾病更名是出于多方面的考虑。在社会压力下，人们不愿公开讨论女性性行为和性健康问题。例如仍有很多媒体不愿使用‘阴道’这个词。而‘萎缩’这个词有令人不悦的内涵，而且并不是患者都有的。”

“事实上，萎缩本身是衰老的一部分，是很多女性都会经历的，而未闭是个问题；一些发生萎缩的女性并没有症状，而其他女性有明显症状。我们认为，‘绝经期生殖泌尿综合征’非常准确地描述了受累的各个身体部分——即生殖系统和下尿路。”

“综合征”这次词的使用进一步允许基于女性可能出现的症状作出诊断，而不局限于特定的症状。“这不是一种疾病或缺陷，因此我们认为‘绝经期生殖泌尿综合征’是个中性的、可接受的术语。”

名称的改变有可能引起更有建设性、促进健康的对话。Portman博士在发言时以男性性功能障碍为例，解释了一个能使患者和媒体更容易接受的术语可以如何开启会话、改变态度，并促进人们理解和接受更开放的传播。

1992年，国立卫生研究院的一个共识开发小组确定，“勃起功能障碍”这一术语优于“阳痿”。事实上，随着伟哥和其他与男性性健康相关的药物获准，“勃起功能障碍”目前已被广泛用于广告，被政治家和名人推动，并在社会上被公开讨论。

相反，女性性行为和性健康的开放性讨论仍然受到限制。事实上，对超过1,000名女性——包括330名年龄60~65岁的女性——的调查显示，75%的女性对“社会对女性性表达的约束强于对同龄男性性表达的约束”的说法表示“完全同意”。几乎同样多的女性完全同意“社会更接受讨论男性而非女性的性问题”的说法。超过半数女性完全同意“社会更倾向于相信没有性行为的女性”的说法。

“社会更易接受的”术语(与“阴道”一样，“阴茎”这个词仍然很少被公开使用)的使用已帮助男性性健康成为了一个主流话题；希望从“外阴阴道萎缩”过渡到“更年期生殖泌尿综合征”能给女性性健康带来相似的效果。

与会者达成了一致意见，GSM可被定义为“与雌激素水平降低有关的一系列症状和体征，可涉及大阴唇/小阴唇、前庭/阴道口、阴蒂、阴道、尿道和膀胱”。

这是一种如果症状令人困扰就可以加以治疗的综合征；应当在讨论治疗选项和风险/收益之后，根据症状的严重程度和女性的偏好的进行个体化治疗。

除了致力于就恰当命名达成一致之外，共识会议的参与者还在开发帮助临床医生评估该综合征患者的工具，目前还处于草案阶段。ISSWSH和NAM将在各自的官方期刊——《性医学杂志》和《绝经》杂志——发布工作组的进展情况。这两个组织还计划在今年12月份美国妇产科医师协会(ACOG)会议上提出新名称。届时，ACOG将审查所有与妇产科有关的术语并进行恰当的更新。

Gass博士报告称无相关利益冲突。Portman博士是拜耳、Noven制药、Palatin科技等公司的讲者、顾问和/或接受其提供的补助金或研究支持。

爱思唯尔版权所有  未经授权请勿转载

By: SHARON WORCESTER, Ob.Gyn. News Digital Network

To varying degrees, vulvovaginal atrophy affects an estimated 20%-40% of menopausal women, but the name of the condition fails to appropriately characterize the range of associated signs and symptoms that women may experience.

Representatives from the North American Menopause Society (NAMS) and the International Society for the Study of Women’s Sexual Health, Inc. (ISSWSH) propose a new term: genitourinary syndrome of menopause, or GSM.

Earlier this year, the two organizations convened a 2-day consensus conference to consider what an appropriate term would encompass. The goal of that conference, according to Dr. Margery Gass of the Cleveland Clinic Center for Specialized Women’s Health and the executive director of NAMS, was to identify a term that was descriptive, comprehensive, and suitable for professionals, consumers, and the media.

Participants reviewed the symptoms and signs of genitourinary aging and the available relevant data, and decided on a number of components that should be covered by the new nomenclature, including the affected anatomy, descriptive factors, problems caused by the condition, and context with respect to life phase, she said in an interview.

Dr. Gass and Dr. David J. Portman, director of the Columbus Center for Women’s Health Research and an adjunct instructor at Ohio State University, Columbus, cochaired the consensus conference. They presented the conclusions from the conference at the annual meeting of the North American Menopause Society in October.

"Several concerns have forced the issue of a name change for this condition," Dr. Gass said, noting that persistent societal resistance to openly discussing women’s sexuality and sexual health is not the least among them.

The word "vagina," for example, still can’t be uttered in many media outlets, she explained. Additionally, the term "atrophy" has unpleasant connotations that aren’t necessarily reflective of the experience of women affected by the condition, she noted.

"In fact, atrophy in and of itself is a natural part of aging – something many women experience – and is not necessarily a problem; some women with atrophy experience no symptoms, while others experience significant symptoms.

"We feel that the name we’re putting forward (genitourinary syndrome of menopause) very accurately describes the parts of the body that are involved – namely the genital system and the lower urinary tract," she said.

The use of the word "syndrome" further allows for a diagnosis based on the range of symptoms women may experience, and doesn’t limit the condition to specific symptoms.

"This is not a disease or a deficiency, so we think ‘genitourinary syndrome of menopause’ is a neutral term that would be acceptable, Dr. Gass said.

A change in the nomenclature could potentially open the door to more productive, health-promoting dialogue. During his presentation at the NAMS meeting, Dr. Portman explained how a term that is more acceptable to patients and the media could have the power to start the conversation, change attitudes, and promote understanding and acceptance of more open communication. He used male sexual dysfunction as an example.

In 1992, a National Institutes of Health consensus development panel determined that the term "erectile dysfunction" was preferable to the term "impotence." Indeed, along with the subsequent approval of Viagra and other drugs related to male sexual health, the term "erectile dysfunction" is now widely used in advertising, promoted by politicians and celebrities, and openly discussed in the community, he said.

In contrast, open discussion about women’s sexuality and sexual health remains constrained. In fact, in a survey of more than 1,000 women – including 330 women aged 60-65 years – 75% "completely agreed" that society constrains the sexual expression of "women my age more so than men my age." Nearly as many completely agreed that society is more accepting of discussion around men’s physical sexual problems than women’s physical sexual problems. More than half completely agreed that "society would prefer to believe that women my age do not have sex."

The use of more "socially acceptable" terminology (the word "penis," like "vagina," is still not used openly, Dr. Gass noted) helped make male sexual health a mainstream topic; it is hoped that transitioning from "vulvovaginal atrophy" to "genitourinary syndrome of menopause," would have a similar effect with respect to women’s sexual health, Dr. Portman said.

GSM would be defined as "a collection of symptoms and signs associated with decreased estrogen levels that can involve the labia majora/minora, vestibule/introitus, clitoris, vagina, urethra, and bladder," conference attendees agreed.

It is a syndrome for which treatment is indicated if symptoms are bothersome; treatment should be individualized based on the severity of symptoms and the woman’s preference after discussion of treatment options and risks and benefits.

In addition to working toward agreement on appropriate nomenclature, the consensus conference participants are developing an assessment tool, currently in draft form, to aid clinicians in evaluating women for the syndrome.

"We feel we’ve identified a number of signs and findings that would help clinicians – particularly those who don’t treat a lot of patients with this condition. The tool – which involves a grid-based design outlining mild, moderate, and severe symptom categories – may prove valuable for providers who want to chart severity or just scan the grid to assist in making a diagnosis," Dr. Gass said. The tool also could prove useful in the research setting, he added.

ISSWSH and NAMS will be publishing the proceedings of the workshop in upcoming issues of their respective journals – the Journal of Sexual Medicine and the journal Menopause.

The groups also plan to put forward the proposed new name at a December meeting of the American College of Obstetricians and Gynecologists. At that meeting, ACOG will review all terminology related to obstetrics and gynecology and update terminology as appropriate.

"We hope to address the ACOG urogynecology and menopause working group to see if the new name is acceptable to that group as well. Personally I think it’s important to have an accurate term that is as neutral as possible," Dr. Gass said.

Dr. Gass reported having no disclosures. Dr. Portman has been a speaker, consultant, or advisory board member for, and/or received grant or research support from Bayer, Noven Pharmaceuticals, Palatin Technologies, and other companies.