Lottare contro l’ atrofia vulvo-vaginale(VVA)/ la sindrome genito urinaria della menopausa (GSM) per un invecchiamento in buona salute delle donne. Abstact La buona salute vaginale è una componente essenziale dell’ invecchiamento attivo e di una buona salute nelle donne di mezza età o oltre. In conseguenza della privazione ormonale e dell’ invecchiamento, l’ anatomia e la funzione dei tessuti urogenitali sono considerevolmente soggetti ad una atrofia vulvo vaginale( AVV) che può insorgere. In una larga percentuale di donne in menopausa , i sintomi progressivi e cronici dell’ AVV hanno un grande impatto sulla funzione sessuale e la qualità di vita. La nuova definizione della sindrome genitourinaria della manopausa (GSM) comprende i sintomi genitali( secchezza , bruciore, prurito, irritazione, sanguinamento) e i sintomi urinari( disuria, frequenza, urgenza, infezioni urinarie ricorrenti). Numerose sono le variabili ( età, attività sessuale e stato del partner) che influenzano l’impatto clinico dei sintomi e dei segni VVA/GSM delle donne anziane che le portano ad un consulto per ricevere un trattamento efficace. I fattori psicologici giocano un ruolo essenziale nel funzionamento sessuale, ma l’ integrità del sistema urogenitale è altrettanto importante , influenzando numerose parti della salute delle donne in menopausa, compresa la funzione sessuale. Diversi sondaggi internazionali hanno largamente documentato la necessità di migliorare la gestione della VVA/GSM in ragione di un forte impatto sulla vita quotidiana delle donne e sull’ intimità della coppia. L’ assistenza sanitaria dovrebbe essere attiva nel riconoscere precocemente VVA/GSM al fine di preservare la longevità urogenitale e sessuale, utilizzando strategie ormonali e non ormonali. La diagnosi clinica è basata sull’ esame dei genitali per identificare i segni oggettive sull’ utilizzo di scale di valutazione soggettive per valutare i sintomi più fastidiosi, in particolare la secchezza vaginale. Studi recenti sottolineano l’importanza di trattare la VVA/GSM come un marker potenziale precoce di una cattiva salute generale in analogia con i sintomi vasomotori. Di conseguenza , una normale cura della VVA/GSM nelle donne anziane è indicato per migliorare il benessere fisico, emozionale e mentale. REVIEW published: 21 August 2019 doi: 10.3389/fendo.2019.00561 Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women Rossella E. Nappi 1,2*, Ellis Martini 1, Laura Cucinella 1,2, Silvia Martella 1,2, Lara Tiranini 1,2, Alessandra Inzoli 1,2, Emanuela Brambilla 1,2, David Bosoni 1,2, Chiara Cassani 3 and Barbara Gardella 2,3 1 Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy, 2 Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy, 3 Obstetrics and Gynecology Unit, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy Vaginal health is an essential component of active and healthy aging in women at Edited by: midlife and beyond. As a consequence of hormonal deprivation and senescence, the Sandro La Vignera, anatomy and function of urogenital tissues are significantly affected and vulvovaginal University of Catania, Italy atrophy (VVA) may occur. In a high proportion of postmenopausal women, progressive Reviewed by: and chronic VVA symptoms have a strong impact on sexual function and quality of life. Erika Limoncin, University of Rome Tor Vergata, Italy The new definition of genitourinary syndrome of menopause (GSM) comprises genital Roberta Venturella, symptoms (dryness, burning, itching, irritation, bleeding), sexual symptoms (dyspareunia Università degli Studi Magna Græcia di Catanzaro, Italy and other sexual dysfunctions) and urinary symptoms (dysuria, frequency, urgency, *Correspondence: recurrent urinary infections). Many variables (age, sexual activity and partnership status) Rossella E. Nappi influence the clinical impact VVA/GSM symptoms and attitudes of elderly women to [email protected] consult for receiving effective treatments. Psychosocial factors play a critical role in Specialty section: sexual functioning, but the integrity of the urogenital system is as well important affecting This article was submitted to many domains of postmenopausal women’s health, including sexual function. Several Endocrinology of Aging, international surveys have extensively documented the need to improve VVA/GSM a section of the journal Frontiers in Endocrinology management because of the strong impact on women’s daily life and on couple’s Received: 22 May 2019 intimacy. Health care providers (HCPs) need to be proactive in the early recognition of Accepted: 31 July 2019 VVA/GSM in order to preserve urogenital and sexual longevity, by using hormonal and Published: 21 August 2019 non-hormonal strategies. The clinical diagnosis is based on genital examination to identify Citation: Nappi RE, Martini E, Cucinella L, objective signs and on the use of subjective scales to rate most bothersome symptoms Martella S, Tiranini L, Inzoli A, (MBS), especially vaginal dryness. Recent studies point to the importance of addressing Brambilla E, Bosoni D, Cassani C and VVA/GSM as a potential early marker of poor general health in analogy with vasomotor Gardella B (2019) Addressing Vulvovaginal Atrophy symptoms. Therefore, a standard of VVA/GSM care in elderly women is desirable to (VVA)/Genitourinary Syndrome of enhance physical, emotional and mental well-being. Menopause (GSM) for Healthy Aging in Women. Front. Endocrinol. 10:561. Keywords: vulvovaginal atrophy (VVA), genito-urinary syndrome of menopause (GSM), aging, longevity, vaginal doi: 10.3389/fendo.2019.00561 dryness, dyspareunia, female sexual dysfunction (FSD), quality of life (QoL) Frontiers in Endocrinology | www.frontiersin.org 1 August 2019 | Volume 10 | Article 561 Nappi et al. Vaginal Health and Aging INTRODUCTION sexual health is a sensitive topic (27). In addition, the condition is believed to be transient and part of the natural aging phenomena Women live longer than men all around the world (1) and in (28, 29). In the Vaginal Health: Insights, Views & Attitudes developed countries they expect to survive more than 30 years (VIVA) survey, 55% of women with vaginal discomfort reported following natural menopause, which usually occurs between 48 experiencing symptoms for 3 years or longer and only a minority and 52 of age (2). That being so, the impact of reproductive aging (4%) attributed their symptoms to vaginal atrophy (25). Age, on healthy longevity becomes increasingly important because attitudes toward menopause, sexual activity, chronic disorders, of the potential conditions associated with menopause-related previous and/or current use of menopausal hormone therapy hormonal deficiency (3). Estrogen deprivation is the hallmark of and other biopsychosocial determinants influence the level of ovarian exhaustion leading to the manifestation of several signs distress associated with VVA symptoms and the rate of reporting and symptoms with a significant impact on quality of life (QoL) female sexual dysfunction (FSD) (30, 31). General and sexual and on physical, mental and sexual health (4). Even androgen health of the partner, as well as the quality and duration of the insufficiency, an endocrine feature more evident in women relationship, are also very important and addressing age-related with premature ovarian failure (natural, surgical, iatrogenic), changes in both members of a couple may contribute to a better may contribute to the clinical events related to menopause management of VVA and sexual dysfunctions (32). (5). Separating the effect of menopause from the variety of Urogenital aging is an old problem, newly recognized, which changes associated with senescence is quite difficult, but recent can be highly prevented upon early recognition of signs and observations bring about the idea that menopause accelerates symptoms (33). Vaginal dryness, followed by dyspareunia, is biological aging, especially when reproductive failure occurs the most common symptoms reported by postmenopausal prematurely (6). women both in surveys (22) and in clinical studies (21, 34). The present narrative review points to the importance In the REVIVE surveys conducted both in United States (US) of addressing the chronic condition of vulvovaginal atrophy (23) and in Europe (EU) (24) the onset of VVA symptoms (VVA)/genitourinary syndrome of menopause (GSM) in the has already been reported in the majority of women within context of promoting urogenital and sexual longevity in women the perimenopause/early postmenopause. Interestingly, in the at midlife and beyond. It merely reflects the expert opinion of AGATA study, which included a sample of Italian women asking the authors by analyzing the amount of available evidence (1990– for a routine gynecological examination, a clinical diagnosis of 2019) in this complex field of research. Therapeutic strategies to VVA displayed a prevalence ranging from 64.7 to 84.2%, starting effectively manage sexual symptoms associated with VVA/GSM from 1 to 6 years after menopause (35). It is essential that health have been reviewed extensively elsewhere (7–12) and, in here, care providers (HCPs) are proactive to uncover the topic of they will be discussed briefly to serve the scope of preventing vaginal health because women who discuss VVA with HCPs are severe VVA/GSM in elderly women. twice as likely to be current specific-treatment users (59.7% as compared to 22.7%