01.03.2024

The Unending Indignities of ‘Vaginal Atrophy’

In other words, the phrase “vaginal atrophy” wasn’t just potentially offensive, it was also clinically misleading. Millions of women and other people going through menopause go undiagnosed for treatable symptoms, said Dr. James Simon, a clinical professor of obstetrics and gynecology at George Washington University School of Medicine and Health Sciences and a member of the panel reconsidering the term.

“We felt that one of the reasons was bad terminology,” he said.

In 2014, the panel agreed on a new term incorporating these insights: genitourinary syndrome of menopause, or G.S.M. It wasn’t particularly catchy, but it brought the urinary system to the party, and unlike the term vaginal atrophy, it “didn’t have shame, wasn’t something that women did wrong or brought upon themselves,” Dr. Simon said. “It was just a natural process of aging that had a constellation of symptoms that could be lumped together as a syndrome.”

There was precedent for rebranding a genital condition to make it more palatable to patients. In 1992, the National Institutes of Health replaced the term impotence with erectile dysfunction, or E.D. The reasoning was similar: Impotence was considered to be disparaging and imprecise, and was thought to imply that the condition was mainly psychological, adding to barriers in communication between patients and health care providers.

Yet while E.D. has become firmly established in both the medical and popular lexicon, G.S.M. hasn’t had the same success. Vaginal atrophy is still the primary term used by most estrogen therapy companies, as well as many providers. “I don’t know that it’s commonly known,” said Dr. Faubion, who often finds herself having to explain the term to colleagues.

Even doctors who don’t want to subject their patients to the term can find it difficult to avoid. Dr. Robin Noble, an obstetrician-gynecologist in Portland, Maine, tries to focus her conversations with patients on specific symptoms such as dryness and irritation. Yet when she prescribes vaginal estrogen, she still has to choose “vaginal atrophy” from a drop-down menu of diagnoses on her hospital computer system, and patients might end up seeing it in their medical notes. “I can’t avoid it entirely,” she said.

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