Current commentaries about deep dyspareunia and the genito-urinary syndrome of menopause

The authors carried out an evaluation of the genito-urinary syndrome of menopause, which is defined as a set of signs and symptoms associated with the reduction of estrogen and other sex steroids involving changes in labia maiora and minora, clitoris, vaginal vestibule, urethra and bladder, which create discomfort and are not better explained by another diagnosis. The syndrome may include, but not be limited to, genital symptoms of dryness, burning and irritation, sexual symptoms of lack of lubrication, discomfort or pain, and impaired functions, and may be associated with urinary symptoms of urgency, dysuria and recurrent urinary infections. Affected women may have some or all these signs and symptoms; however, specifically regarding deep dyspareunia, a discomfort caused by pain felt in the vaginal fundus during sexual relations, a better explanation is the relative short vagina syndrome. This syndrome is related to incompatibility of penis size with the size of the extended vagina or to an organic cause such as loss of vaginal elasticity due to atrophy caused by the lack of sex steroids, with consequent vaginal shortening and reduced capacity of vaginal distention. Accepting this explanation facilitates the approach to this symptom and permits gynecologists to treat affected women in an appropriate manner. The treatment of this type of discomfort requires changes in sexual practices during the climacteric and menopause, together with hormone replacement, as recommended by professionals who are aware of the two syndromes. Correspondence to: Ângelo C. S. Matthes, Av Costabile Romano, 2201. Ribeirão Preto, 14096-000, Brazil, Tel: 55 (16) 3603-7000, 55 (16) 981 45 85 65; E-mail: [email protected]