Urogenital ageing: an old problem newly recognized

Urogenital symptoms associated with estrogen loss can occur episodically throughout a woman's life (e.g. during lactation, during treatment with GnRH agonists, etc.) but it is most common and chronic in duration in postmenopausal women. More than 50% of postmenopausal women experience lack of vaginal lubrication and frequent vaginal infections [1]. These urogenital complaints were associated with a diminished frequency of all forms of sexual behaviour. Complaints associated with urogenital ageing include vaginal dryness, irritation and pressure, vaginal discharge and infection, vulvo-vaginal pruritus, dyspareunia, post-coital bleeding, urinary frequency, urgency and incontinence and recurrent urinary tract infections. Although these symptoms have affected women for centuries, they are now becoming more widely recognized by health professionals and society in general because of the increased life expectancy, the acceptance of open discussion of this topic, and the advent of effective therapy. Urogenital ageing is a public health issue because of its high prevalence and because early detection and pharmacological intervention may prevent the development of serious conditions such as uterine prolapse and urinary incontinence. Although systemic hormone replacement therapy is frequently used for the treatment of urogenital atrophy, recent attention has also focused on local delivery of estrogen to the affected urogenital tissue. In this era of fiscal constraint, intervention to maintain urogenital health by the use of estrogen must be considered for all postmenopausal women.