Thread by @rachelsrubin1

Ok Urologists: It’s #AUA19 time and there are new GUIDELINES about women with recurrent #UTI that include doing a pelvic exam and giving vaginal estrogen. Follow me on this #sexmed vulvar educational thread and change your practice pattern! @AmerUrological

UTIs are a problem. They cause morbidity, overcrowd your clinic and frustrate you and your patients when they keep coming back. Let’s work on evidence-based PREVENTION strategies. #AUA19 auanet.org/guidelines/rec…

Prevention means understanding the vulva/vagina and how hormones affect the tissue. You must get comfortable talking about GSM (genitourinary syndrome of menopause). It’s the cool “new” term for vaginal atrophy. #AUA19
tandfonline.com/doi/abs/10.310…

Say it with me G-S-M. Don’t tell a woman her vagina is atrophic. It doesn’t sound nice and it makes it seem like it’s not your problem as a urologist. Definitely our problem. genitoURINARY syndrome of Menopause. Urine. Our problem. #AUA19

Without estrogens & androgens, over time the vaginal and vulvar tissues thin, the urethra protrudes and prolapses, the introitus narrows, the labia minora resorb, and vaginal pH increases. #AUA19 ncbi.nlm.nih.gov/pubmed/29870471

The labia minora LITERALLY fade away! If all penises shriveled up starting at age 52, we’d have vaccines available for prevention. #AUA19

Symptoms of #GSM: decreased lubrication, pain w/ sex, urinary frequency/ urgency, and recurrent urinary tract infections. Why is fixing this referred to as #rejuvenation!? #AUA19

GSM is chronic, increases in severity over time, and does not improve without treatment. #AUA19

Women will NOT bring up #GSM. They have never heard of it and nobody warns them what happens to their bodies in #Menopause. All they hear is hot flashes. It is our responsibility to educate our patients about #GSM. #AUA19.

When the urethra is falling on the floor and the tissue is thin and friable of COURSE women will get UTIs. Nitrofurantoin and peeing after sex will not fix a prolapsing urethra! #AUA19

Treatment is easy, safe, and it works! Local vaginal therapy does not increase risk of clots, heart disease, dementia. Data shows no increase risk of breast cancer and many oncologists will allow it in patients with active breast cancer. #AUA19 europepmc.org/articles/pmc57…

If words don’t convince you then let’s go to pictures. Antibiotics and cranberry pills will not change vulva #2. Vaginal hormonal therapy WILL and quickly. Show your patients this picture. No woman on earth will forget their twice weekly treatment. #AUA19

Healing vulva #2 is one of the most rewarding things I do as a urologist. I stop the UTIs, I make sex comfortable and even fix urinary frequency and urgency (often with a little help from my physical therapy teammates). #AUA19

Forget UTIs. I am fellowship trained in #sexualmedicine. I treat men & women. If I put in a penile implant then I better ask about their partner. If the partner has severe #GSM, where is the implant going to go and how much pain will it cause!? #treatthecouple. #AUA19

And now how to treat. Many of these products should not cost your patients more than $35/month. There are some new great FDA approved options to learn about. Visit the vendors at #AUA19 and get to know your reps. Advocate for your female patients. They deserve this. #AUA19

How long do patients need treatment? Simple answer: Forever. Their bodies will never make estrogen again. You remove someone’s thyroid they take replacement forever. Vulvas, urethras, pelvic floors need estrogens and androgens. #AUA19

Thank you @AmerUrological for publishing these guidelines and for hosting a podium and a course on female sexual medicine. Come join us on Saturday and hear me rant in person! You’ll never look at a Vulva the same way again. #sexmed #AUA19

Saturday, May 4 10:00 AM – 12:00 PM Location: MCP: W185bc 036IC: What the Urologist Needs to Know to Manage Female Sexual Dysfunction. #AUA19 cdmcd.co/REAz #AUA19