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During the NAMS video, Dr Shapiro recommended nonpharmacological treatment options for GSM that include vaginal moisturizers, lubricants, and pelvic PT. Another treatment that she mentioned during her interview with Dr. Shifren was the pharmacological use of low dose vaginal estrogen. This can be given as tablets twice a week, or a cream that is inserted to the vagina.Although nonpharmacological treatment options are first-line, they only provide limited relief (ACOG, 2016). Vaginal estrogen therapy has been shown to provide women with symptomatic relief of urogenital symptoms associated with perimenopause and menopause (NAMS, 2016). They come in 3 different forms including vaginal ring, tablets and creams. These are the preferred form, when genitourinary symptoms are the only complaint (Kim, Kang, Chung, Kim, & Kim, 2015). Choosing which form to use for the treatment of GSM should be made in conjunction with the patient for better treatment adherence. As mentioned by Dr Shapiro, low dose vaginal estrogen therapy is usually safe for most women but is contraindicated in women with estrogen-dependent neoplasia.When it comes to the comfort level of taking a complete sexual history, I am more comfortable now than when I started my nursing career. For the most part, I feel pretty comfortable asking a patient about their sexual history. For some reason, I feel more comfortable with younger as well as patients my age. I don’t know why that is. I don’t really have a different comfort level when it comes to male and female patients. The only time I was not comfortable doing a sexual history on a male was during my last term with my preceptor he became a bit inappropriate with use. Although this happened, we stayed professional, mentioned something to the patient and continued with the history taking.The NAMS videos as mentioned earlier were interesting and made me aware of the GSM.Although I knew that changes happen as women age and go through menopause, I was surprised to see that 1 in every 10 women is affected by sexual disfunction problems. With this new gained knowledge, I will make sure that a sexual history will be obtained on my patients including the mature and elderly
patients’ population, if not done so, and routinely reassess their history for any changes that could affect her sexual health.Po w er e d b y T C PD F ( w w w .tc pd f. or g )
, 65-71. doi:
The Use of Vaginal Estrogen in Women
Dependent-Breast-Cancer?IsMobileSet=false The Northern American Menopause Society, (2016). Dr. Shifren discusses GSM. Retrieved from
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