Vaginal health is an essential component of active and healthy aging in women at midlife and beyond. As a consequence of hormonal deprivation and senescence, the anatomy and function of urogenital tissues are significantly affected and vulvovaginal atrophy (VVA) may occur. In a high proportion of postmenopausal women, progressive and chronic VVA symptoms have a strong impact on sexual function and quality of life. The new definition of genitourinary syndrome of menopause (GSM) comprises genital symptoms (dryness, burning, itching, irritation, bleeding), sexual symptoms (dyspareunia and other sexual dysfunctions) and urinary symptoms (dysuria, frequency, urgency, recurrent urinary infections). Many variables (age, sexual activity and partnership status) influence the clinical impact VVA/GSM symptoms and attitudes of elderly women to consult for receiving effective treatments. Psychosocial factors play a critical role in sexual functioning, but the integrity of the urogenital system is as well important affecting many domains of postmenopausal women's health, including sexual function. Several international surveys have extensively documented the need to improve VVA/GSM management because of the strong impact on women's daily life and on couple's intimacy. Health care providers (HCPs) need to be proactive in the early recognition of VVA/GSM in order to preserve urogenital and sexual longevity, by using hormonal and non-hormonal strategies. The clinical diagnosis is based on genital examination to identify objective signs and on the use of subjective scales to rate most bothersome symptoms (MBS), especially vaginal dryness. Recent studies point to the importance of addressing VVA/GSM as a potential early marker of poor general health in analogy with vasomotor symptoms. Therefore, a standard of VVA/GSM care in elderly women is desirable to enhance physical, emotional and mental well-being.

Primary carcinoma of the vagina is an uncommon condition, accounting for 1%-2% of all gynecologic malignancies. 1 It usually affects elderly women and symptoms include vaginal bleeding, dysuria, and pelvic pain. The concurrence of vaginal cancer with irreducible uterine prolapse is even more rare (Figure 1). Treatment is always challenging, and options involve radiotherapy, surgery, or palliative treatment.External beam radiotherapy field-in the presence of associated advanced prolapse-may be associated with higher exposure of bladder and bowel to radiation, thus increasing the associated complications, such as vesicovaginal or enterovaginal fistulae. 2 Brachytherapy is

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Introduction/Background Anal high-grade intraepithelial neoplasia (AIN2-3) is the precursor of HPV-related anal cancer. Although anal cancer is rare, its incidence is rising, especially in women. Women with high-grade cervical neoplasia (CIN2-3) or HPV-related genital cancer are at increased risk of developing AIN. Other risk groups include people living with HIV, immunocompromised patients, and Men who have Sex with Men (MSM).

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