Relationship Between Genitourinary Syndrome of Menopause and 3D High-Frequency Endovaginal Ultrasound Measurement of Vaginal Wall Thickness

Abstract

Background To date, there is no certain method for diagnosis of genitourinary syndrome of menopause (GSM) and vaginal atrophy. Aim We aim to evaluate vaginal wall thickness (VWT) using 3D high frequency endovaginal ultrasound (3D EVUS) in GSM and also to investigate whether there is any association between VWT and postmenopausal sexual dysfunction. Methods Postmenopausal women applied for routine gynecologic examination were assessed at the Outpatient Clinic of Gynecology, Maltepe University Hospital. After pelvic examination, GSM symptoms were questioned for all women and vaginal health scoring tool was applied. Twenty women with GSM and 20 women without GSM were included in the study. Outcomes All patients filled in the Female Sexual Function Index (FSFI) and underwent 3D EVUS to evaluate VWT. RESULTS The women with GSM had significantly lower anterior and posterior VWT (P=.007 and P=.049, respectively). The total FSFI score, lubrication and pain sub-scores in patients with GSM was significantly lower than the patients without GSM. Anterior VWT was positively correlated with BMI and pain sub-score of FSFI (r=0.279, P=.047; r=0.344, P=.013, respectively). A significant negative correlation was detected between anterior vaginal VWT and age, time since menopause and satisfaction sub-score of FSFI (r=-0.332, P=.017; r=-0.354, P=.011; r=-0.301, P=.032, respectively). Posterior VWT was positively correlated with FSFI total score, arousal, lubrication and pain sub-scores (r=0.451, P=.001; r=0.437, P=.001; r=0.415, P=.002; r=0.335, P=.016; respectively). Clinical Implications Based on our results, measurement of VWT using 3D EVUS can be a useful non-invasive tool for the objective diagnosis of GSM. Strengths and Limitations Considering that only total vaginal thickness can be measured with traditional transabdominal and transvaginal techniques, the main strength of the study is the use of 3D EVUS for separate measurement of anterior and posterior VWT. The study has sufficient statistical power. The small sample size of study is the main limitation. CONCLUSION The 3D EVUS can be used for objective diagnosis of GSM and can also shed light on the causes of various sexual dysfunction symptoms in postmenopausal women, as it enables measuring the anterior and posterior walls of the vagina separately.

Vaginal wall thickness as potential biomarker of vaginal health. A proposal for standardized ultrasound measurement using three‐dimensional transvaginal ultrasound

“…As vaginal wall thinning is a real phenomenon in the GSM, ultrasound measurement of vaginal wall thickness has been proposed as a potential biomarker of vaginal health. In fact, some authors have advocated this measurement using ultrasound 5–11 . However, we observed that there is no standardized approach for measuring vaginal wall thickness.…”

Ultrasonographic measurement of vaginal thickness: Relation to menopausal status and genitourinary syndrome of menopause

“…20 The other is using 3D endovaginal probe to measure the anterior and posterior walls separately. 21 These methods can be applicable for research purposes, however 2D transabdominal ultrasonography is widely used and the described technique is easy to learn. The method is also acceptable for the patient since it does not require any vaginal intervention which can be painful for women with vaginal atrophy.…”

“…One of these is using in vivo microscopy to measure the distance between the subepithelial microcirculation and the epithelial surface 20 . The other is using 3D endovaginal probe to measure the anterior and posterior walls separately 21 . These methods can be applicable for research purposes, however 2D transabdominal ultrasonography is widely used and the described technique is easy to learn.…”

Genitourinary syndrome of menopause—I know it when I see it—or do I?

“…Transvaginal ultrasound has been piloted to measure vaginal mucosa and vaginal wall thickness in postmenopausal women. 7 Differences in thickness were noted and correlated with GSM symptoms in women with and without GSM as defined by the Vaginal Health Index. Transvaginal ultrasound measurements have been correlated with histology of pelvic floor structures.…”

“…Techniques used in research of pelvic floor disorders and sexual medicine research offer new possibilities for assessing these factors. Transvaginal ultrasound has been piloted to measure vaginal mucosa and vaginal wall thickness in postmenopausal women 7 . Differences in thickness were noted and correlated with GSM symptoms in women with and without GSM as defined by the Vaginal Health Index.…”