Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-26T21:51:25.613Z Has data issue: false hasContentIssue false

Chapter 30 - Gynecologic Issues

from Section III - Care of the Elderly by Organ System

Published online by Cambridge University Press:  30 June 2022

By
Rebecca Jackson  and
Ashley R. Tran
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

Gynecologic issues continue throughout a woman’s lifespan. Elderly patients are less likely to report symptoms than younger patients, especially when pertaining to gynecologic concerns and sexual dysfunction. Sensitive history taking with careful attention to risk factors and sexual history is an important part of caring for older women. If a pelvic exam is going to be performed, adjustments may need to be made. This chapter focuses on the most common gynecologic issues of the elderly: vulvovaginitis and other vulvar conditions, menopausal symptoms, pelvic floor prolapse, sexual dysfunction, and gynecologic malignancies.

Keywords

menopausal symptomsgynecologic malignanciespelvic organ prolapsesexual dysfunctiongenitourinary syndrome of menopausevulvovaginal symptoms
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 373 - 382
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

The utility and indications for routine pelvic examination. ACOG Committee Opinion No. 754. American College of Obstetricians and Gynecologists. Obest Gynecol.2018; 132:e174–180.Google Scholar
Zawora, M, Hsieh, C. Gynecologic issues in the elderly. In: Busby-Whitehead, J et al., eds. Reichel’s Care of the Elderly: Clinical Aspects of Aging, 7th edition. Cambridge: Cambridge University Press, 2016.Google Scholar
Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013 (Sep.); 20(9):888–902.Google Scholar
Urogenital health. Menopause and osteoporosis update 2009. J Obstet Gynaecol Can. 2009 (Jan.); 31(1 Suppl. 1):S27–30.Google Scholar
ACOG practice bulletin no. 141: Management of menopausal symptoms. Obstet Gynecol. 2014; 123:202–216.Google Scholar
North American Menopause Society. The 2017 hormone therapy position statement of the North American Menopause Society. Menopause. 2017; 24(7):728–753.Google Scholar
Funaro, D. Lichen sclerosus: A review and practical approach. Dermatologic Therapy. 2004; 17(1):28–37.Google Scholar
Kirtschig, G, Becker, K, Günthert, A, et al. Evidence-based (S3) guideline on (anogenital) Lichen sclerosus. J Eur Acad Dermatol Venereol. 2015; 29:e1.CrossRefGoogle ScholarPubMed
Perkins, KE, King, MC. Geriatric gynecology. Emerg Med Clin N Am. 2012; 30:1007–1019.CrossRefGoogle ScholarPubMed
Letvak, S, Schoder, D. Sexually transmitted diseases in the elderly: What you need to know – The young aren’t the only ones at risk for STDs. Geriatric Nursing. 1996; 17(4):156–160.CrossRefGoogle Scholar
Bachmann, GA., Nevadunsky, NS. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician. 2000 (May 15); 61(10):3090–3096.Google Scholar
Walter, LC, Covinsky, KE. Cancer screening in elderly patients: A framework for individualized decision making. JAMA. 2001; 285(21):2750–2756.Google Scholar
Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2010–2016. HIV Surveillance Supplemental Report. 2019; 24(1).Google Scholar
Centers for Disease Control and Prevention. HIV Surveillance Report, 2017, vol. 29. Atlanta, GA: U.S. Department of Health and Human Services, 2017.Google Scholar
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2018. Atlanta, GA: U.S. Department of Health and Human Services, 2019.Google Scholar
Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines 2015. Morbidity and Mortality Weekly Report, 64(3). Atlanta, GA: U.S. Department of Health and Human Services.Google Scholar
Woods, NF, Mitchell, ES. Symptoms during the perimenopause: Prevalence, severity, trajectory, and significance in women’s lives. Am J Med. 2005; 118:S12–24.Google Scholar
Freedman, RR. Physiology of hot flashes. Am J Hum Biol. 2001; 13:453–464.Google Scholar
Politi, MC, Schleinitz, MD, Col, NF. Revisiting the duration of vasomotor symptoms of menopause: A meta-analysis. J Gen Intern Med. 2008; 23:1507–1513.CrossRefGoogle ScholarPubMed
Freeman, EW, Sammel, MD, Sanders, RJ. Risk of long-term hot flashes after natural menopause: Evidence from the Penn Ovarian Aging Study cohort. Menopause. 2014; 21(9):924–932.CrossRefGoogle ScholarPubMed
Rossouw, JE, Anderson, GL, Prentice, RL, LaCroix, AZ, Kooperberg, C, Stefanick, ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized controlled trial. Writing Group for the Women’s Health Initiative Investigators. JAMA. 2002; 288:321–333.Google Scholar
North American Menopause Society. The North American Menopause Society statement on continuing use of systemic hormone therapy after age 65. Menopause. 2015; 22(7):693.Google Scholar
Manson, JE. Current recommendations: What is the clinician to do? Fertil Steril. 2014; 101:916.Google Scholar
Portman, DJ, Gass, ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Menopause. 2014; 21(10):1063‐1068.Google Scholar
Santoro, N, Komi, J. Prevalence and impact of vaginal symptoms among postmenopausal women. J Sex Med. 2009; 6:2133–2142.Google Scholar
Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013; 20(9):888–902.Google Scholar
American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice, Farrell, R. ACOG Committee Opinion No. 659: The use of vaginal estrogen in women with a history of estrogen-dependent breast cancer. Obstet Gynecol. 2016; 127(3):e93‐e96.Google Scholar
Bachmann, GA, Komi, JO. Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: Results from a pivotal phase 3 study. Ospemifene Study Group. Menopause. 2010; 17:480–486.Google Scholar
Labrie, F, Derogatis, L, Archer, DF, et al. Effect of intravaginal prasterone on sexual dysfunction in postmenopausal women with vulvovaginal atrophy. J Sex Med. 2015; 12(12):2401–2412.Google Scholar
Jelovsek, JE, Maher, C, Barber, MD. Pelvic organ prolapse. Lancet. 2007; 369(9566):1027–1038.CrossRefGoogle ScholarPubMed
Iglesia, CB, Smithling, KR. Pelvic organ prolapse. American Family Physician. 2017; 96(3):179–185.Google Scholar
Culligan, PJ. Nonsurgical management of pelvic organ prolapse. Obstet Gynecol. 2012; 119(4):852–860.CrossRefGoogle ScholarPubMed
Bump, RC, Mattiasson, A, Bo, K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996; 175(1):10–17.Google Scholar
Hartford Institute for Geriatric Nursing. Sexuality in the older adult. In: Boltz, M, Capezuti, E, Fulmer, T, Zwicker, D, eds. Evidence-Based Geriatric Nursing Protocols for Best Practice, 4th edition. New York: Springer Publishing Company, 2012, pp. 500–515.Google Scholar
Shifren, J, Gass, M. The North American Menopause Society recommendations for clinical care of midlife women. Menopause. 2014; 21:1038–1062.Google Scholar
Walter, LC, Covinsky, KE. Cancer screening in elderly patients: A framework for individualized decision making. JAMA. 2001; 285(21):2750–2756.Google Scholar
Siegel, R, Miller, K, Jemal, A. Cancer statistics, 2020. CA Cancer J Clin. 2020; 70(1):7–30.Google Scholar
Endometrial cancer. Practice Bulletin No. 149. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2015; 125: 1006–1026.Google Scholar
Dijkhuizen, FP, Mol, BW, Brolmann, HA, Heintz, AP. The accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia: A meta-analysis. Cancer. 2000; 89:1765–1772.Google Scholar
Creasman, WT, Odicino, F, Maisonneuve, P, Quinn, MA, Beller, U, Benedet, JL, et al. Carcinoma of the corpus uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006; 95(suppl. 1):S105–143.Google Scholar
Sorosky, JL. Endometrial cancer. Obstet Gynecol. 2012; 120(2):383–397.Google Scholar
Grady, D, Ernster, VL. Hormone replacement therapy and endometrial cancer: Are current regimens safe? J Natl Cancer Inst. 1997; 89:1088–1089.Google Scholar
Sismondi, P, Biglia, N, Volpi, E, Giai, M, deGrandis, T. Tamoxifen and endometrial cancer. Ann N Y Acad Sci. 1994; 734:310–321.Google Scholar
Renehan, AG, Tyson, M, Egger, M, Heller, RF, Zwahlen, M. Body-mass index and incidence of cancer: A systematic review and meta-analysis of prospective observational studies. Lancet. 2008; 371:569–578.Google Scholar
McPherson, CP, Sellers, TA, Potter, JD, Bostick, RM, Folsom, AR. Reproductive factors and risk of endometrial cancer: The Iowa Women’s Health Study. Am J Epidemiol. 1996; 143:1195–1202.Google Scholar
Barrow, E, Hill, J, Evans, DG. Cancer risk in Lynch syndrome. Fam Cancer. 2013; 12:229–240.Google Scholar
Zhou, B, Yang, L, Sun, Q, Cong, R, Gu, H, Tang, N, et al. Cigarette smoking and the risk of endometrial cancer: A meta-analysis. Am J Med. 2008; 121:501–508.Google Scholar
Brinton, LA, Felix, AS, McMeekin, DS, Creasman, WT, Sherman, ME, Mutch, D, et al. Etiologic heterogeneity in endometrial cancer: Evidence from a Gynecologic Oncology Group trial. Gynecol Oncol. 2013; 129:277–284.Google Scholar
Gierisch, JM, Coeytaux, RR, Urrutia, RP, Havrilesky, LJ, Moorman, PG, Lowery, WJ, et al. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: A systematic review. Cancer Epidemiol Biomarkers Prev. 2013; 22:1931–1943.Google Scholar
Depot-medroxyprogesterone acetate (DMPA) and risk of endometrial cancer. The WHO Collaborative Study of Neoplasia and Steroid Contraceptives. Int J Cancer. 1991; 49:186–190.Google Scholar
Hubacher, D, Grimes, DA. Noncontraceptive health benefits of intrauterine devices: A systematic review. Obstet Gynecol Surv. 2002; 57:120–128.Google Scholar
Lewin, S, Herzog, T, Medel, N, Deutsch, I, Burke, W, Sun, X, Wright, J. Comparative performance of the 2009 International Federation of Gynecology and Obstetrics’ staging system for uterine corpus cancer. Obstet Gynecol. 2010; 116(5):1141–1149.Google Scholar
Erickson, BK, Conner, MG, Landen, CNJr. The role of the fallopian tube in the origin of ovarian cancer. Am J Obstet Gynecol. 2013; 209:409–414Google Scholar
Partridge, E, Kreimer, AR, Greenlee, RT, Williams, C, Xu, JL, Church, TR, et al. Results from four rounds of ovarian cancer screening in a randomized trial. Obstet Gynecol. 2009; 113:775–782.Google Scholar
The role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Committee Opinion No. 477. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2011; 117:742–746.Google Scholar
Screening for ovarian cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2018; 319(6):588–594.CrossRefGoogle Scholar
Berek, J, Crum, C, Friedlander, M. Cancer of the ovary, fallopian tube, and peritoneum. Int J Gynecol Obstet. 2015; 131: S111–122.Google Scholar
Falconer, H, Yin, L, Gronberg, H, Altman, D. Ovarian cancer risk after salpingectomy: A nationwide population-based study. J Natl Cancer Inst. 2015; 107(2):dju410.Google Scholar
Tortolero-Luna, G, Mitchell, MF, Rhodes-Morris, HE. Epidemiology and screening for ovarian cancer. Obstet Gynecol Clin North Am. 1994; 21(1):1–23.Google Scholar
Goff, B, Mandel, L, Muntz, H, Melancon, C. Ovarian carcinoma diagnosis. Cancer. 2000; 89:2068–2075.Google Scholar
Evaluation and management of adnexal masses. Practice Bulletin No. 174. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016; 128:e210–226.Google Scholar
Chow, WB, Rosenthal, RA, Merkow, RP. Optimal preoperative assessment of the geriatric surgical patient: A best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012; 215(4):453–466.Google Scholar
Walboomers, JM, Jacobs, MV, Manos, MM. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999; 189(1): 12‐19.Google Scholar
International Collaboration of Epidemiological Studies of Cervical Cancer. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: Collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. Int J Cancer. 2007; 120(4):885–891.Google Scholar
Sung, HY, Kearney, KA, Miller, M, Kinney, W, Sawaya, GF, Hiatt, RA. Papanicolaou smear history and diagnosis of invasive cervical carcinoma among members of a large prepaid health plan. Cancer. 2000; 88:2283–2289.Google Scholar
Cervical cancer screening and prevention. Practice Bulletin No. 168. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016; 128:e111–130.Google Scholar
Soutter, WP, Sasieni, P, Panoskaltsis, T. Long-term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia. Int J Cancer. 2006; 118:2048–2055.Google Scholar
Perkins, RB, Guido, RS, Castle, PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2020; 24(2):102–131.Google Scholar
DiSaia, PJ, Creasman, WT. Invasive cervical cancer. In: DiSaia, PJ et al., eds. Clinical Gynecologic Oncology, 9th edition. Philadelphia, PA: Mosby Elsevier, 2018, pp. 38–104.Google Scholar
Saraiya, M, Watson, M, Wu, X, et al. Incidence of in situ and invasive vulvar cancer in the US, 1998–2003. Cancer. 2008; 113(10 Suppl.):2865–2872.Google Scholar
Zweizig, S, Korets, S, Cain, JM. Key concepts in management of vulvar cancer. Best Pract Res Clin Obstet Gynaecol. 2014; 28(7):959–966.Google Scholar
Adams, TS, Cuello, MA. Cancer of the vagina. Int J Gynaecol Obstet. 2018; 143 (Suppl. 2):14–21.Google Scholar
Daling, JR, Madeleine, MM, Schwartz, SM, et al. A population-based study of squamous cell vaginal cancer: HPV and cofactors. Gynecol Oncol. 2002; 84(2):263–270.CrossRefGoogle ScholarPubMed
Batista, TP, Martins, M. Vaginal cancer. Int J Canc Prev. 2012; 5(3):235–246.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×