CORRESPONDENCE-POINTS OF VIEW

Question No.1: Where can the dryness of the vaginal mucosa and the side effects caused by the onset of menopause be classified as a pathology?

Answer given by: Vasile NIȚESCU Associate Univ. Prof. Dr., *Ileana MARINESCU Senior Specialist in Endocrinology, Doina NIȚESCU, MD, Ph.D., Internal Medicine Senior Specialist

In the biological involution of the genitals, according to genetic programming.

After the onset of menopause, vaginal morphological changes secondary to estrogen defi- ciency are added to the complex elements caused by the biological involution of the genitals according to age.

This is why the dryness of the vaginal mucosa makes it difficult to penetrate the penis due to the lack of vulvo-vaginal lubrication and intercourse becomes painful.

Also, the sensitivity of the vulvo-vaginal cellular receptors decreases, respectively the de- gree of vaginal excitability is reduced, obtaining orgasm becoming more difficult.

American gynecologists Berek and Novak use the term “urogenital atrophy“, adding, in addition to dyspareunia and vaginal pruritus, the urinary changes caused by prolapse of the anterior vaginal wall, accompanied by urethro-cystocele, and prolapse of the posterior vaginal wall, which causes the appearance of rectocele, with gas incontinence and sometimes feces incontinence (generally when feces have low consistency).

All the mentioned changes reduce the desire for sexual practice with menopause and aging, respectively, and libido, arousal and orgasm become more difficult, depreciating the quality of life, compared to the young woman.

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