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What Happens in Vegas
EDITORIAL
What Happens in Vegas What happens in Vegas doesn’t have to stay in Vegas. In October the North American Menopause Society (NAMS) met in Las Vegas. In November the Sexual Medicine Society of North America (SMSNA) met in Las Vegas. Although the missions and scopes of these societies appear to be vastly different, ultimately they are very similar. The dissemination of information meant to result in better patient management is the ultimate goal of most medical societies, especially sexual medicine societies. What happens in Vegas doesn’t have to stay in Vegas. The city of Las Vegas is all about bright lights, slot machines, and . of course, sex. The International Society for Sexual Medicine (ISSM) and its regional affiliate societies, including SMSNA and the International Society for the Study of Women’s Sexual Health (ISSWSH) may not have the bright lights and slot machines, but they are all about, specifically, sexual health. What is different as we move into 2016 is that other societies, such as NAMS, have come to recognize that sexual health should be considered and addressed in contexts other than just our “sexual medicine societies.” For example, this year at the NAMS meeting in Las Vegas there was a great deal of discussion about genitourinary syndrome of menopause (GSM), especially concerning the sexual health consequences of menopause. In our sexual medicine world, we now recognize that the various interpretations of the Women’s Health Initiative (WHI) data have led to millions and millions of American women discontinuing sex steroid hormone treatment and thus experiencing bothersome and distressing sexual dysfunctions from the sex steroid hormone deficiency states noted in menopause. Arguably, in United States history, the WHI is the largest study ever, performed which, as a consequence, led to the most women ever developing sexual dysfunction as a consequence of its data interpretation. This year at NAMS the discussion included presentations of large data sets showing that bioidentical estradiol not only does not increase risk but is cardioprotective if started early enough in perimenopause. These data also showed that estradiol can be safely provided to women many years after menopause. Further, the NAMS leadership discussed the need to revise their guidelines, indicating that “hormone therapy should be used for as short a period as possible.” Based on new data sets, estradiol should be provided as long as symptoms occur. In other words, if an older woman who no longer has hot flashes wants to have sexual activity without GSM, she should be prescribed estradiol and progesterone as appropriate. The new acceptance of sex steroid hormone use in menopausal women is a turnaround that will be disseminated among menopause providers and must not stay in Vegas!!!! Sex Med Rev 2016;4:1e2
In addition, as a follow-up, a contingent from NAMS including ISSWSH President Sharon Parish met with the Food and Drug Administration in an attempt to have the black box warning about heart attacks removed from topical low-dose vaginal estradiol treatments. What happened in Vegas surely did not stay in Vegas! I am an American urologist/sexual medicine physician so I cannot address what is happening around the world in nonsexual medicine societies, but I do know about the American Urological Association (AUA). Twenty years ago the AUA accepted only a minimum number of abstracts in any area of sexual medicine, primarily related to penile implant data. Over the last 17 years, with additional products such as phosphodiesterase type 5 inhibitors, additional research in the field has increased dramatically, so that podium and poster sessions in men’s and women’s sexual health at the AUA are now commonplace. I have been fortunate enough to have taught postgraduate courses on women’s sexual function and dysfunction during the AUA annual meeting as well as at freestanding AUA courses in conjunction with other topics. The revised AUA curriculum for residents contains content on both men’s and women’s sexual health, courtesy of the SMSNA. One of my children is a pediatric interventional cardiologist (how’s that for a mouthful?) and at one of his conferences this year they alluded to sexual health, possibly for the first time. How often have we taught that erectile dysfunction (ED) is a precursor to a heart attack and that that ED is a sentinel warning sign of cardiovascular disease? At the International Pelvic Pain Society (IPPS) annual conference in October, one of the lunch and learn sessions was on the sexual health concerns regarding persistent genital arousal disorder (PGAD). Last year we saw a change in nomenclature based on an historic international consensus conference that focused on pain—the third of its kind—with contributions from ISSWSH, IPPS, the International Society for the Study of Vulvovaginal Diseases (ISSVD), and the National Vulvodynia Association. Not only has the new nomenclature been adopted by IPPS, ISSVD and ISSWSH; more recently, it also was endorsed by SMSNA. In 2014 ISSWSH and NAMS convened a meeting to discuss vulvovaginal atrophy, a term disliked by many women, who do not want to be told they have atrophy. Their recommendation was endorsed by the International Menopause Society and published in Climacteric, Menopause and The Journal of Sexual Medicine. Today we talk about GSM as a direct result of that meeting. In 2014 ISSWSH determined there was a need for an international consensus nomenclature conference with regard to new 1
2
definitions for sexual desire, sexual arousal, and orgasm dysfunctions that could be more clinically relevant to health care providers, researchers, and regulatory agencies. Although an initiative again of ISSWSH, participating thought leaders from a multitude of other societies also have been involved. Last summer SMSNA assembled leaders in treating men with symptomatic hypogonadism (AOH) to discuss the clinically relevant presentations of men with low testosterone and associated subjective and objective clinical findings accompanied by low or normal gonadotropin levels. Those results will be published shortly, again with a potential of changing the way we speak about another sexual health problem, adult onset hypogonadism. It is through sharing knowledge and allowing experts in related fields to sit down together in one room, with common language and common goals, that ultimately we can progress in our sexual medicine field.
Goldstein
If you attend a sexual medicine conference in Las Vegas and listen intently but don’t integrate what you have learned into your sexual medicine practice or your sexual medicine research lab, then why attend? If you let what happens in Vegas stay in Vegas, you are not only doing yourself a disservice, but you are affecting those around you: your patients, your staff, your trainees, the men or women in your life. If you need support in implementing changes based on new information, grab your copy of Sexual Medicine Reviews (SMR) and show others that what you are proposing is evidence-based. Don’t go to the show and forget to hum the show tunes. Bring that message home from Las Vegas or wherever your conference may be. And help spread that word. Read your SMR, write for your SMR, and review for your SMR. You can make a difference! Irwin Goldstein, MD Editor-in-Chief
Sex Med Rev 2016;4:1e2
What Happens in Vegas What happens in Vegas doesn’t have to stay in Vegas. In October the North American Menopause Society (NAMS) met in Las Vegas. In November the Sexual Medicine Society of North America (SMSNA) met in Las Vegas. Although the missions and scopes of these societies appear to be vastly different, ultimately they are very similar. The dissemination of information meant to result in better patient management is the ultimate goal of most medical societies, especially sexual medicine societies. What happens in Vegas doesn’t have to stay in Vegas. The city of Las Vegas is all about bright lights, slot machines, and . of course, sex. The International Society for Sexual Medicine (ISSM) and its regional affiliate societies, including SMSNA and the International Society for the Study of Women’s Sexual Health (ISSWSH) may not have the bright lights and slot machines, but they are all about, specifically, sexual health. What is different as we move into 2016 is that other societies, such as NAMS, have come to recognize that sexual health should be considered and addressed in contexts other than just our “sexual medicine societies.” For example, this year at the NAMS meeting in Las Vegas there was a great deal of discussion about genitourinary syndrome of menopause (GSM), especially concerning the sexual health consequences of menopause. In our sexual medicine world, we now recognize that the various interpretations of the Women’s Health Initiative (WHI) data have led to millions and millions of American women discontinuing sex steroid hormone treatment and thus experiencing bothersome and distressing sexual dysfunctions from the sex steroid hormone deficiency states noted in menopause. Arguably, in United States history, the WHI is the largest study ever, performed which, as a consequence, led to the most women ever developing sexual dysfunction as a consequence of its data interpretation. This year at NAMS the discussion included presentations of large data sets showing that bioidentical estradiol not only does not increase risk but is cardioprotective if started early enough in perimenopause. These data also showed that estradiol can be safely provided to women many years after menopause. Further, the NAMS leadership discussed the need to revise their guidelines, indicating that “hormone therapy should be used for as short a period as possible.” Based on new data sets, estradiol should be provided as long as symptoms occur. In other words, if an older woman who no longer has hot flashes wants to have sexual activity without GSM, she should be prescribed estradiol and progesterone as appropriate. The new acceptance of sex steroid hormone use in menopausal women is a turnaround that will be disseminated among menopause providers and must not stay in Vegas!!!! Sex Med Rev 2016;4:1e2
In addition, as a follow-up, a contingent from NAMS including ISSWSH President Sharon Parish met with the Food and Drug Administration in an attempt to have the black box warning about heart attacks removed from topical low-dose vaginal estradiol treatments. What happened in Vegas surely did not stay in Vegas! I am an American urologist/sexual medicine physician so I cannot address what is happening around the world in nonsexual medicine societies, but I do know about the American Urological Association (AUA). Twenty years ago the AUA accepted only a minimum number of abstracts in any area of sexual medicine, primarily related to penile implant data. Over the last 17 years, with additional products such as phosphodiesterase type 5 inhibitors, additional research in the field has increased dramatically, so that podium and poster sessions in men’s and women’s sexual health at the AUA are now commonplace. I have been fortunate enough to have taught postgraduate courses on women’s sexual function and dysfunction during the AUA annual meeting as well as at freestanding AUA courses in conjunction with other topics. The revised AUA curriculum for residents contains content on both men’s and women’s sexual health, courtesy of the SMSNA. One of my children is a pediatric interventional cardiologist (how’s that for a mouthful?) and at one of his conferences this year they alluded to sexual health, possibly for the first time. How often have we taught that erectile dysfunction (ED) is a precursor to a heart attack and that that ED is a sentinel warning sign of cardiovascular disease? At the International Pelvic Pain Society (IPPS) annual conference in October, one of the lunch and learn sessions was on the sexual health concerns regarding persistent genital arousal disorder (PGAD). Last year we saw a change in nomenclature based on an historic international consensus conference that focused on pain—the third of its kind—with contributions from ISSWSH, IPPS, the International Society for the Study of Vulvovaginal Diseases (ISSVD), and the National Vulvodynia Association. Not only has the new nomenclature been adopted by IPPS, ISSVD and ISSWSH; more recently, it also was endorsed by SMSNA. In 2014 ISSWSH and NAMS convened a meeting to discuss vulvovaginal atrophy, a term disliked by many women, who do not want to be told they have atrophy. Their recommendation was endorsed by the International Menopause Society and published in Climacteric, Menopause and The Journal of Sexual Medicine. Today we talk about GSM as a direct result of that meeting. In 2014 ISSWSH determined there was a need for an international consensus nomenclature conference with regard to new 1
2
definitions for sexual desire, sexual arousal, and orgasm dysfunctions that could be more clinically relevant to health care providers, researchers, and regulatory agencies. Although an initiative again of ISSWSH, participating thought leaders from a multitude of other societies also have been involved. Last summer SMSNA assembled leaders in treating men with symptomatic hypogonadism (AOH) to discuss the clinically relevant presentations of men with low testosterone and associated subjective and objective clinical findings accompanied by low or normal gonadotropin levels. Those results will be published shortly, again with a potential of changing the way we speak about another sexual health problem, adult onset hypogonadism. It is through sharing knowledge and allowing experts in related fields to sit down together in one room, with common language and common goals, that ultimately we can progress in our sexual medicine field.
Goldstein
If you attend a sexual medicine conference in Las Vegas and listen intently but don’t integrate what you have learned into your sexual medicine practice or your sexual medicine research lab, then why attend? If you let what happens in Vegas stay in Vegas, you are not only doing yourself a disservice, but you are affecting those around you: your patients, your staff, your trainees, the men or women in your life. If you need support in implementing changes based on new information, grab your copy of Sexual Medicine Reviews (SMR) and show others that what you are proposing is evidence-based. Don’t go to the show and forget to hum the show tunes. Bring that message home from Las Vegas or wherever your conference may be. And help spread that word. Read your SMR, write for your SMR, and review for your SMR. You can make a difference! Irwin Goldstein, MD Editor-in-Chief
Sex Med Rev 2016;4:1e2