Genitourinary Syndrome of Menopause (GSM) is defined as a set of signs and symptoms, involving tissue changes in the large and small lips, clitoris, vaginal opening, vagina, urethra and bladder, which can affect up to 50% of menopausal women. (1) Despite all knowledge about the pathophysiology of GSM, its prevalence and impact on sexual function, little is known about the impact of the syndrome on other dimensions of well-being. (2) Genital self-image is an emerging aspect of body image relevant to sexual functioning and sexual satisfaction. (3) Given the evident influence of vaginal atrophy on women's sexual health and its high post-menopausal prevalence, there is a need to assess, in fact, how much it affects sexual function and how it alters the self-perception of the genitalia. The objective of this study is to assess the relationship between genital self-image and sexual function of women with Genitourinary Syndrome of Menopause.

This is an analytical cross-sectional study that evaluated 49 women in the post-menopausal period with GSM. The diagnosis was established based on at least 1 subjective symptom reported in the interview, associated with, at least, 1 objective sign evaluated on physical examination by an experienced physiotherapist. After the evaluation, the patients answered three questionnaires: Visual Numerical Scale (VNS), the Female Genital Self-Image Scale (FGSIS) and the Female Sexual Function Index (FSFI), which investigates, respectively, the intensity of the most common symptoms of GSM, genital self-image and sexual function of the patients. The study was carried out in a physiotherapy clinic with a specialized urogynecology service in the city of Salvador, BA. To estimate the sample number of women with GSM needed to answer the primary objective of the present study: the relationship between sexual function and genital self-image, a correlation coefficient of 0.4 was estimated, which translates a weak / moderate coefficient, and a power statistic of 80%. Therefore, it is necessary to have a sample of, at least, 47 women. The sample calculation was performed using the Winpepi calculator.  The statistical analysis was based on a power of 80% and a significance of 0.05.

The sample consisted of 49 patients with mean age of 57.1 ± 5.4 years. In VNS, the three highest scores were attributed to vaginal dryness, with a median of 8.0 (5.5-10.0), followed by dyspareunia 5.0 (0.0-9.0) and a vaginal burning 1.5 (0.0-8.0). It was evidenced that 95.9% of the sample had sexual dysfunction, indicated by the total FSFI score with a median of 9,1 (4,4-16,3). Genital self-image was positive with a median score of 21.0 (18.2-22.0). The correlation coefficient between these two variables was -0.106 (p-value = 0.474).

The sample consisted mostly of women with sexual dysfunction and positive genital self-image, with no correlation between these two variables. In addition, the most affected domains of the FSFI were orgasm, pain and lubrication, and the main complaints of patients were vaginal dryness, dyspareunia and vaginal burning. Through the literature search, no study was found that correlated sexual function and genital self-image in women with GSM, this being a pioneering research, despite the small sample.

There was no linear association between sexual function and genital self-image in women with Genitourinary Syndrome of Menopause. In addition, the majority of the of the subjects consisted of women with sexual dysfunction, good genital self-image and the most frequent complaint of vaginal dryness.

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