Vulvovaginal atrophy! Say what?? Yes, that’s what it’s actually called by the medical community. The clinical definition is as follows (via The Mayo Clinic): thinning, drying and inflammation of the vaginal walls due to women having less estrogen primarily as a result of menopause. No one would argue that it is a legitimate physical condition, or that it occurs in the overwhelming majority of menopausal and post-menopausal women. Yet women and doctors don’t talk about it. And I don’t blame the concerned parties. Vulvovaginal atrophy—let me cite the acronym so we don’t have to hear this name again, VVA—evokes horror, laughter, outrage, embarrassment and denial among women who have it. We cringe at the thought just as we cringe at the torture scene from Casino Royale, where Le Chiffre repeatedly swats the genitals of James Bond with a thick rope.
Several pharmaceutical companies with remedies at the ready are urging women in TV and magazine promotion to speak with their doctors about VVA. It’s a noble idea. But they are throwing money down the drain because the whole dynamic begs one central question: what are women supposed to say?
It’s a woman’s problem
First, let’s acknowledge that as a condition affecting women, it no doubt falls off the radar of urgent concern commonly reserved for conditions that primarily affect men (Looking at you, ED and Low T). The medical and commercial communities have handily rebranded male ‘impotence’ or ‘sexual inadequacy’ so that conversations can proceed, and options for studied relief pursued. In light of this observation, one scratches one’s head as to why a similarly robust effort has not been successfully undertaken for a condition that affects nearly every woman.
Doctors don’t treat age
One would think that any health-related matter would be fair game for a conversation with a medical professional. This could not be further from the truth. Doctors go to medical school to learn about illness and dysfunction and how to prescribe medicine to fix these things. They are not taught nutrition or chiropracty or acupuncture or exercise regimens or anything other than medical remedies. For the same reason they do not treat weight, they do not treat age: it’s not pathological, it’s normal. People eat too much. People get old. When an ophthalmologist tells you that you are showing signs of macular degeneration, and you ask what you can do, the answer is, “nothing; it’s part of the aging process.” Menopause is a natural part of aging, so doctors don’t bring up the subject.
Let’s try to make it about painful sex
Doctor’s do treat pain, so that is where pharmaceutical companies are spending the bulk of the money in their efforts to stir up a dialogue around the condition and potential medical responses. You do not have to look far to see the attractive, smiling women featured alone in a color photo, telling other women and doctors alike that sex shouldn’t be painful. With the exception of the SMBD segment, who could disagree? Well, the problem is twofold: 1) VVA doesn’t cause painful sex, it causes a cluster of symptoms that are very unpleasant and, sometimes, results in sex that is painful; and 2) believe it or not, painful sex isn’t the number one complaint of women with VVA. So the message is simple and clear, but is it relevant?
A good idea that’s poorly executed
Like any condition that is poorly branded, VVA will never receive the attention and respect it deserves unless better language is coined and adopted by women, healthcare professionals, and the advocacy groups supporting them. Some efforts have been made. The North American Menopause Society (NAMS) and The International Society for the Study of Women’s Sexual Health (ISSWSH), two advocacy groups promoting women’s health, took a shot at rebranding VVA in May 2013 and they came up with GSM: genitourinary syndrome of menopause. Does this seem helpful or less off-putting than VVA? Hardly. NAMS and ISSWSH had the right idea, but they went about it in the wrong way: they never invited the very women who suffer from VVA symptoms to help with the rebranding—an all-too-common error.
Novo Nordisc, promoters of Vagifem, a brand indicated for Atrophic Vaginitis, another terrible variation on VVA, have also tried their hand. They attempt to co-opt existing nomenclature with a promotional message that directs our attention to “the other ED (estrogen deficiency).” While their instincts are correct in identifying a “deficiency” that can simply be supplemented or replaced, their analogy falls short. ED or erectile dysfunction, is a branded condition that is simple and has one specific symptom: the penis cannot achieve rigidity. Not so VVA. Unfortunately, “female sexual dysfunction” does not easily lend itself to such easy, physical measurements. Symptoms of VVA include dryness, inflammation, soreness, itching, urinary incontinence, and urinary urgency among others. Estrogen deficiency is a valiant try, but reduces the issue to its lowest common denominator, thereby making it, um, inadequate.
Best practices for resolving the silence
As a branding expert and friend of many menopausal and post-menopausal women, I find the lack of resolution around this issue disgraceful. Women deserve to be able to talk about their health issues and seek remedies, or not, with the same ease and frequency of men. The only real obstacle to success here is a lack of consensus among the various constituencies on how to brand the condition so that all parties welcome talking about it. This begins and ends with a multi-disciplinary action group comprised of menopausal women, healthcare professionals and advocacy groups. In a single workshop, ideas that are universally effective can be ideated and selected for further research with the key audiences that would most benefit: women and their doctors. Once that is achieved, it becomes a simple matter of announcing it in the very channels that other, less successful efforts have already been fielded, namely, websites, public relations, clinical journals, speakers bureaus and promotion.
Combining the lessons currently learned by existing parties reveals some good ideas. These are:
- Focusing the problem on an estrogen deficiency rather than on the deteriorating genitals of aging women
- Calling it a syndrome—a grouping of related symptoms—which is the case
- And attempting to co-opt existing nomenclature—ED—in an effort to fit into a pattern of terms rather than try to exist outside of it on its own.
Efforts point to a syndrome or deficiency or some such easily understood and de-stigmatized terminology. If all parties wish to solve this matter, then they should join forces rather than try to move the world from their little corner of it.
Let’s hope that the New Year brings a resolution to this important and completely unnecessary scourge of our lovely, wise, aging female population.