Missed Opportunities in GSM Care: Specialty Differences in Vaginal Estrogen Knowledge and Prescribing

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVES: Topical vaginal estrogen is a well-established, safe, and effective therapy for Genitourinary Syndrome of Menopause (GSM), vulvovaginal atrophy (VVA), and recurrent urinary tract infections (rUTIs). It relieves urogenital symptoms with minimal systemic absorption and strong safety data. Despite guideline support, misconceptions persist that limit use. As urologists increasingly manage women with GSM-related symptoms, evaluating clinician knowledge and prescribing behaviors is critical to optimizing patient care. This study evaluated clinician knowledge, perceptions, and prescribing patterns within a large integrated health system. METHODS: A cross-sectional, observational study was conducted using an anonymous electronic Qualtrics survey distributed in December 2024 across Michigan’s largest nonprofit health system. The survey assessed clinician familiarity with GSM/VVA symptoms, safety perceptions, and prescribing and referral practices. Inclusion criteria required active outpatient practice. RESULTS: Of 366 responses, 258 met inclusion criteria. Awareness of GSM/VVA symptoms and treatment indications varied by specialty. Family Medicine (5.6%) and OB/GYN (5.3%) demonstrated the highest complete symptom recognition, while Urology reported the most comprehensive understanding of appropriate indications (15.4%) and safe use in patients with comorbidities (38.5%). Commonly recognized indications included vaginal dryness, burning, itching, soreness, and irritation (89.4%), followed by dyspareunia (81.9%). Eight percent were unaware that vaginal estrogen treats GSM/VVA. Although clinical evidence supports its safety, misconceptions persisted: 7.0% cited cancer risk, 6.6% thrombosis, and 4.6% cardiovascular concerns. Cost was perceived as a barrier by 37.9%. Prescribing frequency differed significantly by specialty, with OB/GYN (96%) and urogynecology/reconstructive pelvic surgery (URPS) clinicians (86.9%) reporting the highest use. However, 58.7% of all respondents did not routinely refer patients for GSM/VVA care; of those who did, 81.3% referred to OB/GYN. Regional variation was not significant. CONCLUSIONS: Despite strong evidence supporting local vaginal estrogen, specialty-based disparities in knowledge and utilization persist. Urologists demonstrated strong understanding of safety and indications yet remain underrepresented among frequent prescribers. Targeted education and multidisciplinary collaboration could expand access to evidence-based GSM management, positioning urology as a leading specialty in optimizing women’s urogenital health.

Volume

215

Issue

5S

First Page

e1357

Last Page

e1357

Comments

American Urological Association Annual Meeting, May 15-18, 2026, Washington, DC

DOI

10.1097/01.JU.0001191692.83096.0e.06

Link to Full Text

Share

COinS