(005) SYSTEMATIC REVIEW OF GENITOURINARY SYNDROME OF LACTATION: AN UNDERRECOGNIZED CONDITION IN POSTPARTUM HEALTH

Abstract Introduction The postpartum period presents substantial physiological changes, particularly during lactation, when the body is in a hyperprolactinaemia and hypoestrogenic state. This hormonal shift can lead to symptoms such as vaginal dryness, dyspareunia, urinary incontinence, and changes in sexual function, collectively referred to as the “Genitourinary Syndrome of Lactation” (GSL). Despite the prevalence of GSL, it remains underrecognized and thus underdiagnosed, potentially impacting maternal well-being and quality of life. Objective This systematic review seeks to consolidate the best available evidence on the prevalence of GSL and its associated symptoms, including vaginal dryness, vaginal atrophy, urinary issues, dyspareunia, and sexual dysfunction among postpartum lactating individuals. By assessing the prevalence and symptomatology of GSL, we aim to address its impact on postpartum health to guide potential management strategies. Methods The systematic review adhered to PRISMA guidelines. A comprehensive search of PubMed, Google Scholar, Scopus, ScienceDirect, and Cochrane Library databases was conducted through April 30, 2024. Search terms included combinations of “postpartum breastfeeding” and “genitourinary symptoms.” Eligibility was limited to studies on postpartum individuals assigned female at birth (AFAB) without congenital vulvar abnormalities, and in English. Studies including participants on exogenous hormone therapy, or with diagnosed hormonal disorders were excluded. Screening involved two independent reviewers, with conflicts resolved by a third. Data on patient demographics, study design, and GSL symptom presentation were extracted and analysed using R software. Study quality was assessed using the OCEBM Levels of Evidence and the JBI Critical Appraisal Checklist. Results Of the 1560 studies initially screened, 68 met inclusion criteria. This review highlighted a spectrum of GSL symptoms impacting pelvic floor integrity, vaginal health, and urinary function, with lactation-associated hypoestrogenism linked to decreased vaginal muscle tone, increased urinary urgency, and reduced sexual satisfaction. Among lactating individuals, the prevalence of vaginal atrophy and dryness was 63.9% and 53.6%, respectively. Meta-analyses revealed pooled prevalence estimates for dyspareunia at 3, 6, and 12 months postpartum to be 60.0%, 39.7%, and 28.5%, respectively. Additionally, the pooled odds ratios for dyspareunia at 3, 6, and 12 months postpartum among lactating individuals versus controls were 2.33, 2.24, and 1.45, respectively. The pooled mean Female Sexual Function Index (FSFI) score was found to be 21.5 (threshold for sexual dysfunction <26). Conclusions This systematic review highlights the significant impact of lactation-induced hypoestrogenism on genitourinary health. Understanding and clarifying GSL enhances clarity and precision in diagnosis and improves our understanding, management, and effective addressing of the condition, benefiting both healthcare providers and patients. Given the high burden and potential for long-term sequelae, further studies are warranted to develop standardized diagnostic criteria and treatment guidelines for GSL. Enhanced awareness and improved screening can lead to better identification and management of GSL, ultimately supporting postpartum women’s health and well-being. Disclosure No.