Hiroaki Ota: GSM Femtech and Femcare in the Era of 100-Year Lifespans — Toward a New Normal

Japan is expected to be the first country to enter the "era of 100-year lifespans." Some views suggest that in 50 years, one in 10 people will reach age 100, and in 90 years, one in two will reach age 100, with the average life expectancy reaching 107 (The Asahi Shimbun GLOBE+, January 7, 2018 issue). Among the most recent supercentenarian population, 88.4% are women, showing a remarkable longevity for females. However, women's healthy life expectancy is not as long as their biological lifespan; their period of ill health is longer than that of men, posing a risk of living a long life in poor health.

As the elderly population increases, diseases that could be called "longevity risks" are what the WHO advocates as "Non-Communicable Diseases (NCDs)." Representative examples include cancer, diabetes, cardiovascular disease, and respiratory disease. These are thought to involve interactions between genetic predisposition and environmental factors. They increase with age, have long asymptomatic periods, and tend to become chronic or progressive over time. Therefore, preemptive medicine is required. Preemptive medicine is a new mission in geriatric care that involves diagnosing or predicting diseases with a high probability during the pre-onset stage—before clinical findings or diagnostic criteria are finalized—and performing therapeutic interventions to prevent or delay the onset.

Meanwhile, Femtech is an initiative that aims to solve women's health issues—the health issues of approximately half the total population—by utilizing new technologies. Since the 2010s, overseas themes have included improving menstrual pain, predicting menstrual cycles, improving QOL during pregnancy, infertility measures, improving menopausal disorders, sexual health, and diseases specific to women. These include items that support sensuality care to achieve a "sensual life," such as delicate zone care items, sanitary items, vaginal training goods, and pleasure tech.

This is a field currently attracting attention in Japan, with the market predicted to reach 2 trillion yen by 2025. Items that do not involve digital technology are called "Femcare." As health issues for elderly women, osteoporosis and dementia—both caused by the decline of the female hormone estrogen—are the two major NCDs for women, and are prime examples of diseases requiring medical Femtech and Femcare.

Furthermore, since 2014, the biggest topic in the women's medical field has been the response to GSM (Genitourinary Syndrome of Menopause), which is triggered by a decline in sex hormones (not just female hormones). GSM involves a combination of functional symptoms related to genital symptoms and lower urinary tract symptoms (frequent urination, urinary incontinence), and also presents "dyspareunia" (painful intercourse), which is a sexual functional symptom. These symptoms are often a broad syndrome of overlapping conditions rather than occurring in isolation, requiring comprehensive Femtech and Femcare that can address them.

In a nationwide web survey we conducted of 10,000 people aged 40 to 90, including approximately 20% premenopausal women, the prevalence of symptoms reached 45%, revealing that these are not necessarily symptoms limited to the elderly. Japan's most recent female population is 64.6 million, of which approximately 41.45 million are aged 40 or older. If 45% of them are symptomatic, it is estimated that the number of people with GSM symptoms in Japan exceeds a massive 18.65 million. In other words, among NCDs, GSM lasts for the longest period—from age 40 through the end of life—and has a broad impact on daily functioning, health, QOL, and sexual function.

From the above, it is clear that GSM is a primary common disease among women's NCDs, and preemptive medicine should be considered. Therefore, it is also important to provide guidance on improving self-care in the living environment, such as keeping the GSM area clean and avoiding irritant stimuli to the skin and mucous membranes from urine or body fluids. This serves as the first-line of prevention and falls under preemptive medicine.

GSM is difficult to talk about, and while people hesitate to seek medical attention, the condition progresses and health risks increase. Moreover, as shown by our web survey, there are few specialists familiar with this disease. Even when patients finally seek help, underdiagnosis and undertreatment mean they are not connected to effective therapy. This is the current situation common not only in Japan, which is a latecomer in GSM clinical practice, but also in countries advanced in GSM care.

As a mission for gynecologists and urologists primarily involved in GSM care, the first step is to educate women that it is possible to live comfortably by avoiding illness and improving their condition through appropriate prevention and treatment. The next mission is to provide multifaceted and specialized interventions, including Femtech suited to the pathology, for GSM treatment as necessary.

In both the medical and industrial worlds, the need to address GSM by pushing past the "Vaginal Taboo" is increasing at the same time. Under these circumstances, with the aim of realizing a healthy and long-lived society, I established the GSM Research Group in 2019 as the representative organizer. This serves as a coexistence of women's medicine with Femtech and Femcare, intended as a starting point to contribute even slightly to the vitality of Japanese women through the presentation of new ideas and results.