Old maid syndrome: where does the term come from and what conditions does it hide?

The term "spinster syndrome" does not appear in the World Health Organization's International Classification of Diseases (ICD-11) or in modern psychiatric classifications. It is not a diagnosis or a medical term, but a cultural stereotype that mistakenly links a woman's health to her marital status or sexual activity. This label discourages prompt treatment for real symptoms and reinforces stigma. [1]

Historically, "spinster" was a term used to describe an unmarried woman; the term has become established in everyday life and literature, but not in clinical practice. Modern guidelines on women's health and mental well-being use precise, neutral terms for conditions (e.g., "genitourinary syndrome of menopause," "genito-pelvic pain/penetration disorder," "depressive disorder," "anxiety disorder")—they make no reference to marital status. [2]

Sexual inactivity is not a disease and does not "cause" gynecological problems in and of itself. However, isolation and chronic loneliness (regardless of marital status) are indeed associated with poorer health outcomes and higher mortality—this is important to recognize and treat as a socio-medical issue, not as a "syndrome." [3]

So, instead of a mythical "syndrome," we're talking about specific, understandable conditions. Below is what most often underlies them and what to do about them according to modern recommendations. [4]

What is usually "meant" by myth: real states

1) Genitourinary syndrome of menopause (GSM)

After estrogen levels drop, some women experience dryness, burning, discomfort, pain during intercourse, and increased urination. This is called GSM—a physiologically understandable, treatable symptom complex that is not affected by marital status. Vaginal moisturizers/lubricants, topical estrogens, DHEA, and selective estrogen receptor modulators (as indicated) can help. [5]

2) Genito-pelvic pain/penetration disorder (GPPPD)

What was previously called "vaginismus/dyspareunia" is now combined in the DSM-5-TR under the diagnosis of Genito-Pelvic Pain/Penetration Disorder: pain with attempted penetration, severe pelvic floor muscle tension, and fear/anticipation of pain. Treatment is multidisciplinary: education and psychoeducation, pelvic floor physical therapy, desensitization, treatment of associated dermatological/inflammatory causes, and, if necessary, cognitive behavioral therapy and trauma work. [6]

3) Mood and anxiety states

Long-term stress, uncertainty, and loneliness increase the risk of depression and anxiety disorders. This isn't a "marital status" issue, but a combination of personal and social factors. Psychotherapy, community/family support, and, if necessary, pharmacotherapy according to clinical guidelines are effective. In large meta-analyses, social isolation and loneliness are associated with higher overall mortality—an additional argument for focusing on prevention and treatment. [7]

4) Chronic gynecological/dermatological causes of pain

Lichen sclerosis, provoked vestibulodynia, chronic vulvovaginitis, endometriosis, pelvic floor muscle hypertonicity, and the consequences of injuries/surgeries are common causes of pain and discomfort, which are sometimes simply dismissed as a mythical "syndrome." What's needed is an examination, accurate diagnosis, and targeted treatment, not moralizing. [8]

How to distinguish a myth from a real problem: scientific diagnostics

The first step is to name the symptom: dryness? Itching? Pain during intercourse? Burning during urination? The name suggests the diagnostic procedure. For GSM, a clinical examination is sufficient; for GPPPD, a collection of complaints, a gentle examination, and an assessment of pain and pelvic floor muscle tone are sufficient; if a dermatosis or infection is suspected, specialized tests are performed. No "labels" in a passport replace a medical diagnosis. [9]

It's important to remember that GPPPD is a clinical diagnosis in the DSM-5-TR with clear criteria for duration and severity. It describes a combination of pain/tension/fear, not a "character" or "morality." This helps guide appropriate interventions—from pelvic floor physical therapy to psychotherapy and treatment of underlying medical conditions. [10]

If genitourinary symptoms are present during menopause, NAMS (North American Menopause Society) recommends a stepwise approach: non-pharmacological topical care (moisturizers/lubricants), then low-dose topical hormonal agents if insufficient; systemic hormonal therapy is considered on a general basis based on indications/contraindications. [11]

At the same time, it's worth assessing psychological well-being and level of social support. If depression, anxiety, or chronic loneliness are pronounced, these are independent treatment goals, where a combination of psychotherapy, lifestyle interventions, and, if necessary, medications can be effective. [12]

What helps: evidence-based treatment strategies

GSM. Regular vaginal moisturizers/lubricants + topical estrogens (suppositories/cream/tablets) or vaginal DHEA; if indicated, osphemifene. This reduces dryness, pain, and dysuria, and improves quality of life; decisions are made in consultation with a physician, taking into account the patient's medical history. [13]

GPPPD/pain on penetration. Trigger education and elimination, pelvic floor physical therapy, gradual desensitization/dilator training, pain catastrophizing, treatment of dermatoses/inflammation, psychotherapy if necessary, targeted pain relief, and sometimes botulinum toxin in specialized centers. The goal is painlessness and restoration of control, not "mandatory" sexual activity. [14]

Mental health and loneliness. Cognitive-behavioral and interpersonal approaches, "social prescriptions" (involvement in groups, volunteering, interest clubs), sleep/exercise/nutrition interventions. This reduces the risks associated with social isolation in large analyses. [15]

Stigma prevention. Correct language and respectful attitudes are part of treatment. We discuss symptoms and goals, rather than "guilt" or "status." This reduces barriers to help-seeking and improves outcomes. [16]

Myths and facts (briefly)

• Myth: “If a woman goes without sex for a long time, it leads to illness.”

Fact: Neither ICD-11 nor clinical guidelines support this thesis. Diseases have specific causes; symptoms and conditions are treated, not “status.” [17]

• Myth: “Pain during intercourse is a sign of ‘character’ or ‘tightness’.”

Fact: This is a medical problem (GPPPD) with well-understood mechanisms and effective therapy. [18]

• Myth: “During menopause, ‘everything inevitably dries up’; there’s no use in helping.”

Fact: There are effective non-drug and drug options recommended by specialist societies.[19]

• Myth: “Loneliness is just a feeling and doesn’t affect your health.”

Fact: Chronic loneliness and social isolation are linked to increased risks of illness and mortality - and it is treatable/preventable.[20]

When to see a doctor (and which one)

Consult a gynecologist if you experience dryness, pain, itching, changes in discharge, or discomfort during intercourse or a gynecological examination; a pelvic floor physiotherapist if you suspect hypertonicity/pain; and a psychotherapist/psychiatrist if you experience severe anxiety/depression, fear of pain, or avoidance behavior. These are normal, work-related issues—not “shameful topics.” [21]

If you don't have any symptoms but are bothered by feelings of isolation, discuss a plan with your family doctor or psychologist to improve your social interactions and habits. This is just as much a preventative measure as monitoring your blood pressure or cholesterol. [22]