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Climacteric : the Journal of the... Apr 2015Our aim was to systematically review published articles for the prevalence of persistent estrogen depletion symptoms among women aged 65+ years. (Review)
Review
OBJECTIVE
Our aim was to systematically review published articles for the prevalence of persistent estrogen depletion symptoms among women aged 65+ years.
METHODS
A systematic literature search of English-language publications was performed using MEDLINE, EMBASE, CINAHL, and PsycINFO. Twenty-three studies that included information on the prevalence of vasomotor and/or urogenital atrophy symptoms among older women (65 + years) met our inclusion criteria. Risk of bias of the included studies was assessed using a risk-of-bias tool explicitly designed for the systematic review of prevalence studies.
RESULTS
The available data suggest that vasomotor symptoms are experienced by a considerable proportion of older women, that symptoms of urogenital atrophy including urinary incontinence are widespread, and that women remain sexually active well into later life. A high degree of variability was observed for the prevalence of estrogen deficiency symptoms for women age 65+ years. Discrepancies in modes of recruitment, sampling procedures, time frames over which symptoms were assessed and use of different and non-validated assessment tools contributed to the inconsistencies across the published studies.
CONCLUSION
Larger and appropriately sampled studies, employing validated questionnaires, are still needed to establish the prevalence of persistent estrogen depletion symptoms in women aged 65+ years.
Topics: Aged; Atrophy; Estrogens; Fecal Incontinence; Female; Female Urogenital Diseases; Hot Flashes; Humans; MEDLINE; Sexual Behavior; Sweating; Urinary Incontinence; Urogenital System; Vagina; Vasomotor System; Vulva
PubMed: 25382674
DOI: 10.3109/13697137.2014.978754 -
Surgical Oncology Dec 2017Vulvar cancer is a rare disease accounting for approximately 5% of female genital tract tumors worldwide. Currently surgery represents the mainstay alone or sometimes,... (Review)
Review
BACKGROUND
Vulvar cancer is a rare disease accounting for approximately 5% of female genital tract tumors worldwide. Currently surgery represents the mainstay alone or sometimes, in combination with chemo-radiotherapy, for locally advanced tumors and recurrent disease. However, significant physical and sexual impairment mostly due to anatomical distortion of external genitalia are a consequence of radical surgical treatment. Postoperative reconstruction after demolitive surgeries improves aesthetic and functional results, guarantees an adequate coverage of large tumors and assures safe surgical margin. The present study aimed to analyze feasibility and complication rates of fascio-cutaneous flap after excision for vulvovaginal malignancies.
METHODS
PubMed (MEDLINE), Web of Science, and CINAHL were searched for records of validated vulvovaginal reconstructive techniques after demolitive surgery for vulvar cancer. All cohorts were rated for quality using a scoring method taking into account the design of the study, the sample size and quality of report of surgical data and complications.
RESULTS
A total of 24 studies met all eligibility criteria for this systematic review. All the studies were realized between 1996 and 2015. The overall sample size was 443 patients. Two major group of flap according to type of movement were identified: Advancement Flap (V-Y Gluteal Fold Flap; Medial Thigh Flap) and Transpositional Flap (Lotus Petal Flap; Gluteal Thigh Flap; Gluteal Fold Flap and Anterolateral Thigh Flap). The overall complications rates reported for advancement (26.7% among 165 patients on 11 series) and transposition flaps (22.3% among 278 patients on 13 series) were comparable.
CONCLUSIONS
A tailored procedure, based on patients' characteristics, size and location of the defect is still the goal of a successful reconstructive surgery. Proper planning of the surgical procedures, knowledge of the different surgical options and technical skills are required in order to obtain reliable and satisfying results.
Topics: Female; Humans; Morbidity; Prognosis; Plastic Surgery Procedures; Surgical Flaps; Vaginal Neoplasms; Vulvar Neoplasms
PubMed: 29113672
DOI: 10.1016/j.suronc.2017.10.002 -
Applied Nursing Research : ANR Oct 2022Identify literature regarding urogenital health and hygiene practices/behaviors of U.S. active-duty service women (ADSW) with attention to environmental conditions;...
AIM
Identify literature regarding urogenital health and hygiene practices/behaviors of U.S. active-duty service women (ADSW) with attention to environmental conditions; access to water, sanitation, and hygiene (WASH) resources in austere environments. Synthesize relationships among the 3-dimensions and 5-levels of the Integrated Behavioral Model for Water, Sanitation, and Hygiene (IBM-WASH).
BACKGROUND
ADSW face sex-specific urogenital health challenges due to decreased access to WASH resources in austere environments, leading to increased risk for urogenital infection-related outcomes (urinary tract infections, vulvovaginal candidiasis, and bacterial vaginosis). During military conflicts in Afghanistan and Iraq, urogenital infections in ADSW were reported as one of the top five medical encounters, and one of the top seven reasons for medical evacuation.
METHODS
A systematic review was performed in MEDLINE, CINAHL, Embase, and ClinicalTrials.gov databases, between January 2007-November 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a reporting guideline. Eligible literature was evaluated utilizing the Johns Hopkins Research Evidence Appraisal Tool. WASH interactions were mapped using the IBM-WASH interactive matrix.
RESULTS
Evidence gaps include shifting focus from "deployment" to environmental austerity; lack of training/education; shifting male-centric culture; and innovative technologies for safety/security.
CONCLUSIONS
The IBM-WASH framework allowed for quantification and interpretation of complex interactions occurring in real world austere environments. Some could be overcome individually, but in aggregate they lead to progressive urogenital conditions and potential mission failure. Prevention, diagnosis, and treatment can mitigate disease sequelae. Preventive knowledge and access to innovative technologies designed for ease and private use are critical to preserve operational readiness.
Topics: Female; Humans; Hygiene; Male; Sanitation; Water; Women's Health
PubMed: 36116869
DOI: 10.1016/j.apnr.2022.151620 -
International Journal of Clinical... Jul 2021Bacterial vaginosis is a frequent source of vaginal infection among reproductive-aged women. Astodrimer gel is a novel drug which demonstrated favourable outcomes for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Bacterial vaginosis is a frequent source of vaginal infection among reproductive-aged women. Astodrimer gel is a novel drug which demonstrated favourable outcomes for treatment of patients with bacterial vaginosis.
AIM
We attempted to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) which examined the efficacy and safety of astodrimer gel in patients with bacterial vaginosis.
METHODS
We searched four databases from inception to August 15, 2020, using relevant keywords. We identified all RCTs which surveyed the efficacy and safety of astodrimer gel in treating patients with bacterial vaginosis. We appraised the quality of the included RCTs using the Cochrane risk of bias assessment tool. We pooled dichotomous outcomes as numbers and totals and reported them as risk ratios (RR) with 95% confidence intervals (95% CI) under random- or fixed-effects meta-analysis models depending on heterogeneity.
RESULTS
Three eligible studies comprising four independent RCTs and 1165 patients were identified (614 and 551 patients received astodrimer gel and placebo, respectively). For efficacy outcomes (n = 320 astodrimer gel versus n = 260 placebo), astodrimer gel was significantly superior to placebo for all pooled efficacy outcomes, including clinical cure rate (at 9-12 and 21-30 days), microbiological Nugent cure rate (at 9-12 and 21-30 days), patient self-reported absence of vaginal odor/discharge (at 9-12 and 21-30 days), resolution of Amsel criteria (at 9-12 days) and percentage of patients who did not receive rescue therapy during study. With respect to safety outcomes (n = 614 astodrimer gel versus n = 551 placebo), astodrimer gel demonstrated equal tolerability to placebo for all pooled safety endpoints, expect unfavourably for vulvovaginal candidiasis and treatment-related vulvovaginal candidiasis.
CONCLUSIONS
Astodrimer gel is effective in treating bacterial vaginosis and corroborated by clinical (Amsel criteria) and microbiological (Nugent score) measurements as well as patient-reported symptoms. Moreover, astodrimer gel is largely safe and associated with marginal rate of vulvovaginal candidiasis.
Topics: Adult; Female; Humans; Randomized Controlled Trials as Topic; Vaginosis, Bacterial
PubMed: 33749959
DOI: 10.1111/ijcp.14165 -
International Journal of Environmental... Apr 2021Radiotherapy, as a method of treatment of cervical and uterine cancers, may induce severe late-onset vaginal side effects. Unfortunately, little evidence on the... (Review)
Review
BACKGROUND
Radiotherapy, as a method of treatment of cervical and uterine cancers, may induce severe late-onset vaginal side effects. Unfortunately, little evidence on the management of adverse effects has been presented. This study aimed to evaluate the available interventions which reduce symptoms of vaginitis and vaginal atrophy by improving dyspareunia, mucosal inflammation, vaginal pH and vaginal dryness in women who have undergone brachytherapy or radiotherapy due to uterine or cervical malignancies.
MATERIALS AND METHODS
A comprehensive literature search was performed following PRISMA guidelines. The systematic search was conducted using electronic databases, namely Scopus, Web of Science and PubMed, between October and November 2020 to identify randomized controlled trials (RCT) and, prospective randomized studies (PRS).
RESULTS
The analyzed population consists of 376 patients with uterine or cervical cancer, treated with hyaluronic acid, vitamin A, vitamin E, alpha-tocopherol acetate and dienestrol. Intervention with HA along with vitamin A and vitamin E revealed advantage in endpoints such as reduced dyspareunia, vaginal mucosal inflammation, vaginal dryness, bleeding, fibrosis and cellular atypia. Administration of alpha-tocopherol acetate reduced vaginal mucosal inflammation and improved vaginal acanthosis, whereas dienestrol resulted in reduced dyspareunia, vaginal caliber and bleeding.
CONCLUSIONS
Vaginal suppositories were found to be clinically effective at the management of late-onset vulvovaginal side effects after radiotherapy.
Topics: Atrophy; Brachytherapy; Dyspareunia; Female; Humans; Vaginal Diseases; Vaginitis
PubMed: 33918070
DOI: 10.3390/ijerph18083932 -
Maturitas Feb 2022Genitourinary syndrome of menopause (GSM) can have a great impact on the quality of life (QOL), and affects between 53.8% and 90% of postmenopausal women. The literature...
BACKGROUND
Genitourinary syndrome of menopause (GSM) can have a great impact on the quality of life (QOL), and affects between 53.8% and 90% of postmenopausal women. The literature suggests that vaginal laser therapy could be an effective treatment for GSM symptoms, but its efficacy and safety have not been established and international societies do not endorse its use. Despite that, there has been an increase in the use of vaginal laser therapy globally over the last decade.
OBJECTIVE
The objective of this review is to evaluate the literature which assesses the efficacy and safety of the vaginal laser therapy in the treatment of GSM.
METHODS
A comprehensive literature search was conducted electronically using Embase and PubMed to retrieve studies assessing evidence for the efficacy and safety of vaginal laser therapy for GSM or vulvovaginal atrophy up to June 2021.
RESULTS
A total of 64 studies were finally included in the review. There were 10 controlled intervention studies, 7 observational cohort and cross-sectional studies and 47 before-after studies without a control group.
CONCLUSION
Vaginal laser seems to improve scores on the Visual Analogue Scale (VAS), Female Sexual Function Index (FSFI) and Vaginal Health Index (VHI) in GSM over the short term. Safety outcomes are underreported and short-term. Further well-designed clinical trials with sham-laser control groups and evaluating objective variables are needed to provide the best evidence on efficacy.
Topics: Atrophy; Cross-Sectional Studies; Female; Humans; Laser Therapy; Lasers, Gas; Menopause; Quality of Life; Vagina
PubMed: 34217581
DOI: 10.1016/j.maturitas.2021.06.005 -
Archives of Gynecology and Obstetrics Jun 2024Tumors affecting the female genital tract and their treatments have the potential to induce adverse modifications in vaginal health and impact personal aspects of... (Review)
Review
PURPOSE
Tumors affecting the female genital tract and their treatments have the potential to induce adverse modifications in vaginal health and impact personal aspects of patient's lives. Vulvovaginal atrophy is one of the morphological changes observed in individuals with a history of gynecological cancer, influenced both by the biological environment of tumors and the main therapeutic modalities employed. Therefore, the purpose of this study was to identify approaches to treat vulvovaginal atrophy while assessing the impact on the emotional and sexual health of women diagnosed with gynecological cancers.
METHODS
To achieve this goal, a systematic review was conducted following the methodological guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases used for literature research were PubMed and Web of Science.
RESULTS
Initially, 886 articles were obtained. After eliminating duplicates and applying inclusion/exclusion criteria, seven articles were selected for analysis. The period of highest publication activity spanned from 2017 to 2020, with the majority conducted in Italy. Five treatment modalities were identified and categorized as vaginal suppository, oral medication, surgical procedure, CO2 laser therapy, and vaginal dilator. Twenty-four outcomes related to vaginal health and 30 outcomes related to overall, sexual, and emotional quality of life were analyzed.
CONCLUSION
In general, all interventions demonstrated the ability to improve vaginal health or, at the very least, the sexual health of patients. Thus, despite limitations, all treatments have the potential to address vulvovaginal atrophy in patients with a history of gynecological cancer.
PubMed: 38898186
DOI: 10.1007/s00404-024-07552-9 -
International Journal of Reproductive... Dec 2023Management for pelvic floor disorders needs to be improved. Platelet-rich plasma (PRP) offers an innovative treatment in general medical care to promote cell... (Review)
Review
BACKGROUND
Management for pelvic floor disorders needs to be improved. Platelet-rich plasma (PRP) offers an innovative treatment in general medical care to promote cell regeneration.
OBJECTIVE
This review aims to investigate the role of PRP in pelvic floor disorders.
MATERIALS AND METHODS
6 international databases were accessed using several keywords namely PubMed, Science Direct, Cochrane Library, ProQuest, Google Scholar, and Scopus. The inclusion criteria were articles written in English, published in 10-yr period from 2012 until 2022, and investigated the relevant topic. This systematic review followed PRISMA guideline.
RESULTS
644 articles were found in several databases and 15 articles met the criteria. Management for pelvic floor disorders needs to be improved, but there are still many challenges, such as less effective treatments, risk of recurrence, and postoperative wound healing. PRP offers an innovative treatment in general medical care to promote cell regeneration. A total of 644 articles from the database were found, but 15 studies met the criteria. A total of 600 women with various pelvic floor disorders treated with PRP were analyzed. PRP positively impacts female sexual dysfunction, perineal trauma, vulvovaginal atrophy, stress urinary incontinence, vesicovaginal fistula, perineal rupture, and pelvic organ prolapse. Dosages, preparation techniques, injection techniques, and additive materials are varied. Most studies do not report side effects from the therapy, but the urinary disorder complaints must be paid attention to.
CONCLUSION
PRP can be used to manage pelvic floor disorders. Future studies should clarify and standardize the dose in each case and how to make PRP produce the best results.
PubMed: 38370486
DOI: 10.18502/ijrm.v21i12.15034 -
International Urogynecology Journal May 2017Interest in laser therapy as a nonhormonal option for the treatment of genitourinary syndrome of menopause (GSM) has increased. We conducted a systematic review of the... (Review)
Review
Interest in laser therapy as a nonhormonal option for the treatment of genitourinary syndrome of menopause (GSM) has increased. We conducted a systematic review of the use of laser therapy for the relief of GSM symptoms. Six electronic databases were searched and conference abstracts were searched manually from the introduction of laser therapy to the present date. The keywords used were: "genitourinary syndrome", "vulvovaginal atrophy", "postmenopausal symptoms", "laser therapy" and "fractional laser treatment". Of the 165 articles identified in the search, none was a randomized controlled trial. As a result, we included three observational studies without a control group and one case-control study that met our inclusion criteria. The total number of women included in the four studies was 220. The collated data suggest that laser therapy may be valuable as a nonhormonal therapeutic modality in the management of GSM. Higher quality of evidence from randomized controlled trials is required to establish the efficacy of laser treatment in the management of GSM.
Topics: Atrophy; Case-Control Studies; Female; Female Urogenital Diseases; Humans; Laser Therapy; Lasers, Gas; Menopause; Observational Studies as Topic; Syndrome; Treatment Outcome; Vagina; Vulva
PubMed: 28154914
DOI: 10.1007/s00192-017-3282-y -
The Journal of International Medical... May 2022The appearance of severe vulvovaginal varicosities (VVs) is challenging in pregnancy. The management of VVs may require a multidisciplinary approach, including...
The appearance of severe vulvovaginal varicosities (VVs) is challenging in pregnancy. The management of VVs may require a multidisciplinary approach, including radiologists, vascular surgeons, and obstetricians. We report a rare case of enormous VVs and pubic varicosities and summarize similar cases in the literature. A woman in her 20s with a full-term pregnancy visited our hospital for severe VVs and pubic varicosities. She had been in a spoke maternity unit where a cesarean section was scheduled. After a multidisciplinary evaluation, we offered her the chance to have a vaginal delivery (VD). The woman had an uneventful VD, and VVs disappeared after 40 days. A comprehensive literature search on this topic showed 11 cases of VVs during pregnancy (five VDs and six cesarean sections). The presence of VVs represented the indication for surgery in 70% of cases. Severe complications occurred in 20% of VDs vs. 50% of CSs. In pregnant women with VVs, the risk-benefit ratio suggests a chance of having VD.
Topics: Cesarean Section; Delivery, Obstetric; Female; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Vaginal Diseases; Varicose Veins; Vulvar Diseases; Young Adult
PubMed: 35635336
DOI: 10.1177/03000605221097764