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Clinical Breast Cancer Aug 2019Genitourinary syndrome of menopause (GSM) is caused by hypo-estrogenism, resulting in vaginal dryness, pain, dyspareunia, and urinary tract infection. It is more severe... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Genitourinary syndrome of menopause (GSM) is caused by hypo-estrogenism, resulting in vaginal dryness, pain, dyspareunia, and urinary tract infection. It is more severe and common in breast cancer (BC) survivors owing to the severity of induced menopause following treatment (ie, chemotherapy, GnRH agonists/anti-estrogen therapy). It has a detrimental effect on quality of life. The gold standard therapy is topical estrogen, which is highly effective; however, it is contraindicated in patients with BC owing to concerns with recurrence. Recently, vaginal laser therapy has been used to restore vaginal mucosal thickness, lubrication, and elasticity with good effect in menopausal women with GSM. The aim of this study is to assess the impact of vaginal laser therapy on BC-associated GSM.
MATERIALS AND METHODS
This study is a systematic review and meta-analysis.
RESULTS
A total of 48 papers were identified, revealing 10 observational studies of GSM symptoms before and after vaginal laser therapy with no randomized trials. Vaginal laser was effective in treating GSM in BC survivors with improvement in the Vaginal Health Index and the Visual Analogue Scale score for dyspareunia and vaginal dryness, sexual function, and overall satisfaction in the short term with minimal adverse events.
CONCLUSION
Vaginal laser may be effective in treating GSM in BC survivors in the short term, but there are no long-term data on safety and efficacy. More research is needed looking at longer term follow-up, health economic costs, and sub-group analysis as well as the complex interplay between GSM and the other negative impacts of BC therapy on intimate relationships.
Topics: Breast Neoplasms; Cancer Survivors; Female; Female Urogenital Diseases; Humans; Laser Therapy; Menopause; Prognosis; Syndrome
PubMed: 31227415
DOI: 10.1016/j.clbc.2019.04.007 -
European Journal of Obstetrics,... Oct 2018Genitourinary syndrome of menopause (GSM) increases the probability of female sexual dysfunction (FSD). The aim of the current study is to systematically assess data... (Meta-Analysis)
Meta-Analysis
Efficacy of vaginal therapies alternative to vaginal estrogens on sexual function and orgasm of menopausal women: A systematic review and meta-analysis of randomized controlled trials.
Genitourinary syndrome of menopause (GSM) increases the probability of female sexual dysfunction (FSD). The aim of the current study is to systematically assess data regarding sexual function and use of vaginal therapies, alternative to vaginal estrogens (VE), in menopausal women with GSM. PubMed, Scopus and Cochrane Library were searched (May-September 2017) using combination keywords: "dyspareunia and vaginal therapy", "sexual function and vaginal therapy", "orgasm and vaginal therapy", "vaginal atrophy" and "genitourinary syndrome of menopause". Eligible studies were RCTs focusing on the use of vaginal therapies, alternative to VE, in menopausal women. These studies were written in English language and published in peer-reviewed journals with impact factor. Assessment of risk of bias was performed using the Cochrane Risk of Bias Tool. Outcomes involved dyspareunia, vaginal dryness, orgasm and all parameters of sexual function. Twenty-nine RCTs including 3689 menopausal women, were included. Vaginal therapies, alternative to VE included non-hormonal (vaginal laser, lubricants/moisturizers, phytoestrogens and lidocaine) and hormonal ones (Dehyadroapiandrosterone (DHEA), testosterone and oxytocin). Dyspareunia and/or vaginal dryness were assessed in 72% of the articles, while the FSD and orgasm in 45% and 28% of articles, respectively. Dyspareunia and vaginal dryness improved in all relevant studies. Sexuality scores of lubricants were inferior to estrogens [3 studies, n = 138, standardized mean difference (smd) -0.64, (95%CI -1.1, -0.2)]. Orgasm domain was the same for the DHEA 0.5% and placebo (2 studies, n = 663, smd 1.29 (95% -0.47, 3.05), I:90%). Sexual satisfaction and sexuality score were the same when testosterone was compared or added to estrogen therapy (2 studies, n = 99, smd 0.16 (95%CI-0.23,0.56), I:12% and 2 studies (n = 87), smd 0.20 (95%CI-0.23,0.62), I:0%, respectively. Available data are not adequate to provide counseling by the physicians in menopausal women regarding the efficacy of vaginal therapies as an alternative to estrogens, on all parameters of sexual function.
Topics: Female; Humans; Menopause; Randomized Controlled Trials as Topic; Sexual Dysfunction, Physiological; Vaginal Diseases
PubMed: 30103082
DOI: 10.1016/j.ejogrb.2018.08.008 -
Journal of Menopausal Medicine Dec 2019Menopause is associated with the onset of climacteric symptoms due to low estradiol levels, which may cause insufficient maturation of the vaginal mucosa. Vitamin D may... (Review)
Review
Menopause is associated with the onset of climacteric symptoms due to low estradiol levels, which may cause insufficient maturation of the vaginal mucosa. Vitamin D may regulate the growth and differentiation of cells that are adversely affected due to low estradiol levels, thereby restoring vaginal health. The objective of this systematic review, the first on this subject, was to investigate the effect of vitamin D on the vaginal health of menopausal women. PubMed, Embase, Scopus, Web of Science, and Google Scholar databases and reference lists of hand-searched articles were searched for published studies from February 2000 to November 2018. The selection criteria were as follows: randomized or quasi-randomized trials that compared the effects of vitamin D or related compounds, alone or with calcium, on vaginal health (growth and differentiation of epithelial cells, dryness, acidity [pH]) outcomes in menopausal women. The methodological quality of these studies was examined using the Cochrane tool checklist by two independent investigators, following which the data were extracted. Of six examined studies, two showed that vitamin D administration improved the growth and differentiation of vaginal epithelial cells, improved vaginal pH, and decreased vaginal dryness in menopausal women. Although the level of evidence for the effects of vitamin D on vaginal health is low in our study, we concluded that vitamin D may improve the vaginal health of women, especially during menopause.
PubMed: 32307935
DOI: 10.6118/jmm.19194 -
Maturitas Sep 2017This study aimed to identify and then synthesize all available data regarding the efficacy of laser therapy for postmenopausal women with genitourinary syndrome of... (Meta-Analysis)
Meta-Analysis Review
This study aimed to identify and then synthesize all available data regarding the efficacy of laser therapy for postmenopausal women with genitourinary syndrome of menopause (GSM) with/without urinary incontinence (UI). PubMed, Scopus, Web of Science, Cochrane Library and ClinicalTrials.gov were searched in October 2016. The keywords were "laser genitourinary syndrome of menopause", "laser vulvovaginal atrophy", "laser vaginal atrophy" and "laser women incontinence". Quality of reporting and risk of bias of the included studies were assessed according to STROBE and MINORs checklists, respectively. Quality of the body of evidence was evaluated with the GRADE approach. Fourteen studies involving 542 participants were included in this systematic review and meta-analysis. All GSM symptoms (dryness/dyspareunia/itching/burning/dysuria/urgency/frequency) and UI decreased significantly and consistently in all available publications. The pooled mean differences for the various symptoms were: dryness -5.5(95%CI:-6.7,-4.4;7studies;I:0%), dyspareunia -5.6(95%CI:-6.8,-4.5;7 studies;I:0%), itching -4(95%CI:-5.7,-2.2;6 studies;I:79%), burning -3.9(95%CI:-5.9,-2;6 studies;I:87%), dysuria -2.9(95%CI:-5.1,-0.7;4 studies;I:90%) and UI -4.9(95%CI:-6.4,-3.4;2 studies;I:0%). Because urgency/frequency was assessed by different methodologies the data could not be meta-analyzed. Furthermore, KHQ, UDI-6, MCS12/PCS12, FSFI, overall sexual satisfaction and measurements of the effect of laser therapy on the local pathophysiology improved significantly. In conclusion, laser therapy for postmenopausal women with GSM appears promising. It may reduce symptom severity, improve quality of life of postmenopausal women and restore the vaginal mucosa to premenopausal status. However, the quality of the body of evidence is "low" or "very low" and, thus, evidence-based modification of current clinical practice cannot be suggested.
Topics: Female; Genital Diseases, Female; Humans; Laser Therapy; Menopause; Syndrome; Urologic Diseases
PubMed: 28778337
DOI: 10.1016/j.maturitas.2017.06.029 -
JNCI Cancer Spectrum Oct 2023Sexual health outcomes (SHO), which entail the physical, emotional, mental, and social impacts, are an important consideration for adolescent and young adults (AYA, ages... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sexual health outcomes (SHO), which entail the physical, emotional, mental, and social impacts, are an important consideration for adolescent and young adults (AYA, ages 15-39) affected by cancer. The objective of this systematic review and meta-analysis is to summarize the current literature and evaluate AYA cancer impact on SHO.
METHODS
EMBASE and MEDLINE were searched from January 1, 2000 to September 28, 2022 to identify epidemiologic studies that used an analytic observational design, included individuals with AYA cancer and non-cancer control participants, and evaluated SHO. Odds ratios and prevalence ratios were calculated; random effects models were used to obtain pooled measures where possible.
RESULTS
Of 2621 articles, 8 were included that investigated 23 SHO in 9038 AYA cancer patients. Based on the sexual response cycle, outcomes were categorized as those occurring among males (desire = 1, arousal = 1, orgasm = 4, other = 3) and females (desire = 2, arousal = 1, orgasm = 2, pain = 6, other = 3). It was feasible to conduct meta-analysis for 3 female SHO and 5 male SHO. There were associations between AYA cancer and 3 SHO: vaginal dryness (pooled odds ratio = 3.94; 95% confidence interval (CI) = 2.02 to 7.70), ejaculatory dysfunction (pooled odds ratio = 3.66; 95% CI = 2.20 to 6.08), and testosterone level (pooled mean difference = -2.56 nmol/liter; 95% CI = -3.46 to -1.66; P = .00001).
CONCLUSION
This study found increased ejaculatory dysfunction and reduced testosterone levels in male AYA cancer patients and increased vaginal dryness in female AYA cancer patients, highlighting the need for sexual health resources in this population.
Topics: Humans; Male; Female; Adolescent; Young Adult; Sexual Behavior; Orgasm; Neoplasms; Testosterone; Outcome Assessment, Health Care
PubMed: 37878813
DOI: 10.1093/jncics/pkad087 -
International Journal of Gynecological... Sep 2014Quality of life (QoL) and sexual health have become increasingly important in cervical cancer survivors (CCSs). The aims of this review were to summarize research... (Review)
Review
OBJECTIVES
Quality of life (QoL) and sexual health have become increasingly important in cervical cancer survivors (CCSs). The aims of this review were to summarize research findings of QoL and sexual function in CCSs after treatment on the basis of self-reported questionnaires and to update the current knowledge of overall QoL and sexual function in CCSs.
METHODS
Studies from electronic database between May 1966 and May 2013 were rated on their internal validity as methodological assessment. Thirty-two studies were included, wherein 15 studies had a relatively good methodology.
RESULTS
Anorectal function, urinary symptoms, and lymphedema were commonly reported as physical symptoms. As to psychosocial domains, the studies illustrated that anxiety decreased with age, whereas depression generally increased with age. Sexual function was involved in most of the studies. Vaginal dryness, dyspareunia, short vagina, and sexual dissatisfaction were prominent issues of sexual dysfunction and vaginal changes in CCSs. In terms of treatment modality, radiotherapy was thought to be associated with worse QoL and sexual function in CCSs.
CONCLUSIONS
The studies showed that QoL and sexual function in CCSs were compromised compared with the general population to different extents. Quality of life and sexual function should be paid with more attention in patients with cervical cancer after treatment.
Topics: Anxiety Disorders; Depressive Disorder; Female; Humans; Quality of Life; Sexual Dysfunction, Physiological; Sexuality; Surveys and Questionnaires; Survivors; Uterine Cervical Neoplasms
PubMed: 25033255
DOI: 10.1097/IGC.0000000000000207 -
Climacteric : the Journal of the... Aug 2019The objective of this review is to provide an overview of existing and evolving methods of assessing symptomatic vulvar, vaginal, and lower urinary tract atrophy A...
The objective of this review is to provide an overview of existing and evolving methods of assessing symptomatic vulvar, vaginal, and lower urinary tract atrophy A systematic literature search was carried out on MEDLINE and Embase in order to identify studies on diagnostic instruments for vulvar, vaginal, and lower urinary tract atrophy, as well as new possibilities allowing for an improved diagnostic future. Measurement of the most bothersome symptoms, especially dyspareunia and vaginal dryness, is possibly the most useful parameter in clinical practice, even though it is a subjective measurement. Regarding objective result measurements, the two main parameters to be studied are the vaginal maturation index and vaginal pH measurement. In addition, clinical exploration has value both with the vaginal health index and with the vulvar health index. Other research tools are arising, such as a broader knowledge of the vaginal lamina propria elements, the measurement of vaginal distension, and the possibilities of having vaginal tissue 'on a chip'. Gynecologists can make a diagnosis based on the patient's symptoms and a thorough physical examination. However, in cases in which you want to be sure of the diagnosis, and when you want to evaluate and compare treatment options, we need to assess the associated symptoms, vaginal maturation index, and vaginal pH with a clinical estimation by the physician. However, there is an increasing need for new objective parameters helping in the evaluation process.
Topics: Atrophy; Female; Humans; Menopause; Urinary Tract; Vagina; Vulva
PubMed: 31157569
DOI: 10.1080/13697137.2019.1600499 -
Nutrients Jun 2021Colostrum is the first secretion of mammalian glands during the early period after birth giving. Its components are biologically active and have beneficial effects on...
Colostrum is the first secretion of mammalian glands during the early period after birth giving. Its components are biologically active and have beneficial effects on new-born growth and well-being. Bovine colostrum has the highest concentration of these substances and its supplementation or application may provide health benefits. This systematic review was conducted to update current knowledge on bovine colostrum effects including all administration routes on healthy and sick subjects. Full texts or abstracts of twenty-eight papers as reports of systematic reviews, randomized controlled trials, observational studies and case series were included after searches in Medline, Embase, Cochrane Library and Cinahl databases. The full texts of selected studies were assessed for quality using validated tools and their results were summarized in different categories. Studies were highly heterogeneous as regards to population, intervention, outcome and risk of bias. Bovine colostrum topical application was shown effective on vaginal dryness related symptoms limitation. Its use as food supplement showed interesting effects preventing upper respiratory illness in sportsmen, modulating immune system response and reducing intestinal permeability in healthy and sick subjects. Conflicting results were provided in pediatric population and little evidence is available on its use with older adults. Further studies are mandatory to better understand all factors influencing its activity.
Topics: Adult; Aged; Animals; Cattle; Child; Colostrum; Dietary Supplements; Female; Humans; Male; Nutritional Physiological Phenomena; Pregnancy
PubMed: 34202206
DOI: 10.3390/nu13072194 -
European Journal of Obstetrics,... Oct 2021In the absence of an effective screening test, women with a high genetic predisposition for ovarian cancer are recommended to undergo risk-reducing bilateral... (Meta-Analysis)
Meta-Analysis Review
The impact of risk reducing bilateral salpingo-oophorectomy on sexual function in BRCA1/2 mutation carriers and women with Lynch syndrome: A systematic review and meta-analysis.
OBJECTIVE
In the absence of an effective screening test, women with a high genetic predisposition for ovarian cancer are recommended to undergo risk-reducing bilateral salpingo-oophorectomy (RRBSO) once childbearing is complete. This reduces the risk of ovarian cancer by up to 96%, but can result in undesirable side effects, including menopausal symptoms and sexual dysfunction. We have performed a systematic review and meta-analysis to investigate the effect of RRBSO on sexual function in women at high risk of breast/and or ovarian cancer.
METHODS
A literature search of the AMED (Allied and complementary medicine), Embase and Medline databases was performed, using search terms including sexual function, risk reducing and oophorectomy. Results were filtered according to the PRISMA protocol. Quality assessment of studies was performed using the Newcastle-Ottawa scale. Data were pooled in meta-analysis.
RESULTS
There were 21 eligible studies, 10 of which reported sufficient data for meta-analysis. Most studies were retrospective cohort or observational studies. Fifteen of the 21 studies (71%) reported a negative impact of RRBSO on sexual function. Participant numbers ranged from 37 to 1522. Meta-analysis was performed with studies including 3201 patients. This demonstrated that RRBSO has a statistically significant negative impact on sexual function (SMD -0.63, [-0.82, -0.44], p = 0.03). There was a trend towards reduced sexual pleasure and increased discomfort but this did not reach statistical significance. There was minimal change in the frequency of sex. There was a significant increase in vaginal dryness post-RRBSO (SMD 9.25, [3.66, 14.83], p < 0.00001). There was no significant difference in sexual function between pre-menopausal and post-menopausal RRBSO. Hormone replacement therapy (HRT) did not abolish this negative impact.
CONCLUSION
Sexual function declines post RRBSO, independent of menopausal status. Comprehensive pre-operative counselling regarding anticipated menopausal and sexual symptoms is key to setting realistic patient expectations and minimising post-operative distress. Information and support regarding management of these side effects should be available to all patients.
Topics: BRCA1 Protein; Colorectal Neoplasms, Hereditary Nonpolyposis; Female; Humans; Mutation; Ovarian Neoplasms; Retrospective Studies; Salpingo-oophorectomy
PubMed: 34416580
DOI: 10.1016/j.ejogrb.2021.08.001 -
Journal of Obstetrics and Gynaecology :... 2016This study evaluated the efficacy of red clover to relieve hot flashes and menopausal symptoms in peri/postmenopausal women. Electronic databases (MEDLINE, Scopus and... (Meta-Analysis)
Meta-Analysis Review
This study evaluated the efficacy of red clover to relieve hot flashes and menopausal symptoms in peri/postmenopausal women. Electronic databases (MEDLINE, Scopus and the Cochrane Library) were searched. The mean frequency of hot flashes in red clover groups was lower compared with that in the control groups (close to statistical significance). Difference in means (MD) of hot flashes frequency was - 1.99 (- 4.12-0.139; p = 0.067; heterogeneity P > 0.01; I(2) = 94.93%; Random effect model). Subjective (vaginal dryness) and objective (maturation value) symptoms of vaginal atrophy showed a significant improvement with 80-mg dose of red clover. Red clover showed less therapeutic effect on psychology status, sexual problems and sleeping disorders. Red clover consumption may decrease frequency of hot flashes, especially in women with severe hot flashes (≥ 5 per day). Red clover may reduce other menopausal symptoms. Further trials are needed to confirm the current systematic review findings.
Topics: Anxiety; Bone and Bones; Depression; Female; Hot Flashes; Humans; Menopause; Phytotherapy; Plant Extracts; Sexual Dysfunction, Physiological; Sleep; Trifolium; Vagina; Vasomotor System
PubMed: 26471215
DOI: 10.3109/01443615.2015.1049249