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Urology May 2021The implications of estrogen depletion on the lower urinary tract and vagina are relevant to the urologist treating women with genitourinary symptoms. The main symptoms...
The implications of estrogen depletion on the lower urinary tract and vagina are relevant to the urologist treating women with genitourinary symptoms. The main symptoms of vaginal estrogen depletion that affect women are dyspareunia and vaginal dryness, recurrent urinary tract infection, and lower urinary tract symptoms. Vaginal estrogen can be used to effectively treat these conditions. Vaginal estrogen is available in a variety of formulations. Each formulation has different considerations regarding its use and patients should be actively involved in choosing the right product for them. Contrary to concerns over the risks of oral estrogen, vaginal estrogen has a low-risk profile. In terms of contra-indications for use, there are relatively few absolute contraindications for vaginal estrogen. A thorough understanding of vaginal estrogen's safety, efficacy and correct use is essential to the urologist treating the post-menopausal female.
Topics: Administration, Intravaginal; Estrogens; Female; Female Urogenital Diseases; Humans; Urology; Vagina
PubMed: 32504683
DOI: 10.1016/j.urology.2020.05.034 -
International Urogynecology Journal Jan 2015The aim of this study is to provide an evidence-based definition of vaginal atrophy (VA) and present an overview of subjective and objective measurements of VA... (Review)
Review
INTRODUCTION AND HYPOTHESIS
The aim of this study is to provide an evidence-based definition of vaginal atrophy (VA) and present an overview of subjective and objective measurements of VA applicable in clinical practice and research.
METHODS
A systematic literature search was performed in MEDLINE and EMBASE to identify studies reporting on measurement properties of diagnostic instruments for VA. Additional searches in MEDLINE aimed to document the definitions, diagnostic criteria, and outcome measures of VA. Studies reporting on definitions, diagnosis, outcome measurements, and measurement properties of diagnostic instruments of VA were selected.
RESULTS
Specific symptoms for VA that were consistently described could be identified to suggest an evidence-based definition of VA. As subjective outcome measurements, seven scoring systems to assess the signs of VA during physical examination were identified. The most bothersome symptom (MBS) approach is most useful in clinical practice and research as it focuses on the most common symptoms of VA. As objective outcome measurements, numerous ways to assess vaginal cytology and vaginal pH were identified.
CONCLUSIONS
At the moment, there is no consensus on the definition and assessment of VA. We propose to define VA as a common manifestation of estrogen decline associated with specific symptoms of which the most common are: vaginal dryness, itching or irritation, and dyspareunia. In both clinical and research settings, subjective assessment (the MBS approach) and objective assessments of VA (measurement of vaginal maturation index and vaginal pH) should be combined.
Topics: Atrophy; Female; Humans; Severity of Illness Index; Vagina; Vaginal Diseases
PubMed: 25047897
DOI: 10.1007/s00192-014-2464-0 -
Climacteric : the Journal of the... Oct 2017To evaluate efficacy, tolerability and safety of Monurelle Biogel vaginal gel for treatment of vaginal dryness. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To evaluate efficacy, tolerability and safety of Monurelle Biogel vaginal gel for treatment of vaginal dryness.
METHODS
Multicenter, national, randomized, controlled vs. no-treatment, open-label study. Ninety-five postmenopausal women were randomized (48 to Monurelle Biogel and 47 to no treatment). Primary endpoint was the change of Verbal Rating Scale (VRS) total score of vaginal atrophy (VA) symptoms after 8-week treatment. The main secondary endpoints were VRS single-item score, Vaginal Health Index (VHI) score, Maturation Index (MI), Female Sexual Function Index (FSFI), and Female Sexual Distress Scale-Revised (FSDS-R).
RESULTS
The VRS total score was statistically significant in favor of the treatment group on day 28 (p = 0.001) but not on day 56 (p = 0.064). By excluding women who were not sexually active, the total VRS scores reached the criteria for clinical success in 27/43 subjects (62.8%) in the control arm and in 38/46 subjects (82.6%) in the treatment arm (p = 0.035) on day 56. The VHI score significantly changed in the active arm (4.71 ± 4.85 vs. 0.28 ± 1.71) (p < 0.001) on day 56. Even the MI significantly improved, with an increase in the percentage of superficial cells (p = 0.01). The improvements in both VHI and MI were still present at the follow-up visit after the discontinuation of the treatment (day 84). Sexual function and distress showed a statistical significant difference on day 56.
CONCLUSIONS
Monurelle Biogel vaginal gel applied twice daily for 8 weeks is effective in relieving vaginal dryness and other VA symptoms. Such a clinical meaningful effect persists at least 4 weeks and is supported by an improvement in the vaginal environment. Trial Registration clinicaltrials.gov Identifier: NCT02994342.
Topics: Administration, Intravaginal; Aged; Atrophy; Female; Gels; Humans; Middle Aged; Postmenopause; Quality of Life; Sexual Dysfunction, Physiological; Vagina; Vaginal Creams, Foams, and Jellies; Vaginal Diseases
PubMed: 28657769
DOI: 10.1080/13697137.2017.1335703 -
American Family Physician Apr 2011Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal... (Review)
Review
Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal lactobacilli of the vagina are replaced by mostly anaerobic bacteria. Diagnosis is commonly made using the Amsel criteria, which include vaginal pH greater than 4.5, positive whiff test, milky discharge, and the presence of clue cells on microscopic examination of vaginal fluid. Oral and topical clindamycin and metronidazole are equally effective at eradicating bacterial vaginosis. Symptoms and signs of trichomoniasis are not specific; diagnosis by microscopy is more reliable. Features of trichomoniasis are trichomonads seen microscopically in saline, more leukocytes than epithelial cells, positive whiff test, and vaginal pH greater than 5.4. Any nitroimidazole drug (e.g., metronidazole) given orally as a single dose or over a longer period resolves 90 percent of trichomoniasis cases. Sex partners should be treated simultaneously. Most patients with vulvovaginal candidiasis are diagnosed by the presence of vulvar inflammation plus vaginal discharge or with microscopic examination of vaginal secretions in 10 percent potassium hydroxide solution. Vaginal pH is usually normal (4.0 to 4.5). Vulvovaginal candidiasis should be treated with one of many topical or oral antifungals, which appear to be equally effective. Rapid point-of-care tests are available to aid in accurate diagnosis of infectious vaginitis. Atrophic vaginitis, a form of vaginitis caused by estrogen deficiency, produces symptoms of vaginal dryness, itching, irritation, discharge, and dyspareunia. Both systemic and topical estrogen treatments are effective. Allergic and irritant contact forms of vaginitis can also occur.
Topics: Administration, Intravaginal; Administration, Oral; Anti-Bacterial Agents; Anti-Infective Agents; Antifungal Agents; Atrophic Vaginitis; Bacterial Load; Candidiasis, Vulvovaginal; Clindamycin; Estrogens; Female; Gynecological Examination; Humans; Hydrogen-Ion Concentration; Metronidazole; Microscopy; Treatment Outcome; Trichomonas Vaginitis; Vaginal Discharge; Vaginosis, Bacterial
PubMed: 21524046
DOI: No ID Found -
European Journal of Obstetrics,... Mar 2022During menopausal transition, women are frequently affected by vulvovaginal atrophy (VVA), due to the decline of estrogen levels. Resulting symptoms are itching,... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
During menopausal transition, women are frequently affected by vulvovaginal atrophy (VVA), due to the decline of estrogen levels. Resulting symptoms are itching, burning, dyspareunia, and vaginal dryness (reported in up to 85%). The aim of this trial was to verify if medical device polycarbophil vaginal (PCV) moisturizer gel is not less effective than hyaluronic acid (HA) gel in treating vaginal dryness.
MATERIAL AND METHODS
This was a multicenter, open label, randomized, parallel group, comparative study with non-inferiority design. Female included were ≥45 to ≤55 years in the menopausal transition, with subjective dryness, any objective sign of VVA, pH > 5, and body mass index of ≥18.5 to ≤36 kg/m. Subjects were randomized to 1 g of PCV gel twice a week for 30 days or 3 g of HA vaginal gel every 3 days for 30 days.
RESULTS
53 subjects (mean age 49.45 ± 2.96 years) were analyzed. Vaginal health index showed an improvement (p < 0.001) in both groups (from 12.54 ± 1.37 to 16.36 ± 2.66 for PCV, from 12.00 ± 1.91 to 16.60 ± 2.50 for HA), but the difference between final means (95%CI: -1.66 to 1.18) evidenced that PCV is non-inferior to HA treatment. Similarly, an improvement was evidenced in vaginal maturation index (p = 0.005 for PCV, ns. for HA), female sexual function index (p < 0.001 for PCV, p < 0.001 for HA), and SF-12 (p < 0.001 for PCV, p < 0.001 for HA), with no difference between groups. Safety was optimal and no adverse events were reported.
CONCLUSIONS
The use of HA gel does not give additional benefits to those that are already provided by the moisturizing PCV.
Topics: Acrylic Resins; Atrophy; Female; Humans; Hyaluronic Acid; Menopause; Middle Aged; Postmenopause; Prospective Studies; Treatment Outcome; Vagina; Vaginal Creams, Foams, and Jellies; Vaginal Diseases; Vulva
PubMed: 35131532
DOI: 10.1016/j.ejogrb.2022.01.021 -
European Review For Medical and... Sep 2016Vaginal atrophy is a chronic, progressive medical condition that affects fifty percent of postmenopausal women, causing symptoms like dyspareunia, vaginal dryness, and... (Review)
Review
OBJECTIVE
Vaginal atrophy is a chronic, progressive medical condition that affects fifty percent of postmenopausal women, causing symptoms like dyspareunia, vaginal dryness, and vaginal irritation. Until recently, the only prescription options were systemic and vaginal estrogen therapies that might be limited by concerns about long-term safety and breast cancer risk. The objective is to analyze the literature about ospemifene, a tissue-selective estrogen receptor modulator (SERM) recently approved for the treatment of vulvovaginal atrophy and dyspareunia and to compare its effects with those of the other SERMs to assess its safety.
MATERIALS AND METHODS
Review. Medline search.
RESULTS
Ospemifene treats vaginal atrophy, and, if compared with other SERMS, it has no or not significant effects on endometrium and thromboembolism. Experimental and animal models suggest an inhibitory effect on the growth of malignant breast tissue. The available clinical data support ospemifene breast safety.
CONCLUSIONS
Ospemifene relieves moderate to severe symptoms of vulvovaginal atrophy, like dryness, irritation and soreness around the genital area, and painful sexual intercourse, in menopausal women. It is well tolerated, and it has neutral effects on endometrium and coagulation. Clinical trials and even long-term studies on breast cancer effects support ospemifene overall safety.
Topics: Animals; Atrophy; Dyspareunia; Female; Humans; Models, Animal; Postmenopause; Tamoxifen; Vagina; Vulva
PubMed: 27735020
DOI: No ID Found -
The Journal of Sexual Medicine Sep 2009There is limited research comparing cross-cultural differences in women's experiences of vaginal dryness. (Comparative Study)
Comparative Study
INTRODUCTION
There is limited research comparing cross-cultural differences in women's experiences of vaginal dryness.
AIM
To examine international differences in the prevalence of vaginal dryness, the degree to which it is experienced as problematic or bothersome, the use of lubricants to alleviate it, and women's discussion of this problem with physicians.
MAIN OUTCOME MEASURES
Questionnaire measuring the level of vaginal dryness and degree to which it is perceived as bothersome.
METHODS
The Global Survey of Sexual Attitudes and Practices was administered to 6,725 women from 11 countries: UK, Germany, Japan, Australia, Canada, Spain, Italy, Mexico, Argentina, Brazil and Thailand.
RESULTS
Prevalence of self-reported vaginal dryness varied from a minimum of 5.8% in Italy to a maximum of 19.7% in Brazil. The proportion of women with self-reported vaginal dryness who found it very bothersome varied as well (e.g., 5.6% UK, 26.4% Germany). Pain during intercourse ranged from a reported low of 3.6% in Australia to 18.6% in Brazil. Older women (50-65 years) as compared with younger women (18-34 years) reported significantly more vaginal dryness in the UK, Australia, Canada, Italy, Spain, Argentina, and Thailand (P values <0.02). The majority of women under 50 attributed vaginal dryness to inadequate sexual arousal while women over 50 believed it was because of aging or menopause. Cross-culturally, women differed substantially in the likelihood of discussing their sexual life/concerns with a physician.
CONCLUSION
Women from different countries differ substantially in their experiences, concerns, and reports of vaginal dryness/sexual pain, as well as their familiarity with personal lubricants as a treatment. Researchers should assess the prevalence and degree of the bother of vaginal dryness in order to make international comparisons of the burden of this condition.
Topics: Adolescent; Adult; Age Factors; Aged; Culture; Data Collection; Dyspareunia; Female; Global Health; Health Knowledge, Attitudes, Practice; Humans; Internationality; Middle Aged; Prevalence; Risk Factors; Sexuality; Surveys and Questionnaires; Vagina; Vaginal Diseases; Young Adult
PubMed: 19627461
DOI: 10.1111/j.1743-6109.2009.01369.x -
Journal of Midwifery & Women's Health Nov 2021Genitourinary syndrome of menopause (GSM) occurs in approximately 50% of menopausal women but is both underrecognized and undertreated despite numerous treatment... (Review)
Review
Genitourinary syndrome of menopause (GSM) occurs in approximately 50% of menopausal women but is both underrecognized and undertreated despite numerous treatment options. Vaginal dryness, irritation, dyspareunia, urinary frequency, and urinary urgency are some of the more common symptoms that can have a negative effect on women's lives and relationships. Treatment options can include over-the-counter moisturizers and lubricants that can be composed of water or silicone or have an oil base. However, women and health care providers need be aware of the effects of excipients in these products so that the therapy does not cause vaginal irritation. US Food and Drug Administration (FDA)-approved treatment options include vaginally administered estrogen products as well as dehydroepiandrosterone (prasterone) and the selective estrogen receptor modulator ospemifene. The prescription options have proven efficacy and safety and can be considered for use by women with a history of cancer following collaboration with the oncologist. Despite the FDA warning that recommends vaginal lasers not be used for vaginal rejuvenation, vaginal lasers have also been used as a treatment for GSM, but studies on their safety are limited. This article reviews GSM, including its impact, diagnosis, and treatment.
Topics: Humans; Menopause; United States
PubMed: 34464022
DOI: 10.1111/jmwh.13277 -
Journal of Contemporary Brachytherapy Dec 2018To evaluate vaginal toxicity (primary endpoint) and local control (secondary endpoint) in patients with endometrial cancer who underwent primary surgery and adjuvant... (Review)
Review
PURPOSE
To evaluate vaginal toxicity (primary endpoint) and local control (secondary endpoint) in patients with endometrial cancer who underwent primary surgery and adjuvant high-dose-rate (HDR) endovaginal brachytherapy (BT).
MATERIAL AND METHODS
In September 2017, the authors conducted a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus, and Cochrane library. In this systematic review, the authors included randomized trials, non-randomized trials, prospective studies, retrospective studies, and cases. The time period of the research included articles published from September 1997 to September 2017.
RESULTS
Acute endovaginal toxicity occurred in less than 20.6% and all acute toxicities were G1-G2. The most common early side effects due to HDR-BT treatment were vaginal inflammation, vaginal irritation, dryness, discharge, soreness, swelling, and fungal infection. G1-G2 late toxicity occurred in less than 27.7%. Finally, G3-G4 late vaginal occurred in less than 2%. The most common late side effects consisted of vaginal discharge, dryness, itching, bleeding, fibrosis, telangiectasias, stenosis, short or narrow vagina, and dyspareunia.
CONCLUSIONS
The data suggest that HDR endovaginal brachytherapy, with or without chemotherapy, is very well tolerated with low rates of acute and late vaginal toxicities. Further prospective studies with higher numbers of patients and longer follow-up are necessary to evaluate acute and late toxicities after HDR endovaginal brachytherapy.
PubMed: 30662479
DOI: 10.5114/jcb.2018.79713 -
The Journal of Sexual Medicine Mar 2011Vaginal atrophy, which is associated with vaginal itching, burning, dryness, irritation, and pain, is estimated to affect up to 40% of postmenopausal women. Estrogens... (Review)
Review
INTRODUCTION
Vaginal atrophy, which is associated with vaginal itching, burning, dryness, irritation, and pain, is estimated to affect up to 40% of postmenopausal women. Estrogens play a key role in maintaining vaginal health; women with low serum estradiol are more likely to experience vaginal dryness, dyspareunia, and reduced sexual activity compared with women who have higher estradiol levels.
AIMS
The purpose of this review is to assess the prevalence and impact of dyspareunia, a symptom of vaginal atrophy, on the health of postmenopausal women and to evaluate treatment options using vaginal estrogens (U.S. Food and Drug Administration [FDA] approved).
METHODS
Relevant published literature was identified by searching Index Medicus using the PubMed online database. The search terms dyspareunia, vaginal estrogen, vaginal hormone therapy, vaginal atrophy, and atrophic vaginitis were the focus of the literature review.
RESULTS
Current treatment guidelines for vaginal atrophy recommend the use of minimally absorbed local vaginal estrogens, along with non-hormonal lubricants or moisturizers, coupled with maintenance of sexual activity. Vaginal estrogen therapy has been shown to provide improvement in the signs and symptoms of vaginal or vulvar atrophy. Vaginal tablets, rings, and creams are indicated for the treatment of vaginal atrophy, and the FDA has recently approved a low-dose regimen of conjugated estrogens cream to treat moderate-to-severe postmenopausal dyspareunia. The use of low-dose vaginal estrogens has been shown to be effective in treating symptoms of vaginal atrophy without causing significant proliferation of the endometrial lining, and no significant differences have been seen among vaginal preparations in terms of endometrial safety.
CONCLUSION
Women should be informed of the potential benefits and risks of the treatment options available, and with the help of their healthcare provider, choose an intervention that is most suitable to their individual needs and circumstances.
Topics: Administration, Intravaginal; Aged; Counseling; Dyspareunia; Estrogens; Female; Humans; Menopause; Middle Aged; Prevalence; Vagina
PubMed: 21091878
DOI: 10.1111/j.1743-6109.2010.02114.x