1,074 research outputs found

    Vulvovaginal atrophy during menopause

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    Objective: To present a basic clinical research based on current evidence about advanced treatment methods for vulvovaginal atrophy during menopause.And on principles of management of patients with vulvovaginal atrophy.Vulvovaginal atrophy (VVA) is a common and underreported condition associated with decreased estrogenization of the vaginal tissue. Symptoms include dryness, irritation, soreness, and dyspareunia with urinary frequency, urgency, and urge incontinence. It can occur at any time in a woman's life cycle, although more commonly in the postmenopausal phase, during which the prevalence is close to 50%. Clinical findings include the presence of pale and dry vulvovaginal mucosa with petechiae. Vaginal rugae disappear, and the cervix may become flush with the vaginal wal

    The use of human adipose-derived stem cells in the treatment of physiological and pathological vulvar dystrophies

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    ‚ÄúVulvar dystrophy‚ÄĚ is characterized by chronic alterations of vulvar trophism, occurring in both physiological (menopause) and pathological (lichen sclerosus, vulvar graft-versus-host disease) conditions. Associated symptoms are itching, burning, dyspareunia and vaginal dryness. Current treatments often do not imply a complete remission of symptoms. Adipose-Derived Stem Cells (ADSCs) injection represents a valid alternative therapy to enhance trophism and tone of dystrophic tissues. We evaluated efficacy of ADSCs-based therapy in the dystrophic areas. From February to April 2013 we enrolled 8 patients with vulvar dystrophy. A biopsy specimen was performed before and after treatment. Digital photographs were taken at baseline and during the follow-up. Pain was detected with Visual Analogue Scale and sexual function was evaluated with Female Sexual Function Index. All patients received 2 treatments in 3 months. Follow-up was at 1 week , 1 and 3 months, and 1 and 2 years. We obtained a significant vulvar trophism enhancement in all patients, who reported pain reduction and sexual function improvement. Objective exam with speculum was easy to perform after treatment. We believe ADSCs-based therapy finds its application in the treatment of vulvar dystrophies, since ADSCs could induce increased vascularization due to their angiogenic properties and tissue trophism improvement thanks to their eutrophic effect

    Comparison of anogenital distance and correlation with vulvo-vaginal atrophy: a pilot study on premenopausal and postmenopausal women

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    OBJECTIVES: Anogenital distance (AGD) represents the space between labia posterior commissure and anus. This was pilot study to investigate how menopause and so lack of oestrogens affects AGD. METHODS: A total of 109 patients were enrolled. AGD was measured in lithotomy position using sterile paper ruler. Anogenital index (AGI) was used to control 2 variables of height and weight (body mass index, kg/m2). Vaginal health index (VHI) was used to evaluate vaginal wellness. Female sexual function index (FSFI) questionnaire was administered to all women to evaluate the impact of menopause on their sexual function. RESULTS: AGD (30.87 ¬Ī 2.98 vs. 17.57 ¬Ī 2.18; P = 0.0001) and AGI (1.40 ¬Ī 0.21 vs. 0.70 ¬Ī 0.15; P = 0.0001) were both significantly lower in the postmenopausal group. Postmenopausal women were affected by vulvovaginal atrophy (VVA) significantly. Thus, VHI scores were dramatically worse in postmenopausal group (23.95 ¬Ī 1.28 vs. 10.75 ¬Ī 3.41; P = 0.0001) as well as FSFI results (32.68 ¬Ī 2.25 vs. 19.78 ¬Ī 5.46; P = 0.0001). CONCLUSIONS: This study confirms that AGD in post-menopausal women was significantly shorter than AGD in premenopausal women, correlating with an increase of VVA and sexual impairment. Changes of AGD and AGI demonstrated to predict hormonal changes that may occur after menopause

    Treatment of symptoms of the menopause: an endocrine society clinical practice guideline

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    Objective: The objective of this document is to generate a practice guideline for the management and treatment of symptoms of the menopause. Participants: The Treatment of Symptoms of the Menopause Task Force included six experts, a methodologist, and a medical writer, all appointed by The Endocrine Society. Evidence: The Task Force developed this evidenced-based guideline using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence. The Task Force commissioned three systematic reviews of published data and considered several other existing meta-analyses and trials. Consensus Process: Multiple e-mail communications, conference calls, and one face-to-face meeting determined consensus. Committees of The Endocrine Society, representatives from endorsing societies, and members of The Endocrine Society reviewed and commented on the drafts of the guidelines. The Australasian Menopause Society, the British Menopause Society, European Menopause and Andropause Society, the European Society of Endocrinology, and the International Menopause Society (co-sponsors of the guideline) reviewed and commented on the draft. Conclusions: Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and other symptoms of the climacteric. Benefits may exceed risks for the majority of symptomatic postmenopausal women who are under age 60 or under 10 years since the onset of menopause. Health care professionals should individualize therapy based on clinical factors and patient preference. They should screen women before initiating MHT for cardiovascular and breast cancer risk and recommend the most appropriate therapy depending on risk/benefit considerations. Current evidence does not justify the use of MHT to prevent coronary heart disease, breast cancer, or dementia. Other options are available for those with vasomotor symptoms who prefer not to use MHT or who have contraindications because these patients should not use MHT. Low-dose vaginal estrogen and ospemifene provide effective therapy for the genitourinary syndrome of menopause, and vaginal moisturizers and lubricants are available for those not choosing hormonal therapy. All postmenopausal women should embrace appropriate lifestyle measures

    An Overview of Vulvovaginal Atrophy‚ÄĎRelated Sexual Dysfunction in Postmenopausal Women

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    Menopause and the climacteric period are associated with adverse risk factors for the development of vulvovaginal atrophyrelated¬†sexual dysfunction. Sexual dysfunction is a common problem in postmenopausal women, often underdiagnosed,¬†inadequately treated, frequently overlooked, and most often impairing the quality of life of these women. To provide clinicians¬†with current information on vulvovaginal atrophy‚ÄĎrelated sexual dysfunction in postmenopausal women. This study is a¬†literature review on vulvovaginal atrophy‚ÄĎrelated sexual dysfunction in postmenopausal women. Relevant publications were¬†identified through a search of PubMed and Medline, selected references, journals, and textbooks on this topic, and were¬†included in the review. The prevalence of female sexual dysfunction increases with age. It is a common multidimensional¬†problem for postmenopausal women that alter the physiological, biochemical, psychological, and sociocultural environment of¬†a woman. Menopause‚ÄĎrelated sexual dysfunction may not be reversible without therapy. Estrogen therapy is the most effective¬†option and is the current standard of care for vulvovaginal atrophy‚ÄĎrelated sexual dysfunction in postmenopausal women.¬†Sexual dysfunction is a common multidimensional problem for postmenopausal women and often impairs the quality of life¬†of these women. Estrogen preparations are the most effective treatment. Selective estrogen receptor modulators, vaginal¬†dehydroepiandrostenedione, vaginal testosterone, and tissue‚ÄĎselective estrogen complexes are promising therapies, but¬†further studies are required to confirm their role, efficacy, and safety.Keywords: Estrogen, postmenopausal women, sexual dysfunction, vulvo‚ÄĎvagina

    Effects after use of laser therapy for vulvovaginal atrophy in a patient with lichen sclerosus: a case report

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    Objective: Use of laser therapy has most recently been introduced as a non-invasive option for the treatment of genitourinary syndrome of menopause (GSM). Recent literature has shown promise in providing benefit for patients with symptoms of vulvovaginal atrophy (VVA) and stress urinary incontinence with minimal adverse effects. Despite this, the United States Food and Drug Administration has not cleared laser therapy for these specific indications given the lack of sufficient evidence to support safety and efficacy. A case is presented of a patient with GSM in the setting of lichen sclerosus who was referred to a tertiary vulvovaginal disease clinic after worsening of symptoms after three laser therapy treatments. Patient data is protected by the Health Insurance Portability and Accountability Act of 1996. The case presented demonstrates initial worsening of symptoms after treatment with laser therapy, with initial exam findings showing atrophic vaginitis, marked introital narrowing, partial phimosis of the clitoral hood, and fusion of the labia minor and majora. The patient ultimately had complete resolution of post-laser therapy symptoms by one year after initial presentation. The case findings and follow-up are presented. Conclusions: Despite case series and studies in the literature showing promise of the use of laser therapy for GSM and urinary incontinence, laser therapy is not currently FDA-approved for these indications. Large scale, long-term prospective randomized controlled data is necessary to provide data on the safety, efficacy, indications, and appropriate candidates for laser therapy

    Vaginal hormone-free moisturising cream is not inferior to an estriol cream for treating symptoms of vulvovaginal atrophy: Prospective, randomised study.

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    This prospective, open-label, multicentre, multinational, randomised trial investigated the non-inferiority of treatment with a vaginal hormone-free moisturising cream compared to a vaginal estriol (0.1%) cream in a panel of post-menopausal women suffering from symptoms of vulvovaginal dryness in a parallel group design. In total, 172 post-menopausal women were randomly allocated to either one of the two treatments, each administered for 43 days. The primary endpoint was the total severity score of subjective symptoms (dryness, itching, burning and pain unrelated to sexual intercourse) of the respective treatment period. Secondary endpoints were severity of single subjective symptoms (including dyspareunia if sexually active), impairment of daily life, Vaginal Health Index, as well as assessment of safety. In both groups, women treated with hormone-free moisturising cream and those treated with estriol cream, total severity score improved significantly compared to baseline by 5.0 (from 6.1 to 1.1) and by 5.4 (from 6.0 to 0.6), respectively, after 43 days of treatment (p < 0.0001). One-sided test of baseline differences (for a clinically relevant difference őĒ = 1.5) confirmed the hormone-free moisturising cream to be non-inferior to the estriol cream. Severity of dyspareunia as well as impairment of daily life due to subjective symptoms, significantly improved for both treatment groups (p<0.0001). Subgroup analysis of women with mild or moderate impairment of daily life at baseline caused by "vaginal dryness" symptoms benefited from both creams, while women with severe impairment showed a significantly greater benefit from the estriol cream (p = 0.0032). Both treatments were well tolerated with no serious adverse events occurring. This study provides clinical evidence that a hormone-free vaginal moisturising cream cannot only improve vaginal dryness compared to an 0.1% estriol cream but also can relieve dyspareunia as well as improve woman's impairment of daily life, justifying its use as a first choice for mild or moderate vulvovaginal dryness symptoms

    Vaginal Health in Menopausal Women

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    The aim of this review is to provide an overview of genitourinary health in peri- and postmenopause, particularly of vulvovaginal atrophy (VVA), which is part of genitourinary syndrome (GSM). This condition has a high prevalence among post-menopausal women and negatively affects a woman's quality of life. Epidemiology, signs, symptoms, diagnostic criteria of VVA and target treatments for restoring vaginal health are discussed in light of the most recent literature. Issues related to this condition in menopausal women are under-diagnosed, lack objective diagnostic criteria, and consequently under-treated. Over the years, many treatments have been developed but their long-term effectiveness and safety have yet to be clearly defined. Patients are often dissatisfied and stop treatment, suggesting the need for a more personalized and tailored approach to achieve better compliance and thereby effectiveness. The aim of this paper is to provide an overview of the most recent literature on VVA in order to help the gynecologist in the management of this condition

    Pelvic floor muscles training to reduce symptoms and signs of vulvovaginal atrophy : a case study

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    Objective: Vulvovaginal atrophy (VVA), caused by decreased levels of estrogen, is a common problem in aging women. Main symptoms of VVA are vaginal dryness and dyspareunia. First-line treatment consists of the application of local estrogen therapy (ET) or vaginal moisturizer. In some cases however, symptoms and signs persist despite those interventions. This case study describes a 77-year-old woman with severe VVA symptoms despite use of local ET and the addition of pelvic floor muscle (PFM) training to her treatment. Methods: A patient with stress urinary incontinence and VVA was referred to a randomized clinical trial on PFM training. On pretreatment evaluation while on local ET, she showed VVA symptoms on the ICIQ Vaginal Symptoms questionnaire and the ICIQ-Female Sexual Matters associated with lower urinary tract Symptoms questionnaire, and also showed VVA signs during the physical and dynamometric evaluation of the PFM. She was treated with a 12-week PFM training program. Results: The patient reported a reduction in vaginal dryness and dyspareunia symptoms, as well as a better quality of sexual life after 12 weeks of PFM training. On posttreatment physical evaluation, the PFMs' tone and elasticity were improved, although some other VVA signs remained unchanged. Conclusions: Pelvic floor muscle training may improve some VVA symptoms and signs in women taking local ET. Further study is needed to investigate and confirm the present case findings and to explore mechanisms of action of this intervention for VVA

    Impact of vulvovaginal health on postmenopausal women: A review of surveys on symptoms of vulvovaginal atrophy

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    Several recent, large-scale studies have provided valuable insights into patient perspectives on postmenopausal vulvovaginal health. Symptoms of vulvovaginal atrophy, which include dryness, irritation, itching, dysuria, and dyspareunia, can adversely affect interpersonal relationships, quality of life, and sexual function. While approximately half of postmenopausal women report these symptoms, far fewer seek treatment, often because they are uninformed about hypoestrogenic postmenopausal vulvovaginal changes and the availability of safe, effective, and well-tolerated treatments, particularly local vaginal estrogen therapy. Because women hesitate to seek help for symptoms, a proactive approach to conversations about vulvovaginal discomfort would improve diagnosis and treatment
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