Local treatment with a polycarbophil-based cream in postmenopausal women with genitourinary syndrome of menopause

The Link Between Menopause and Urinary Incontinence: A Systematic Review

This study aims to review the subsisting literature on the relationship between menopause and urinary incontinence (UI). To locate research that met the inclusion criteria, a thorough computerized search of relevant databases was carried out. A comprehensive search was carried out on PubMed, SCOPUS, Science Direct, Cochrane Library, and Web of Science to locate relevant material. Our data included 11 trials with 8547 post-menopausal women. The prevalence of UI among post-menopausal women ranged from 13.6% to 84.4%, with a total prevalence of 5394 (63.1%). Across studies, the mean age of menopause varies, with some studies reporting averages around 48 to 50 years. Several studies report that UI prevalence increases with age, particularly in the postmenopausal period. UI symptoms, such as burning micturition and mixed UI, are noted, often related to the genitourinary syndrome of menopause (GSM) and nocturia. These symptoms are linked to reduced quality of life and considerable morbidity. Among postmenopausal women, UI is still a common and complex problem that has a significant negative impact on well-being and life quality. There is no doubt that menopause, aging, and UI are related, but there is still much to learn about the underlying reasons and practical treatment options. The quality of care for postmenopausal women with UI can be improved by standardizing diagnostic procedures, emphasizing non-hormonal therapy, and addressing socioeconomic and lifestyle determinants. These and other initiatives will be addressed in future research and clinical practice.

Effect of Vitamin D on the Proliferation and Barrier of Atrophic Vaginal Epithelial Cells

Atrophic vaginitis is very common in postmenopausal women due to declining estrogen levels. Vitamin D plays an important role in promoting epithelial cell proliferation, migration and adhesion. We established a rat model of ovariectomy (OVX) induced atrophic vaginitis with the aim of investigating the effects of Vitamin D supplementation on the vaginal epithelial barrier. The results showed that ovariectomised rats had significantly higher vaginal pH, reduced Lactobacillus, significantly lower uterine and vaginal weights, and lower vaginal epithelial PCNA, occludin, and E-cadherin mRNA expression compared with sham-operated rats. Vitamin D supplementation could reduce the vaginal pH, promote the proliferation and keratinization of vaginal epithelial cells, enhance the expression of PCNA mRNA in vaginal tissues, and improve the vaginal and uterine atrophy. Vitamin D can also increase the expression of E-cadherin and occludin proteins in vaginal tissues, maintain the integrity of the vaginal epithelium, increase the number of Lactobacillus, and reduce pathogenic bacterial infections. In vitro experiments demonstrated that 1,25(OH)2D3 could promote the proliferation and migration of VK2/E6E7 vaginal epithelial cells and increase the expression of E-cadherin protein. In conclusion, we demonstrated that Vitamin D can regulate the expression of vaginal epithelial tight junction proteins, promotes cell proliferation, and improves vaginal atrophy due to estrogen deficiency.

Awareness about Vulvovaginal Aesthetics Procedures among Medical Students and Health Professionals in Saudi Arabia

OBJECTIVE

 The present study aimed to explore the opinion and ethical consideration of vulvovaginal aesthetics procedures (VVAPs) among health professionals and medical students in Saudi Arabia.

METHODS

 This is a cross-sectional study performed between January 2020 and April 2020. Data was collected through electronic media, WhatsApp, and emails. The results were analyzed by applying the Students t-test, and correlations were considered significant if they presented a p-value < 0.05.

RESULTS

 There is significant demand to educate doctors, health professionals, medical students, and gynecologists for the VVAPs to have a solid foundation, justified indications, and knowledge about various aesthetic options. Although female doctors, medical students, young doctors, and gynecologists have more knowledge about VVAPs, all health professionals ought to be aware of recent trends in vulvovaginal aesthetics (VVA). The present analysis determined that VVA should be under the domain of gynecologists, rather than under that of plastic surgeons, general surgeons, and cosmetologists. The majority of the participants considered that vaginal rejuvenation, "G-spot" augmentation, clitoral surgery, and hymenoplasty are not justifiable on medical grounds.

CONCLUSION

 The decision to opt for different techniques for vaginal tightening and revitalization should be taken very carefully, utilizing the shared decision-making approach. Ethical aspects and moral considerations are important key factors before embarking in the VVAPs purely for cosmetic reasons. Further research is required to determine the sexual, psychological, and body image outcomes for women who underwent elective VVAPs. Moreover, medical educators must consider VVAPs as part of the undergraduate and postgraduate medical curriculum.