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Eichler S, Panz M, Harder A, Masur C, Häuser M, Wiesche ESZ. An effective non-hormonal option with high tolerability for mild to moderate symptoms of vaginal dryness associated with menopause. Maturitas 2024; 185:107978. [PMID: 38583316 DOI: 10.1016/j.maturitas.2024.107978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES The efficacy and tolerability of a non-hormonal pessary (that forms an oil-in-water emollient with the vaginal fluid) were assessed for the treatment of symptoms of vaginal dryness associated with menopause. STUDY DESIGN Seventy-nine postmenopausal women (mean age 60.8 ± 6.5 years) with mild to moderate symptoms of vaginal dryness (including dyspareunia) were enrolled in this open-label, prospective, post-market clinical follow-up trial, conducted in 2022 by one research center in Germany. The investigational pessary was applied for the first 7 days once daily and the subsequent 31 days twice a week, at bedtime. A treatment-free period of 6 days completed the trial. MAIN OUTCOME MEASURES During the trial, participants filled out questionnaires that enabled the calculation of a total severity score for subjective symptoms of atrophy-related vaginal dryness and impairment of daily as well as sexual life. Furthermore, vaginal health index and safety were studied. RESULTS A rapid and significant reduction in the severity scores for symptoms was observed over the 38-day course of treatment and beyond. Quality of life assessed by DIVA (day-to-day impact of vaginal aging) questionnaire, dyspareunia and vaginal health index also clearly improved. The tolerability was mainly rated as "good to very good" by the investigator and 94.9 % of participants. The vast majority were very satisfied with the simple and pleasant handling. No serious adverse events occurred. CONCLUSION Overall, the presented data suggest that the investigated non-hormonal pessary is an effective and well tolerated treatment option for vaginal symptoms associated with dryness, thus improving quality of life for women, even those who are sexually active. CLINICALTRIALS gov identifier NCT05211505.
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Affiliation(s)
- Susann Eichler
- Dr. August Wolff GmbH & Co. KG Arzneimittel, 33611 Bielefeld, Germany.
| | - Mareike Panz
- Dr. August Wolff GmbH & Co. KG Arzneimittel, 33611 Bielefeld, Germany
| | - Anastasia Harder
- Dr. August Wolff GmbH & Co. KG Arzneimittel, 33611 Bielefeld, Germany
| | - Clarissa Masur
- Dr. August Wolff GmbH & Co. KG Arzneimittel, 33611 Bielefeld, Germany
| | - Manuel Häuser
- Dr. August Wolff GmbH & Co. KG Arzneimittel, 33611 Bielefeld, Germany
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Sánchez-Prieto M, Pingarrón C, Bergamaschi L, Bermúdez JC, Subiris González J, Sánchez Sánchez R, Poyo Torcal S, Gómez M, Ruiz Pérez ML, Castillo Martínez M, Peña Penedo ME, Sánchez-Borrego R. Prospective, multicenter, uncontrolled study on the effectiveness and safety of a hyaluronic acid water-based vaginal lubricant in alleviating vaginal dryness and dyspareunia. Gynecol Endocrinol 2024; 40:2317268. [PMID: 38468593 DOI: 10.1080/09513590.2024.2317268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Vaginal dryness (VD) represents a significant concern affecting women across diverse life stages, encompassing both pre- and postmenopausal women at any age. Dyspareunia, defined by genital pain that can be experienced before, during, or after intercourse, is often associated with vaginal dryness. AIM This study aimed to evaluate the effectiveness and safety of a water-based vaginal lubricant with hyaluronic acid to reduce sexual discomfort associated with vaginal dryness. METHODS A prospective, multicenter, uncontrolled clinical investigation was conducted over a three-month period in women aged 18 years or older experiencing pain or difficulty during sexual intercourse for whom the use of a vaginal lubricant was recommended. RESULTS Significant improvements were observed in the FSFI scores, indicating enhanced sexual function (p < .001). Vaginal dryness symptoms, including irritation, dryness, itching, and dyspareunia, significantly decreased after product use (p < .001). CLINICAL IMPLICATIONS This study contributes to the limited scientific knowledge on the application of lubricants in the context of symptoms associated with VD. STRENGTHS & LIMITATIONS In addition to the short study period, inherent limitations of the study design, and lack of placebo control, it is pertinent to acknowledge that some of the pros used in this study were not based on validated questionnaires. However, as far as we know, this study is the only one that analyzes well-being and sexual pleasure as results using a lubricant formulated with hyaluronic acid. CONCLUSION This tested vaginal lubricant with hyaluronic acid has demonstrated efficacy in improving vaginal dryness and female sexual function, particularly in reducing pain and improving lubrication during sexual intercourse, and showed a favorable safety profile, with minimal and transient adverse events.
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Claes M, Tuts L, Robijns J, Mulders K, Van De Werf E, Bulens P, Mebis J. Cancer therapy-related vaginal toxicity: its prevalence and assessment methods-a systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01553-y. [PMID: 38383907 DOI: 10.1007/s11764-024-01553-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE In 2020, almost 9 million women were diagnosed with cancer worldwide. Despite advancements in cancer treatment strategies, patients still suffer from acute and long-term side effects. This systematic review aims to evaluate the most frequently reported adverse effects in the genitourinary system and compare them across cancer types, treatment modalities, and evaluation methods. METHODS Pubmed Central, SCOPUS, and Cochrane Library were searched following the PRISMA guidelines to identify all prospective and retrospective observational cohort studies and randomized controlled trials assessing vaginal side effects of adult female cancer patients. The study quality was evaluated using The Newcastle-Ottawa Scale or the Risk of Bias 2 tool, as appropriate. RESULTS The most prevalent population was breast cancer patients, followed by gynaecological cancer patients. Overall, the focus was on vaginal dryness, while vaginal stenosis was the primary outcome in gynaecological cancer patients. Significant discrepancies were found in the frequency and severity of the reported adverse events. Most studies in this review evaluated side effects using patient-reported outcome measures (PROMs). CONCLUSIONS Genitourinary syndrome of menopause following cancer treatment is most frequently documented in breast and gynaecological cancer patients, often focussing on vaginal dryness and vaginal stenosis based on PROMs. This review provides a complete overview of the literature, but more high-quality clinical trials are necessary to draw firm conclusions on acute and chronic vaginal toxicity following cancer treatment. IMPLICATIONS FOR CANCER SURVIVORS This review could help improve the current preventive and curative management options for genitourinary complications, thereby increasing the patient's QoL and sexual functioning.
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Affiliation(s)
- Marithé Claes
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.
- LCRC, Hasselt, Belgium.
- Dept. Medical Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium.
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium.
| | - L Tuts
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- LCRC, Hasselt, Belgium
- Dept. Medical Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
| | - J Robijns
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- LCRC, Hasselt, Belgium
- Dept. Medical Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
| | - K Mulders
- LCRC, Hasselt, Belgium
- Dept. Medical Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
| | - E Van De Werf
- LCRC, Hasselt, Belgium
- Dept. Radiation Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Radiation Oncology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium
- Dept. Future Health, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium
| | - P Bulens
- LCRC, Hasselt, Belgium
- Dept. Radiation Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Radiation Oncology, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium
- Dept. Future Health, Ziekenhuis Oost-Limburg, Synaps Park 1, 3600, Genk, Belgium
| | - J Mebis
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium
- LCRC, Hasselt, Belgium
- Dept. Medical Oncology, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
- Dept. Jessa & Science, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium
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Mark JKK, Samsudin S, Looi I, Yuen KH. Vaginal dryness: a review of current understanding and management strategies. Climacteric 2024:1-9. [PMID: 38318859 DOI: 10.1080/13697137.2024.2306892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024]
Abstract
The issue of vaginal dryness in genitourinary syndrome of menopause (GSM) and its pervasive impact on women's quality of life is often overlooked. Extensive surveys conducted worldwide reveal limited understanding of vaginal dryness among public and health-care providers. Physician knowledge on menopause medicine varies globally, highlighting the need for standardized training. Effective communication between physicians and patients plays a crucial role in diagnosing and treating GSM symptoms. There are multiple treatment options to improve vaginal lubrication, including hormonal and non-hormonal therapies, along with lifestyle modifications. Tailoring treatments to individual patient preferences is crucial for compliance. Overall, GSM is multifaceted, from the prevalence of vaginal dryness to the nuances of treatment preferences. The urgency of widespread education and awareness of this matter must be underscored to meet the aim of enhancing the well-being and quality of life for women.
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Affiliation(s)
- J K K Mark
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - S Samsudin
- Obstetrics and Gynaecology Department, Seberang Jaya Hospital, Penang, Malaysia
- Clinical Research Centre, Seberang Jaya Hospital, Penang, Malaysia
| | - I Looi
- Clinical Research Centre, Seberang Jaya Hospital, Penang, Malaysia
- Medical Department, Seberang Jaya Hospital, Penang, Malaysia
| | - K H Yuen
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Jahan N, Cathcart-Rake E, Vierkant RA, Larson N, Loprinzi C, O'Sullivan CC, Faubion S, Kuhle C, Vencill JA, Couch F, Olson JE, Ruddy KJ. Sexual Dysfunction in Patients With Metastatic Breast Cancer. Clin Breast Cancer 2024; 24:72-78.e4. [PMID: 37867114 DOI: 10.1016/j.clbc.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/07/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Sexual well-being is a key determinant of quality of life. Sexual dysfunction in patients with metastatic breast cancer (MBC) is understudied. PATIENTS AND METHODS Patients were eligible for this study if they participated in the Mayo Clinic Breast Disease Registry (MCBDR), had a diagnosis of de novo MBC, and responded to a question about sexual dysfunction at the baseline MCBDR survey. Participants reported their sexual dysfunction on a scale of 0 (no dysfunction) to 10 (severe dysfunction) at baseline and then annually for 4 years. Participants answered additional sexual symptom questions in years 2 and 4. Associations between patient attributes and the presence and severity of sexual dysfunction, changes in sexual dysfunction from baseline to subsequent surveys, and associations between specific sexual symptoms and severity of sexual dysfunction were assessed. RESULTS One hundred three patients with de novo MBC answered the sexual dysfunction question at baseline. The prevalence of any sexual dysfunction (score of 1-10) was 56.3% at baseline (n = 103), 57.1 % at year 1 (n = 77), 80.4% at year 2 (n = 46), 65.8% at year 3 (n = 38), and 85% at year 4 (n = 20). Vaginal dryness was reported by approximately 49% and 39% of patients in years 2 and 4 respectively. Vaginal dryness was associated with higher severity of sexual dysfunction. CONCLUSIONS Self-reported sexual dysfunction is frequent in women with de novo MBC. Vaginal dryness is a frequently reported treatable symptom associated with higher severity of sexual dysfunction. Clinicians should assess patients with MBC for sexual dysfunction and discuss potential treatment strategies.
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Affiliation(s)
- Nusrat Jahan
- Division of Hematology and Oncology, University Alabama at Birmingham, Birmingham, AL
| | | | - Robert A Vierkant
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Nicole Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | | | | | | | - Carol Kuhle
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer A Vencill
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Janet E Olson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Cid M, Gal J, Schiappa R, Azuar AS, Merello M, Delpech Y, Gosset M. Information and oncosexological management in breast cancer patients. Eur J Obstet Gynecol Reprod Biol 2023; 291:252-258. [PMID: 37944213 DOI: 10.1016/j.ejogrb.2023.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Breast cancer treatment is a particularly high-risk situation for the deterioration of sexual health, leading to an alteration in body image and physical deteriorations such as vaginal trophicity. The aim of this study was to evaluate the information received by patients concerning this alteration of their sexual health in relation to their treatment, and to identify their expectations and needs in terms of oncosexual management. STUDY DESIGN A bicentric qualitative retrospective study was conducted, involving women aged 18 to 80, treated for breast cancer by total or partial mastectomy after 2014 and having had a follow-up consultation between July and December 2019. Data were collected using medical files and a de-identified questionnaire sent by post or e-mail after obtaining consent. The main outcome measures were the proportion of patients who received informations about oncosexology and those who felt impact on their sexual health. RESULTS Of the 274 patients included in the study, 60% said they had received no information about the sexological side effects of their disease or treatment. Of these, 62.5% dared not talk about it during consultation. Patients were keen to receive oncosexological advice or treatment from a specialized nurse or doctor. In 76.1% of cases, patients declared that they had been sexually active in the year prior to their cancer diagnosis, compared with 54.94% after treatment. They reported a loss of femininity in 24% of cases, and 40.5% had no sexual desire. CONCLUSION Women treated for breast cancer report a lasting alteration in their body image and sexual activity. Information on the impact of the disease and its treatment on sexual health is inadequate, even though patients are keen to receive specialized care with professional sexology consultations. The impact of breast cancer on sexual health should systematically explained to the patients, especially as treatment options exist and can be offered.
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Affiliation(s)
- Marie Cid
- Department of Breast and Gynaecological Surgery, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06100 Nice, France
| | - Jocelyn Gal
- Department of Epidemiology, Biostatistics and Health Data, Centre Antoine-Lacassagne, Université Côte d'Azur, 33 avenue de Valombrose, 06100 Nice, France
| | - Renaud Schiappa
- Department of Epidemiology, Biostatistics and Health Data, Centre Antoine-Lacassagne, Université Côte d'Azur, 33 avenue de Valombrose, 06100 Nice, France
| | - Anne-Sophie Azuar
- Department of Gynecology and Obstetrics, Grasse Hospital Center, Chemin de Clavary, 06130 Grasse, France
| | - Marion Merello
- Department of Gynecology and Obstetrics, Grasse Hospital Center, Chemin de Clavary, 06130 Grasse, France
| | - Yann Delpech
- Department of Breast and Gynaecological Surgery, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06100 Nice, France
| | - Marie Gosset
- Department of Breast and Gynaecological Surgery, Centre Antoine Lacassagne, 33 avenue de Valombrose, 06100 Nice, France.
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Jacobsen S, Glavind-Kristensen M, Jensen AB, Forman A, Bor P. Vaginal CO 2 laser therapy for genitourinary syndrome in breast cancer survivors-VagLaser study protocol: a randomized blinded, placebo-controlled trial. BMC Cancer 2023; 23:1164. [PMID: 38031020 PMCID: PMC10685468 DOI: 10.1186/s12885-023-11656-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Vaginal CO2 laser therapy is a new treatment option for genitourinary syndrome of menopause. Its potential is particularly interesting in breast cancer survivors, where existing treatment options often are insufficient as hormonal treatment is problematic in these women. The objective of this study is to investigate the effectiveness of vaginal laser treatment for alleviation of genitourinary syndrome of menopause in breast cancer survivors treated with adjuvant endocrine therapy. The secondary objective is to explore the importance of repeated vaginal laser treatment and the long-term effects in this patient population. METHODS VagLaser consist of three sub-studies; a dose response study, a randomized, participant blinded, placebo-controlled study and a follow-up study. All studies include breast cancer survivors in adjuvant endocrine therapy, and are conducted at the Department of Obstetrics and Gynecology, Randers Regional Hospital, Denmark. The first participant was recruited on 16th of February 2023. Primary outcome is vaginal dryness. Secondary subjective outcomes are vaginal pain, itching, soreness, urinary symptoms and sexual function. Secondary objective outcomes are change in vaginal histology (punch biopsy), change in vaginal and urine microbiota, and change in vaginal pH. DISCUSSION More randomized controlled trials, with longer follow-up to explore the optimal treatment regimen and the number of repeat vaginal laser treatments for alleviation the symptoms of genitourinary syndrome of menopause in breast cancer survivors treated with endocrine adjuvant therapy, are needed. This study will be the first to investigate change in vaginal and urine microbiota during vaginal laser therapy in breast cancer survivors. TRIAL REGISTRATION ClinicalTrials.gov: NCT06007027 (registered 22 August, 2023). PROTOCOL VERSION Version 1, Date 13.11.2023.
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Affiliation(s)
- Sine Jacobsen
- Department of Obstetrics and Gynaecology, Randers Regional Hospital, Randers, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | | | - Anders Bonde Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Axel Forman
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Pinar Bor
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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Caruso S, Bruno MT, Boemi S, Palermo G, Mazza G, Caruso G. Vaginal health and quality of sexual life of postmenopausal women on hyaluronic acid and Biosaccharide Gum-1 vaginal gel. Taiwan J Obstet Gynecol 2023; 62:702-708. [PMID: 37678998 DOI: 10.1016/j.tjog.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy of daily vaginal gel containing hyaluronic acid (HA) and Biosaccharide Gum-1 (BG-1) on vulvovaginal atrophy (VVA) and on sexual function and quality of life (QoL). MATERIALS AND METHODS One hundred-four postmenopausal women with VVA were enrolled in the nonrandomized comparison cohort study. Of them, 50 women on HA/BG-1 participated in the study group and 54 women on lubricants/moisturizers on-demand as a control group. The primary endpoint was the efficacy of the vaginal gel on VVA evaluated by the Vaginal Health Index (VHI) score. Secondary endpoints included sexual behavior by the self-administered female sexual function index (FSFI) questionnaire, and quality of life (QoL), by the Short Form-36 questionnaire (SF-36). RESULTS All symptoms of AVV improved after 12 weeks of treatment in women on HA/BG-1. The VMI, although improved at the 12-week follow-up compared to baseline, it connoted a low estrogenic stimulation value. Sexual function improved significantly in women on HA/BG-1. Moreover, women reported a significant improvement in the somatic aspects of QoL. No benefits were obtained by the women in the control group. CONCLUSIONS Treatment with HA/BG-1 could have used in postmenopausal women who complain of vaginal dryness. The amelioration of VVA-related signs could improve sexual function and QoL.
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Affiliation(s)
- Salvatore Caruso
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; Research Group for Sexology, University of Catania, Catania, Italy.
| | - Maria Teresa Bruno
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy.
| | - Sara Boemi
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy.
| | - Gaia Palermo
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; Research Group for Sexology, University of Catania, Catania, Italy.
| | - Gabriele Mazza
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy; Research Group for Sexology, University of Catania, Catania, Italy.
| | - Giuseppe Caruso
- Department BIOMETEC, University of Catania, Catania, Italy; Research Group for Sexology, University of Catania, Catania, Italy.
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Warehime J, Carbone L, Gupta A, Francis S, Lenger SM. Use of coconut oil leads to multiple bladder foreign bodies. Int Urogynecol J 2023; 34:1659-1660. [PMID: 37060371 DOI: 10.1007/s00192-023-05536-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/30/2023] [Indexed: 04/16/2023]
Affiliation(s)
- Jenna Warehime
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Ob/Gyn and Women's Health, University of Louisville, 2nd floor, Chair's Suite, 550 S. Jackson Street, Louisville, KY, 40202, USA.
| | - Laurel Carbone
- Department of Ob/Gyn, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Ankita Gupta
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Ob/Gyn and Women's Health, University of Louisville, 2nd floor, Chair's Suite, 550 S. Jackson Street, Louisville, KY, 40202, USA
| | - Sean Francis
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Ob/Gyn and Women's Health, University of Louisville, 2nd floor, Chair's Suite, 550 S. Jackson Street, Louisville, KY, 40202, USA
| | - Stacy M Lenger
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Ob/Gyn and Women's Health, University of Louisville, 2nd floor, Chair's Suite, 550 S. Jackson Street, Louisville, KY, 40202, USA
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Crandall CJ, Larson JC, Ensrud KE, LaCroix AZ, Guthrie KA, Reed SD, Bhasin S, Diem S. Are serum estrogen concentrations associated with menopausal symptom bother among postmenopausal women? Baseline results from two MsFLASH clinical trials. Maturitas 2022; 162:23-30. [PMID: 35489132 DOI: 10.1016/j.maturitas.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/27/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate whether single measurements of serum estradiol (E2), estrone (E1) and sex hormone-binding globulin (SHBG) concentration distinguishes between women with and without menopausal symptom bother. STUDY DESIGN We analyzed baseline data from two clinical trials conducted in 2012-2017: MsFLASH 03 (178 peri-/post-menopausal women aged 40-62 years with bothersome vasomotor symptoms, mean age 54) and MsFLASH 05 (181 post-menopausal women aged 45-70 years with moderate-to-severe vulvovaginal symptoms, mean age 61). MAIN OUTCOME MEASURES Symptom bother (hot flushes or flashes, night sweats, sweating, aching in muscles and joints, change in sexual desire, vaginal dryness during intercourse, and avoiding intimacy) in the past month was assessed using the Menopause-Specific Quality of Life questionnaire. Using logistic regression, we calculated the area under the receiver operating characteristic curve (AUC) values for E1, E2, and SHBG concentration in relation to being at least somewhat bothered (symptom bother score ≥3) by each symptom within each trial study population. RESULTS AUC values (95% confidence interval) ranged between 0.51 (0.41-0.60) and 0.62 (0.53, 0.72) for MsFLASH 03 and between 0.51 (0.42, 0.59) and 0.64 (0.53, 0.75) for MsFLASH 05. There was little evidence of associations between serum hormone levels and bother by a given menopausal symptom. CONCLUSION These findings do not support the clinical utility of a single measurement of serum of E1, E2, or SHBG concentrations in differentiating between women who are bothered by a given menopausal symptom and those who are not.
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Ryu KJ, Yi KW, Kim YJ, Shin JH, Hur JY, Kim T, Seo JB, Lee KS, Park H. Artificial intelligence approaches to the determinants of women's vaginal dryness using general hospital data. J OBSTET GYNAECOL 2022; 42:1518-1523. [PMID: 35000545 DOI: 10.1080/01443615.2021.2013785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study is to analyse the determinants of women's vaginal dryness using machine learning. Data came from Korea University Anam Hospital in Seoul, Republic of Korea, with 3298 women, aged 40-80 years, who attended their general health check from January 2010 to December 2012. Five machine learning methods were applied and compared for the prediction of vaginal dryness, measured by a Menopause Rating Scale. Random forest variable importance, a performance gap between a complete model and a model excluding a certain variable, was adopted for identifying major determinants of vaginal dryness. In terms of the mean squared error, the random forest (1.0597) was much better than linear regression (17.9043) and artificial neural networks with one, two and three hidden layers (1.7452, 1.7148 and 1.7736, respectively). Based on random forest variable importance, the top-10 determinants of vaginal dryness were menopause age, age, menopause, height, thyroid stimulating hormone, neutrophils, years since menopause, lymphocytes, alkaline phosphatase and blood urea nitrogen. In addition, its top-20 determinants were peak expiratory flow rate, low-density lipoprotein cholesterol, white blood cells, monocytes, cancer antigen 19-9, creatinine, eosinophils, total cholesterol, triglyceride and amylase. Machine learning presents a great decision support system for the prediction of vaginal dryness. For preventing vaginal dryness, preventive measures would be needed regarding early menopause, the thyroid function and systematic inflammation.Impact StatementWhat is already known on this subject? Only a few studies have investigated the risk factors of vaginal dryness in middle-aged women. More research is to be done for finding its various risk factors, identifying its major risk groups and drawing its effective clinical implications.What do the results of this study add? This study is the first machine-learning study to predict women's vaginal dryness and analyse their determinants. The random forest could discuss which factors are more important for the prediction of vaginal dryness. Based on random forest variable importance, menopause age was the most important determinant of vaginal dryness and their association was discovered to be negative in this study. Vaginal dryness was closely associated with the height, rather than the body weight or body mass index. The importance rankings of blood conditions related to systematic inflammation were within the top-20 in this study: neutrophils, lymphocytes, white blood cells, monocytes and eosinophils.What are the implications of these findings for clinical practice and/or further research? Machine learning presents a great decision support system for the prediction of vaginal dryness. For preventing vaginal dryness, preventive measures would be needed regarding early menopause and systematic inflammation.
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Affiliation(s)
- Ki-Jin Ryu
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyong Wook Yi
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yong Jin Kim
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung Ho Shin
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jun Young Hur
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Tak Kim
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong Bae Seo
- Department of Biosciences, Mokpo National University, Muan-gun, Republic of Korea.,Department of Biomedicine, Health and Life Convergence Sciences, Mokpo National University, Jeonnam, Republic of Korea
| | - Kwang-Sig Lee
- AI Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyuntae Park
- Department of Obstetrics & Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
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Maris E, Salerno J, Hédon B, Mares P. [Management of vulvovaginal atrophy: Physical therapies. Postmenopausal women management: CNGOF and GEMVi clinical practice guidelines]. Gynecol Obstet Fertil Senol 2021; 49:414-419. [PMID: 33757917 DOI: 10.1016/j.gofs.2021.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION For some patients, local hormonal or non-hormonal treatments for genitourinary syndrome of menopause (SGUM) are contraindicated or insufficiently effective. Different physical therapies such as vaginal laser therapy, radiofrequency therapy, photobiomodulation therapy and local injection of hyaluronic acid, autologous fat (lipofilling) and platelet rich plasma (PRP) have been proposed as alternatives. OBJECTIVE The objective of this review was to elaborate guidelines for clinical practice regarding the physical therapies proposed for management of vulvovaginal atrophy (AVV). METHODS A systematic review of the literature on AVV management with physical therapies was conducted on Medline between January 2014 and December 2020. RESULTS Regarding vaginal laser therapy, there are few randomized controlled trials and no formal conclusions can be drawn. The fractional CO2 laser did not demonstrate its superiority over local estrogen therapy. The ERBIUM:YAG laser has not been studied in randomized controlled trials. The lack of follow-up on the vaginal laser and the series of cases reporting risks of vaginal stenosis or chronic pain do not encourage recommending it as a first-line treatment. The literature concerning other physical treatments of AVV is weak concerning the genital area. CONCLUSION CO2 or ERBIUM:YAG vaginal lasers are not the first-line treatment for AVV (grade C). In patients with a contraindication to local hormonal treatments, treatment with vaginal CO2 laser or ERBIUM:YAG may be considered after information about the risks (burn, stenosis, pain) (expert opinion). The other physical treatments of SGUM have to be evaluated.
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Affiliation(s)
- E Maris
- Department of Obstetrics and Gynecology, Montpellier University Hospital, Université Montpellier, Montpellier, France.
| | - J Salerno
- Department of Obstetrics and Gynecology, Nîmes University Hospital, University Montpellier, Nîmes, France
| | - B Hédon
- Department of Obstetrics and Gynecology, Montpellier University Hospital, Université Montpellier, Montpellier, France
| | - P Mares
- Department of Obstetrics and Gynecology, Nîmes University Hospital, University Montpellier, Nîmes, France
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Pompei LM, Wender MCO, Kulak J, Pires I, Suvarna Y, Nappi RE. Impact of postmenopausal vaginal discomfort on sex and relationships in Brazil: the CLOSER survey. Climacteric 2021; 24:593-599. [PMID: 33899627 DOI: 10.1080/13697137.2021.1908988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The CLOSER (CLarifying Vaginal Atrophy's Impact On SEx and Relationships) survey investigated how postmenopausal vaginal atrophy (VA) affects relationships between Brazilian women and male partners. METHODS Postmenopausal women (age 55-65 years) with VA, and male partners of women with the condition, completed an online survey on the impact of VA and local estrogen treatment on intimacy and relationships. RESULTS A total of 360 women and 352 men from Brazil were included. Women (83%) and men (91%) reported that they were comfortable discussing VA with their partners. Women's key source of information on VA was health-care providers (HCPs), but 44% felt that not enough information is available. VA caused 70% of women to avoid sexual intimacy and resulted in less satisfying sex. VA had a negative impact on women's feelings and self-esteem. Women (76%) and men (70%) both reported that treatment with vaginal estrogen improved their sexual relationship, primarily by alleviating women's pain during sex. Women (56%) and men (59%) felt closer to each other after treatment. CONCLUSIONS VA had a negative impact on sexual relationships for both women and men in Brazil, and reduced women's self-confidence. Vaginal hormone therapy improved couples' sexual relationships. A proactive attitude of HCPs is essential to educate women on VA and the potential benefits of treatment.
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Affiliation(s)
- L M Pompei
- Obstetric and Gynecology Department, Faculdade de Medicina do ABC, São Paulo, Brazil
| | - M C O Wender
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - J Kulak
- Postgraduate Program, Department of Obstetrics and Gynecology, Federal University of Parana, Curitiba, Brazil
| | - I Pires
- Besins Healthcare, São Paulo, Brazil
| | - Y Suvarna
- Global Medical Affairs, Novo Nordisk Global Business Services (GBS), Bangalore, India
| | - R E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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Al-Ezzi M, Tappuni AR, Khan KS. The impact of Sjӧgren's syndrome on the quality of sexual life of female patients in the UK: a controlled analysis. Rheumatol Int 2021. [PMID: 33688999 DOI: 10.1007/s00296-021-04830-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/02/2021] [Indexed: 11/25/2022]
Abstract
Mucosal dryness and dyspareunia are symptoms that may significantly affect women with primary Sjӧgren syndrome (pSS). We investigated whether vaginal dryness is correlated with sexual function, and the impact may have on the quality of life (QoL) and mental health well-being in pSS patients. Ethically approved comparative cross-sectional study was designed to assess sexual function using the Female Sexual Function Index (FSFI) in 65 pSS female patients vs 62 sex-matched controls. The effect of vaginal dryness and fatigue on sexual function was investigated. Vaginal dryness was correlated with oral dryness estimated by salivary flow rate and the Clinical Oral Dryness Score to investigate whether genital dryness is indicative of general mucosal dryness in pSS. Validated questionnaires were used to investigate the effect of sexual function on QoL and mental health well-being. The number of sexually active pSS participants was significantly less than in the control group (28/65 vs 42/62, p < 0.05). The sexual function was significantly impaired in the pSS group (mean FSFI = 19 vs 28.3, p < 0.05). There was no significant association between self-reported vaginal dryness and oral dryness or sexual function. The open-ended questions showed that the most troublesome symptom reported by pSS patients was oral dryness (43%, n = 28/65) followed by fatigue (31%, n = 20/65). Sexual dysfunction had a negative impact on QoL and the mental health well-being of pSS patients in all aspects, especially on the quality of social life (β = 0.7, p = 0.02). Addressing sexual dysfunction can potentially improve the QoL of pSS patients significantly, especially their social well-being.
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Werfalli S, Drangsholt M, Johnsen JM, Jeffrey SK, Dakhil S, Presland RB, LeResche L. Saliva flow rates and clinical characteristics of patients with burning mouth syndrome: A case-control study. Int J Oral Maxillofac Surg 2021; 50:1187-1194. [PMID: 33640241 DOI: 10.1016/j.ijom.2021.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 12/07/2020] [Accepted: 01/22/2021] [Indexed: 12/20/2022]
Abstract
Burning mouth syndrome (BMS) is a chronic pain condition that most commonly affects postmenopausal women older than 50 years of age. Xerostomia is a common complaint among BMS patients. However, previous studies showed inconsistent findings regarding saliva flow rate reduction. This study examined saliva flow rates, degree of mucosal hydration, xerostomia, and clinical characteristics in BMS patients compared with healthy controls. Unstimulated whole saliva (USWS) was collected through passive drooling; residual mucosal saliva (RMS) was collected using filter paper strips. Stimulated whole saliva (SWS) was collected while chewing on gum base. Oral exam and self-report data were collected. A total of 50 women (22 BMS cases and 28 healthy controls) aged 50 years or older were included in the analysis of this study. Mean age was 62 years for cases and 56 years for controls (P=0.05). Compared with controls, cases had significantly lower USWS flow rates (P<0.001) and had a higher prevalence of xerostomia (P=0.001), gastrointestinal disease (P<0.001), and vaginal dryness (P=0.01). These data show that oral and vaginal dryness are common among BMS patients. Further studies are needed to investigate potential pathophysiological mechanisms related to the quality of saliva and mucosal barrier status among these patients.
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Affiliation(s)
- S Werfalli
- Oral Medicine Department, University of Washington, Seattle, WA, USA.
| | - M Drangsholt
- Oral Medicine Department, University of Washington, Seattle, WA, USA
| | - J M Johnsen
- Oral Medicine Department, University of Washington, Seattle, WA, USA
| | - S K Jeffrey
- Oral Medicine Department, University of Washington, Seattle, WA, USA
| | - S Dakhil
- Oral Medicine Department, University of Washington, Seattle, WA, USA
| | - R B Presland
- Oral Medicine Department, University of Washington, Seattle, WA, USA
| | - L LeResche
- Oral Medicine Department, University of Washington, Seattle, WA, USA
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16
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Salvatore S, Nappi RE, Casiraghi A, Ruffolo AF, Degliuomini R, Parma M, Leone Roberti Maggiore U, Athanasiou S, Candiani M. Microablative Fractional CO 2 Laser for Vulvovaginal Atrophy in Women With a History of Breast Cancer: A Pilot Study at 4-week Follow-up. Clin Breast Cancer 2021; 21:e539-e546. [PMID: 33745867 DOI: 10.1016/j.clbc.2021.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/24/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Breast cancer (BC) is the most common female cancer worldwide. Menopausal symptoms are a well-known side effect in women with BC and have a significant negative impact on quality of life (QoL) and sexuality. Nowadays, hormonal replacement therapy and local estrogens are the most common prescriptions to treat vulvovaginal (VVA) symptoms. However, in women with a history of BC, proper therapy for such conditions remains an often inadequately addressed clinical problem. A treatment with microablative fractional CO2 laser (MLT) can produce a remodeling of the vaginal connective tissue without causing damage to the surrounding tissue. The aim of this pilot study is to assess the efficacy and safety of MLT for treating VVA symptoms in women with a history of BC at 20-week follow-up since the first laser treatment. PATIENTS AND METHODS Women with BC and VVA symptoms were enrolled in the study and treated with 5 laser applications (one every 4 weeks). The rate of satisfied patients at 20 weeks of follow-up was evaluated with a 5-point Likert scale. Changes of the Vaginal Health Index (VHI) after treatment was compared with baseline. Effects of the laser treatment on VVA symptoms was measured using a 10-cm visual analog scale (VAS). Changes in overall QoL were assessed with a generic QoL questionnaire: the Short Form 12 (SF-12) that we analyzed considering its physical (PCS12) and mental (MCS12) domains. Sexual function was evaluated by the Female Sexual Function Index (FSFI). RESULTS In this prospective cohort study, we enrolled 40 women with a history of BC and who currently were or (Group 2) who had been (Group 1) on treatment with endocrine therapy for their condition. Six (15.0%) women were very satisfied, 25 (62.5%) were satisfied, 6 (15.0%) were uncertain, and 3 (7.5%) were dissatisfied with the MLT. VVA symptoms and VHI improved significantly at 20 weeks from baseline (P < .05) with no differences between the 2 groups (P > .05). In terms of QoL measured by the SF-12, the PCS12 and the MCS12 significantly improved at the 20-week follow-up. A significant improvement in total FSFI and in all domains was reported in both study groups (P < .05) with no differences between groups (P > .05). CONCLUSION MLT was safe and effective in treating VVA symptoms in women with a history of BC, irrespective of being previously or currently on endocrine therapies.
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Affiliation(s)
- Stefano Salvatore
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rossella E Nappi
- Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS Policlinico S. Matteo Foundation and Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Arianna Casiraghi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Alessandro F Ruffolo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rebecca Degliuomini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Parma
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Stavros Athanasiou
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Massimo Candiani
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Gynecology and Obstetrics, Urogynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Quick AM, Dockter T, Le-Rademacher J, Salani R, Hudson C, Hundley A, Terstriep S, Streicher L, Faubion S, Loprinzi CL, Coleman JS, Wang KC, Lustberg M. Pilot study of fractional CO 2 laser therapy for genitourinary syndrome of menopause in gynecologic cancer survivors. Maturitas 2020; 144:37-44. [PMID: 33358206 DOI: 10.1016/j.maturitas.2020.10.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/19/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The objectives of this study were to evaluate the feasibility and efficacy of fractional CO2 laser therapy in gynecologic cancer survivors. METHODS This was a pilot, multi-institutional randomized sham-controlled trial of women with gynecologic cancers with dyspareunia and/or vaginal dryness. Participants were randomized to fractional CO2 laser treatment or sham laser treatment. The primary aim was to estimate the proportion of patients who had improvement in symptoms based on the Vaginal Assessment Scale (VAS). Secondary aims included changes in sexual function assessed using the Female Sexual Functioning Index (FSFI) and urinary symptoms assessed using the the Urinary Distress Inventory (UDI-6). RESULTS Eighteen women participated in the study, ten in the treatment arm and eight in the sham arm. The majority of participants had stage I (n = 11, 61.1 %) or II (n = 3, 16.7 %) endometrial cancer with adenocarcinoma histology (n = 9, 50 %). In total, 15 (83.3 %) of the participants completed all treatments and follow-up visit. There was no difference in the change in the median VAS score from baseline to follow-up. However, there was an improvement in change in the median total FSFI score with treatment compared with sham (Δ 6.5 vs -0.3, p = 0.02). The change in the median UDI-6 score was lower in the treatment arm (Δ -14.6 vs -2.1, p = 0.17), but this was not statistically significant. There were no reported serious adverse events. CONCLUSIONS Fractional CO2 laser therapy is feasible in gynecologic cancer survivors, with preliminary evidence of safety. In addition, there was preliminary evidence of improvement in sexual function compared with sham treatment. Clinicaltrial.gov Identifier: NCT03372720 (OSU-17261; NCI-2017-02051).
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Affiliation(s)
- Allison M Quick
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH, United States.
| | - Travis Dockter
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | | | - Ritu Salani
- David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Catherine Hudson
- The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Andrew Hundley
- The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Lauren Streicher
- Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, United States
| | | | | | - Jenell S Coleman
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Karen C Wang
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Maryam Lustberg
- The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital, Columbus, OH, United States
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Sindou-Faurie T, Louis-Vahdat C, Oueld Es Cheikh E, Canlorbe G, Mergui JL, Uzan C, Azaïs H. Evaluation of the efficacy of fractional CO 2 laser in the treatment of vulvar and vaginal menopausal symptoms. Arch Gynecol Obstet 2020; 303:955-963. [PMID: 33179118 DOI: 10.1007/s00404-020-05868-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The objective of this study was to evaluate the efficacy of fractional CO2 laser to manage vulvar and vaginal symptoms of Genitourinary Syndrome of Menopause (GSM) in postmenopausal women. METHODS All postmenopausal women with symptoms of GSM undergoing fractional CO2 laser treatment in our centers were asked to fill out a validated quality of life questionnaire (Global Quality of Life Questionnaire), Visual Analog Scale (VAS) for symptoms, a questionnaire on overall discomfort related to pelvic floor symptoms, and the Female Sexual Function Index (FSFI) at several points: before each session (three sessions at monthly intervals) and one 3 months after treatment completion. Statistical analysis compared pre-therapy data and data at 3 months of treatment. RESULTS Forty-six women were included with a mean age of 57.3 years (± 11.1 years). A significant improvement was demonstrated in vaginal dryness (p = 6.34 10-6) and for symptoms of stress urinary incontinence (p = 0.043). Among sexually active patients, there was a significant improvement in the degree of symptom discomfort affecting their satisfaction (p = 0.007), dyspareunia (p = 0.001) and sensitivity during sexual intercourse (p = 0.001). Significantly, more women were able to achieve (p = 0.026) and maintain (p = 0.018) lubrication during intercourse. CONCLUSION CO2 laser treatment seems to improve the quality of life and sexual health of patients as well as GSM symptoms at 3 months of treatment; long-term reevaluation is necessary to demonstrate that improvement persists over time.
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Affiliation(s)
- T Sindou-Faurie
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - C Louis-Vahdat
- Medicine Cabinet, 126 boulevard Saint-Germain, 75006, Paris, France
| | - E Oueld Es Cheikh
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - G Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - J L Mergui
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - C Uzan
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - H Azaïs
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 47-83 boulevard de l'hôpital, 75013, Paris, France.
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He Y, Tian J, Oddy WH, Blizzard L, Dwyer T, Hickey M, Venn AJ. The associations of childhood adiposity with menopausal symptoms in women aged 45-49 years: An Australian Cohort Study. Maturitas 2020; 143:81-88. [PMID: 33308641 DOI: 10.1016/j.maturitas.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/18/2020] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To examine the associations of childhood adiposity with menopausal symptoms in women aged 45-49 years. STUDY DESIGN National population-based cohort study of 334 girls prospectively followed from childhood (aged 11-15) through to midlife (aged 45-49). Childhood overweight and obesity were defined by international age- and sex-specific standards for body mass index (BMI), and abdominal obesity was defined as waist/height ratio≥0.5. MAIN OUTCOME MEASURES Vasomotor symptoms (VMS), vaginal dryness, total menopausal symptoms and domain-specific symptoms (somatic, psychological and urogenital) were measured during 2018-19 using the Menopause Rating Scale (MRS) and classified as none, mild, moderate or severe. RESULTS The prevalence of mild, moderate and severe VMS was 24.0 %, 9.0 % and 3.9 %, and of vaginal dryness was 12.6 %, 4.8 % and 2.4 %. No significant associations of childhood overweight/obesity or abdominal obesity with VMS or vaginal dryness were found after adjustment for childhood age, follow-up length, smoking, socioeconomic status and diet quality. Childhood overweight/obesity was associated with increased risks of more severe total (RR:1.17, 95 % CI:1.02-1.36), psychological (RR:1.19, 95 % CI:1.04-1.35) and urogenital (RR:1.29, 95 % CI:1.14-1.46) symptoms measured using the MRS. Associations with childhood abdominal obesity were mostly stronger with more severe total (RR:2.19, 95 % CI:1.48-3.23), somatic (RR:1.52, 95 % CI:1.15-2.02), psychological (RR:1.21, 95 % CI:1.04-1.42) and urogenital (RR:2.11, 95 % CI:1.39-3.20) symptoms. CONCLUSIONS Childhood adiposity was not associated with increased risks of more severe VMS or vaginal dryness in women aged 45-49 years. Childhood adiposity, especially abdominal obesity, was associated with more severe total, somatic, psychological and urogenital symptoms. However, the association between these symptoms and menopause is not established.
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Affiliation(s)
- Ye He
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jing Tian
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Wendy H Oddy
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Terence Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Martha Hickey
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Australia; The Royal Women's Hospital, Victoria, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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Chemerinski A, Cameron K, Sammel M, Ginsberg J, Carlson C, Gracia C. Relationship of menopausal symptoms and ovarian reserve in reproductive-aged cancer survivors. J Cancer Surviv 2020; 14:607-13. [PMID: 32323140 DOI: 10.1007/s11764-020-00857-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study sought to evaluate the prevalence of menopausal symptoms in a population of reproductive-aged women remote from cancer therapy compared with a group of healthy similar-aged controls and with a cohort of late reproductive-aged (LR) controls. METHODS Participants were assessed for symptoms of menopause, early follicular phase hormones, and ultrasound examinations. Menopausal symptoms were analyzed in exposed participants and controls using χ2 analyses, Wilcoxon-Mann Whitney tests, and multivariable logistic regression models. RESULTS One hundred seventy cancer survivors, 135 similar-aged controls, and 71 LR controls were followed prospectively for an average of 38 months. Compared with similar-aged controls, a greater proportion of survivors reported vasomotor symptoms at some point over the study period (35% vs 19%, p < 0.01), and this proportion was similar to LR controls (44%, p = 0.22). Survivors were more likely to be bothered by vaginal dryness (27%) than similar-aged controls (16%, p = 0.02) or LR controls (14%, p = 0.02). FSH levels were 38.4% higher in those with vasomotor symptoms compared with those without symptoms (p = 0.021). CONCLUSIONS Reproductive-aged cancer survivors have a higher prevalence of vasomotor symptoms and vaginal dryness than their similar-aged peers. IMPLICATIONS FOR CANCER SURVIVORS Providers should be attuned to the high prevalence of menopausal symptoms in cancer survivors.
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Yodplob T, Sirisopana K, Jongwannasiri M, Sirisreetreerux P, Viseshsindh W, Kochakarn W. Local treatment with a polycarbophil-based cream in postmenopausal women with genitourinary syndrome of menopause. Int Urogynecol J 2021; 32:317-22. [PMID: 32206846 DOI: 10.1007/s00192-020-04282-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/06/2020] [Indexed: 01/01/2023]
Abstract
Introduction and hypothesis Genitourinary syndrome of menopause (GSM) is a common problem associated with lower urinary tract and gynecological symptoms due to the decrease in estrogen production in postmenopausal women. Topical estrogen therapy is shown to improve these symptoms; nonetheless, there are limited data on the efficacy of nonhormonal moisturizers in these patients. Methods A prospective cohort study was conducted to compare the symptoms of GSM before and after treatment with a polycarbophil-based cream in 42 women. The quality of life (QoL) and sexual scores were obtained from the Thai version of the International Consultation on Incontinence Modular Questionnaire-Lower Urinary Tract Symptoms (ICIQ-LUTS) along with uroflow measurements before and 4 and 12 weeks after treatment. Results Significant improvements in ICIQ-LUTSqol scores were observed after 4 weeks (9.38 ± 7.47 vs 6.76 ± 5.77; p = 0.017) and 12 weeks (10.03 ± 7.49 vs 5.97 ± 4.02; p = 0.002) when compared with the baseline values before treatment. The ICIQ-LUTS sexual scores were also improved after treatment at 4 weeks (2.29 ± 2.26 vs 0.88 ± 1.34; p < 0.001) and 12 weeks (2.13 ± 2.22 vs 0.42 ± 0.81; p < 0.001) compared with the baseline scores. No differences in ICIQ-LUTSqol and sexual scores were observed between the 4- and 12-week treatment groups. Conclusion The polycarbophil-based cream improved the overall LUTS and sexual symptoms in the patients with GSM, thus indicating that the nonhormonal polycarbophil-based cream may prove effective for the treatment for women with this condition.
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Goncharenko V, Bubnov R, Polivka J, Zubor P, Biringer K, Bielik T, Kuhn W, Golubnitschaja O. Vaginal dryness: individualised patient profiles, risks and mitigating measures. EPMA J 2019; 10:73-79. [PMID: 30984316 DOI: 10.1007/s13167-019-00164-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/14/2019] [Indexed: 11/25/2022]
Abstract
Vaginal dryness (VD) affects both pre- and postmenopausal women at any age. Since the hormonal regulation changes during the climacteric period are considered as being the main course of the VD, affected women prefer not to talk about the problem. However, the problem does exist, and unfortunately if any, relatively minor group in the population possesses the health literacy at sufficient level to understand that VD is a suboptimal health condition which carries a multi-factorial character. Thereby, some of the contributing factors are clearly preventable and, therefore, if treated properly, have a potential to milden the VD. Current chapter demonstrates specific signs and symptoms of Flammer syndrome in women suffering from vaginal dryness, although individualised patient profiles clearly discriminate between pre- and postmenopausal women regarding the subgroup-specific symptoms. Noteworthy, about 20% of the VD patients involved in the study notify a delayed or even impaired wound healing observed for themselves over a couple of years. Optimising modifiable risk factors accompanying FS phenotype at the level of primary prevention is strongly recommended. Individualised patient profiles provide important information for VD mitigating measures tailored to the person. Further, future projects should essentially deal with the complexity of vulvar-vaginal dryness as part of the Sicca syndrome in individuals with FS phenotype, in order to prevent genital female cancers which may occur at any age. In contrast to the human papilloma virus as possible trigger of the disease, the role of the vulvar-vaginal dryness as an important risk factor is strongly underestimated in currently applied diagnostic and treatment approaches.
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Affiliation(s)
- Vadym Goncharenko
- Gynaecologic Department, Clinical Hospital "Pheophania", Kyiv, Ukraine
| | - Rostyslav Bubnov
- Ultrasound Department, Clinical Hospital "Pheophania", Kyiv, Ukraine
- 3Zabolotny Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Kyiv, Ukraine
| | - Jiri Polivka
- 4Department of Histology and Embryology and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
- 5Department of Neurology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Pavol Zubor
- 6Department of Obstetrics and Gynaecology, Jessenius Faculty of Medicine, Martin University Hospital, Martin, Slovak Republic
- 7Division of Oncology, Biomedical Centre Martin, Jessenius Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Kamil Biringer
- 6Department of Obstetrics and Gynaecology, Jessenius Faculty of Medicine, Martin University Hospital, Martin, Slovak Republic
| | - Tibor Bielik
- 6Department of Obstetrics and Gynaecology, Jessenius Faculty of Medicine, Martin University Hospital, Martin, Slovak Republic
| | - Walther Kuhn
- Centre of Obstetrics, Gynaecology and Gynaecologic Oncology, DonauIsar Klinikum Deggendorf-Dingolfing, Landau, Germany
| | - Olga Golubnitschaja
- 9Radiological clinic, UKB, Rheinische Friedrich-Wilhelms-University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
- 10Breast Cancer Research Centre, UKB, Rheinische Friedrich-Wilhelms-University of Bonn, Bonn, Germany
- 11Centre for Integrated Oncology, UKB, Cologne-Bonn, Rheinische Friedrich-Wilhelms-University of Bonn, Bonn, Germany
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Jardin I, Louis-Vahdat C, Canlorbe G, Mergui JL, Uzan C, Azaïs H. [How I do? a treatment with fractional CO 2 LASER for vulvovaginal atrophy symptoms in menopausal women]. ACTA ACUST UNITED AC 2018; 46:735-739. [PMID: 30266539 DOI: 10.1016/j.gofs.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Indexed: 11/17/2022]
Affiliation(s)
- I Jardin
- Service de chirurgie et oncologie gynécologique et mammaire, médecine Sorbonne université, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | | | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, médecine Sorbonne université, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-L Mergui
- Service de chirurgie et oncologie gynécologique et mammaire, médecine Sorbonne université, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, médecine Sorbonne université, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France
| | - H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, médecine Sorbonne université, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, AP-HP, 47/83, boulevard de l'Hôpital, 75013 Paris, France.
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Archer DF, Labrie F, Montesino M, Martel C. Comparison of intravaginal 6.5mg (0.50%) prasterone, 0.3mg conjugated estrogens and 10μg estradiol on symptoms of vulvovaginal atrophy. J Steroid Biochem Mol Biol 2017; 174:1-8. [PMID: 28323042 DOI: 10.1016/j.jsbmb.2017.03.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 03/14/2017] [Accepted: 03/17/2017] [Indexed: 11/26/2022]
Abstract
The objective is to compare the effect of intravaginal dehydroepiandrosterone (DHEA, prasterone), conjugated equine estrogens (CEE) and estradiol (E2) on moderate to severe dyspareunia and/or vaginal dryness. In a review of available data, independent prospective, randomized, double-blind and placebo-controlled Phase III 12-week clinical trials involved daily administration of 6.5mg (0.50%) prasterone, daily (21days on/7days off) 0.3mg CEE, twice weekly 0.3mg CEE or 10μg E2 daily for 2 weeks followed by twice weekly for 10 weeks. Vulvovaginal atrophy (VVA) symptoms were evaluated by questionnaires. The total severity score of dyspareunia decreased from baseline by 1.27 to 1.63 units with prasterone treatment, 1.4 with CEE and 1.23 in one statistically significant study with E2 (combined symptoms). Decreases over placebo ranged from 0.35 to 1.21 with prasterone, 0.7 to 1.0 with CEE and 0.33 for the E2 study. The total decreases in vaginal dryness severity ranged from 1.44 to 1.58 units for prasterone, 1.1 unit for CEE and 1.23 unit for E2. The decreases over placebo of vaginal dryness intensity ranged from 0.30 to 0.43 unit for prasterone, 0.40 unit for CEE and 0.33 for the E2 study with combined symptoms. Daily 6.5mg (0.50%) prasterone appears to be at least as efficacious as 0.3mg CEE or 10μg E2 for treatment of the VVA symptoms. In summary, the beneficial effects on the VVA symptomatology can be obtained by the addition of a small amount of intravaginal prasterone to compensate for the low serum concentration of prasterone observed in the majority of women after menopause without concerns about systemic effects.
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Affiliation(s)
- David F Archer
- CONRAD Clinical Research Center, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
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25
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Henneicke-von Zepelin HH, Williams R, Havemeister W, Wigger-Alberti W, Nolte KU. Clinical trial shows lasting function of a new moisturizing cream against vaginal dryness. Wien Med Wochenschr 2017; 167:189-95. [PMID: 28091974 DOI: 10.1007/s10354-016-0536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/15/2016] [Indexed: 11/27/2022]
Abstract
Vaginal dryness and associated symptoms may occur in women of any age and are a frequent burden after menopause. The North American Menopause Society recommends long-acting non-hormonal vaginal creams as first-line therapy. A new type of such creams was developed (Remifemin® FeuchtCreme in Austria and Germany). This hormone-free cream contains hamamelis virginiana distillate and well-established vaginal cream ingredients. We explored its physical function and tolerability in an open interventional clinical trial. 20 postmenopausal women (54 to 76 years, median 60) treated their vaginal dryness using this cream once daily for 7 days and reported about their symptoms before, 4 to 8 h after first and 14 to 22 h after last application. A physician assessed tolerability and local physical function. All patients completed the study. Local physical function significantly improved from dryness at baseline (mean 4.0 ± SD 1.8) to a normal moisture level, on average (6.3 ± 2.1 after first, 6.7 ± 2.1 after last application, p = 0.0001). Subjective assessment of a feeling vaginal dryness showed a significant improvement at both times (p = 0.0001). Onset and duration of feeling moisturized were reported to be 0 to 2 min and 11.3 ± 6.9 h after application. All women reported vaginal dryness at baseline. 55 and 80% of patients reported no dryness after first application and at the end of the investigation. The cream was seen at the application site for up to 21 h. Tolerability assessments did not reveal any relevant change over time. There were four adverse events in 4 patients, all not serious and of mild intensity: urinary urgency (2), diarrhoea (1) and mild spotting after first application (1). The latter was caused by the dry surface of the applicator and was avoided by moisturizing the surface of the applicator at subsequent applications. In conclusion, these study results indicate a well-tolerated and long-acting function of this new vaginal moisturizing cream. Further clinical research in more patients will follow.
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Nappi RE, Benedetto C, Campolo F, Martella S, Tosti C, Cianci A, Caruso S, Guaschino S, Grimaldi E, Bagolan M, Sardina M. Efficacy, tolerability and safety of a new medical device, Monurelle Biogel(®) vaginal gel, in the treatment of vaginal dryness: a randomized clinical trial in women of reproductive age. Eur J Obstet Gynecol Reprod Biol 2016; 203:82-8. [PMID: 27261817 DOI: 10.1016/j.ejogrb.2016.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 05/01/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To prove the efficacy, tolerability and safety of Monurelle Biogel(®) (ZP-025) vaginal gel, which contains a purified, dialyzed, lyophilized bovine colostrum, in women of reproductive age suffering from vaginal dryness. DESIGN Randomized clinical trial (RCT) (Z7213M01). SETTING Five University Gynaecological Units. PATIENTS Ninety-five subjects were allocated at random to receive either ZP-025 (n=48) for about 23 intermenstrual days (1 or 2 times/daily intra-vaginally) or no treatment (lubricants on demand were allowed). MAIN OUTCOME MEASURES Change of Verbal Rating Scale (VRS) total and single score for vaginal symptoms, Vaginal Health Index (VHI) score, Female Sexual Function index (FSFI) and Female Sexual Distress Scale-revised (FSDS-R) scores. RESULTS A total number of 85 subjects was evaluable for primary analyses. Symptoms (VRS) of vaginal discomfort improved significantly already after 11 days, as compared to the control arm (p<0.0001). The mean VHI score was also significantly higher in ZP-025 group (p<0.001) at the end of the study. The analysis of covariance with the baseline value as covariate carried out on the FSFI Total Score showed a statistically significant difference in favour of the ZP-025 arm (p<0.032). A shift from presence to absence of sexual distress (≤11 points) was more prominent in the ZP-025 arm [10 subjects (40%) in the ZP-025 arm (p<0.0001) and 6 subjects (21.4%) in the control arm (p=0.01)]. Women reported a compliance rate of 100% for one ZP-025 application/day. Local tolerability of ZP-025 was excellent or good in 82.9% of the subjects. CONCLUSIONS The present multicentre RCT supports the use of Monurelle Biogel(®) in women of reproductive age reporting symptoms of vaginal dryness. A positive impact on vaginal health and sexual function was also evident.
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Affiliation(s)
- Rossella E Nappi
- Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Italy; Dept. of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
| | - Chiara Benedetto
- University Gynaecology and Obstetrics 1, Sant'Anna Hospital, Turin, Italy
| | - Federica Campolo
- University Gynaecology and Obstetrics 1, Sant'Anna Hospital, Turin, Italy
| | - Silvia Martella
- Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Italy; Dept. of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Claudia Tosti
- Obstetrics and Gynaecology Clinic, University of Siena, Italy
| | - Antonio Cianci
- Obstetrics and Gynaecology Clinic, Polyclinic of Catania, Italy
| | | | | | - Eva Grimaldi
- Obstetrics and Gynaecology Clinical, University of Trieste, Italy
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Abstract
The menopause transition is associated with various symptoms, which can interact to produce morbidity. Vasomotor symptoms are the most commonly reported, but vaginal dryness/dyspareunia, sleep difficulties and adverse mood changes have all been shown to worsen as women approach menopause. For postmenopausal women changes in cognition are more likely to be related to aging and not to hormones. This article reviews the symptoms of hot flashes (vasomotor symptoms), vaginal dryness/dyspareunia, adverse mood, poor sleep/insomnia, and cognitive complaints, describing their epidemiology, diagnosis, and treatment. This article thus reviews the epidemiology, pathophysiology, diagnosis, and treatment of these common menopausal symptoms.
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Affiliation(s)
- Nanette Santoro
- Department of Obstetrics & Gynecology, University of Colorado School of Medicine, 12631 East 17th Avenue, AO1, Room 4010, Aurora, CO 80045, USA.
| | - C Neill Epperson
- Department of Psychiatry Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104-3309, USA
| | - Sarah B Mathews
- Department of Psychiatry Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104-3309, USA
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28
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Portman D, Palacios S, Nappi RE, Mueck AO. Ospemifene, a non-oestrogen selective oestrogen receptor modulator for the treatment of vaginal dryness associated with postmenopausal vulvar and vaginal atrophy: a randomised, placebo-controlled, phase III trial. Maturitas 2014; 78:91-8. [PMID: 24679891 DOI: 10.1016/j.maturitas.2014.02.015] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 02/25/2014] [Accepted: 02/28/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of ospemifene, a novel selective oestrogen receptor modulator, in the treatment of vaginal dryness in postmenopausal women with vulvovaginal atrophy (VVA). STUDY DESIGN A 12 week, multicentre, randomised, double-blind, parallel-group phase III study of women (40-80 years) with VVA and self-reported vaginal dryness as their most bothersome symptom. MAIN OUTCOME MEASURES The co-primary efficacy endpoints were the change from baseline to Week 12 in (1) percentage of parabasal cells in the maturation index (MI), (2) percentage of superficial cells in the MI, (3) vaginal pH, and (4) severity of vaginal dryness. Safety assessments included physical examination, cervical Papanicolaou test and clinical laboratory analyses. Endometrial thickness and histology was also assessed. RESULTS A total of 314 women were randomised to once-daily ospemifene 60 mg/day (n=160) or placebo (n=154). Significant improvements in the percentages of parabasal and superficial cells in the MI and vaginal pH were observed with ospemifene compared with placebo (p<0.001 for all parameters). The mean change from baseline in severity score of vaginal dryness reported by women receiving ospemifene compared with those receiving placebo approached statistical significance (p=0.080). Improvements in each of the four co-primary endpoints with ospemifene were statistically significant compared to placebo in the per protocol population. The majority of treatment-emergent adverse events were considered mild to moderate in severity. CONCLUSIONS Once-daily oral ospemifene 60 mg was effective for the treatment of VVA in postmenopausal women with vaginal dryness.
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Affiliation(s)
- D Portman
- Columbus Center for Women's Health Research, Columbus, OH 43213, USA.
| | - S Palacios
- Instituto Palacios de Salud y Medicina de la Mujer, c/Antonio Acuña n°9, 28009 Madrid, Spain.
| | - R E Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, University of Pavia, Piazzale Golgi 2, 27100 Pavia, Italy.
| | - A O Mueck
- University Women's Hospital, Tübingen, Germany.
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