Management of vulvovaginal atrophy-related sexual dysfunction in postmenopausal women: an up-to-date review.

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Menopause (New York, N.Y.) (Impact Factor: 3.08). 01/2012; 19(1):109-17. DOI: 10.1097/gme.0b013e31821f92df
Source: PubMed

ABSTRACT Menopause and its transition represent significant risk factors for the development of vulvovaginal atrophy-related sexual dysfunction. The objective of this study was to review the hormonal and nonhormonal therapies available for postmenopausal women with vulvovaginal atrophy-related sexual dysfunction, focusing on practical recommendations through a literature review of the most relevant publications in this field.
This study is a literature review.
Available vaginal estrogen preparations are conjugated equine estrogens, estradiol vaginal cream, a sustained-release intravaginal estradiol ring, or a low-dose estradiol tablet. Vaginal estrogen preparations with the lowest systemic absorption rate may be preferred in women with history of breast cancer and severe vaginal atrophy. Vaginal lubricants and moisturizers applied on a regular basis have an efficacy comparable with that of local estrogen therapy and should be offered to women wishing to avoid the use of vaginal estrogens.
Oral, transdermal, or vaginal estrogen preparations are the most effective treatment options for vulvovaginal atrophy-related sexual dysfunction. Selective estrogen receptor modulators such as lasofoxifene and ospemifene showed a positive impact on vaginal tissue in postmenopausal women. Vaginal dehydroepiandrostenedione, vaginal testosterone, and tissue selective estrogen complexes are also emerging as promising new therapies; however, further studies are warranted to confirm their efficacy and safety.

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    ABSTRACT: 111 Streszczenie Według jednej z nowszych teorii objawy menopauzalne nie wynikają jedynie ze spowodowanego wygaś-nięciem funkcji jajników niedoboru estrogenów, ale są także związane ze stopniowym, postępującym przez kilka lat zmniejszeniem stężenia dehydroepiandrosteronu (DHEA) wydzielanego przez nadnercza. Ponad 50% kobiet po menopauzie zgłasza objawy związane z atrofią nabłonka pochwy: podrażnienie, nawracające infekcje, uczucie suchości, ból podczas współżycia. Ogólnoustrojowa terapia hormonalna z użyciem samych estrogenów lub w połączeniu z progestagenami skutecznie przeciwdziała tym objawom, jednak wiąże się z możliwością wystąpienia działań niepożądanych. Poza tym u kobiet, u których jedynymi uciążliwymi objawami są te zwią-zane z atrofią pochwy, warto pomyśleć o terapii miejscowej. Do obiecujących wyników badań należą te nad dopochwowym zastosowaniem DHEA, w których założono, że terapia fizjologicznymi dawkami DHEA przyczyni się do zwiększenia stężenia androgenów i estrogenów syntetyzowanych miejscowo w tkance poprzez mecha-nizmy intrakrynne przy niewielkim działaniu ogólnoustrojowym. W grupie kobiet leczonych DHEA podawanym dopochwowo wykazano zmniejszenie objawów atrofii pochwy, regresję zmian dysplastycznych na szyjce macicy oraz zwiększenie libido. Słowa kluczowe: dehydroepiandrosteron, atrofia urogenitalna, menopauza. Summary According to novel theory menopausal symptoms are not only connected with estrogen deficiency due to diminished ovarian estrogen secretion, but are also associated with the gradual, progressive decline in the level of dehydroepiandrosterone (DHEA) secreted by the adrenal glands. Over 50% of postmenopausal women re-port symptoms associated with urogenital atrophy, ie: irritation, recurrent infections, dryness, dyspareunia. Systemic hormonal therapy with estrogens or in combination with progestins is an effective treatment of these symptoms, however, it is associated with some adverse effects. In addition, it is worthwhile to think about local therapy in case of women who have only symptoms associated with urogenital atrophy. Promising are results of the studies of DHEA intravaginal therapy, in which it was assumed that physiological doses of DHEA contribute to an increase in androgens and estrogens synthesized locally in tissues by intracrine mechanisms with low sys-temic effects. Previous studies have shown that intravaginal DHEA application reduce the symptoms of vaginal atrophy, regress low-grade cervical dysplasia and increase libido.
    Menopausal Review 01/2013; · 0.23 Impact Factor
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    ABSTRACT: IntroductionThe terminology for the genitourinary tract symptoms related to menopause was vulvovaginal atrophy, which does not accurately describe the symptoms nor is a term that resonates well with patients.AimIn 2012, the Board of Directors of the International Society for the Study of Women's Sexual Health (ISSWSH) and the Board of Trustees of The North American Menopause Society (NAMS) acknowledged the need to review current terminology associated with genitourinary tract symptoms related to menopause.Methods The two societies cosponsored a terminology consensus conference, which was held in May 2013.Main Outcome MeasureThe development of a new terminology that more accurately described the genitourinary tract symptoms related to menopause.ResultsMembers of the consensus conference agreed that the term genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing, and publicly acceptable term than vulvovaginal atrophy. GSM is defined as a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder. The syndrome may include but is not limited to genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria, and recurrent urinary tract infections. Women may present with some or all of the signs and symptoms, which must be bothersome and should not be better accounted for by another diagnosis.Conclusion The term GSM was presented and discussed at the annual meeting of each society. The respective Boards of NAMS and ISSWSH formally endorsed the new terminology—genitourinary syndrome of menopause—in 2014. DJ Portman, MLS Gass, on behalf of the Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: New terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society. J Sex Med **;**:**–**.
    Journal of Sexual Medicine 09/2014; · 3.51 Impact Factor
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    ABSTRACT: Vulvar and vaginal atrophy (VVA) is a chronic and progressive medical condition common in postmenopausal women. Symptoms of VVA such as dyspareunia, vaginal dryness, irritation, and itching can negatively impact sexual function and quality of life. The REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey assessed knowledge about VVA and recorded attitudes about interactions with healthcare providers (HCPs) and available treatment options for VVA. The REVIVE survey identified unmet needs of women with VVA symptoms such as poor understanding of the condition, poor communication with HCPs despite the presence of vaginal symptoms, and concerns about the safety, convenience, and efficacy of available VVA treatments. HCPs can address these unmet needs by proactively identifying patients with VVA and educating them about the condition as well as discussing treatment preferences and available therapies for VVA.
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