Management of vulvovaginal atrophy-related sexual dysfunction in postmenopausal women: an up-to-date review.
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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Article: Aging and sexuality.[show abstract] [hide abstract]
ABSTRACT: Recent research suggesting that a high proportion of men and women remain sexually active well into later life refutes the prevailing myth that aging and sexual dysfunction are inexorably linked. Age-related physiological changes do not render a meaningful sexual relationship impossible or even necessarily difficult. In men, greater physical stimulation is required to attain and maintain erections, and orgasms are less intense. In women, menopause terminates fertility and produces changes stemming from estrogen deficiency. The extent to which aging affects sexual function depends largely on psychological, pharmacological, and illness-related factors. In this article I review the physiological sex-related changes that occur as part of the normal aging process in men and women. I also summarize the effects on sexual function of age-related psychological issues, illness factors, and medication use. An understanding of the sexual changes that accompany normal aging may help physicians give patients realistic and encouraging advice on sexuality. Although it is important that older men and women not fall into the psychosocial trap of expecting (or worse, trying to force) the kind and degree of sexual response characteristic of their youth, it is equally as important that they not fall prey to the negative folklore according to which decreased physical intimacy is an inevitable consequence of the passage of time.Western Journal of Medicine 11/1997; 167(4):285-90.
Article: Proteins of human vaginal fluid.[show abstract] [hide abstract]
ABSTRACT: Proteins of vaginal fluid from normal and hysterectomized women were identified and compared with those of cervical mucus. Albumin, alpha1-antitrypsin, alpha2-haptoglobin, alpha2-macroglobulin, beta-lipoprotein, orosomucoid, ceruloplasmin, gamma chains, gamma G. K. (Bence Jones), and immunoglobulins G, A, and M were present in both vaginal fluid and cervical mucus. Fibrin and C-reactive protein were not found in the vaginal fluid but were identified in cervical mucus. alpha2-Haptoglobin, alpha2-macroglobulin, beta-lipoprotein, orosomucoid, and immunoglobulin M were absent in the vaginal fluid of hysterectomized women, indicating that their presence in the vaginal secretion of normal women may be due to contamination from cervical mucus.Fertility and Sterility 01/1978; 28(12):1345-8. · 4.17 Impact Factor
Article: Urogenital atrophy.[show abstract] [hide abstract]
ABSTRACT: The major cause of urogenital atrophy in menopausal women is estrogen loss. The symptoms are usually progressive in nature and deteriorate with time from the menopausal transition. The most prevalent urogenital symptoms are vaginal dryness, vaginal irritation and itching. The classical changes in an atrophic vulva include loss of labial and vulvar fullness, with narrowing of the introitus and inflamed mucosal surfaces. Dyspareunia and vaginal bleeding from fragile atrophic skin are common problems. Other urogenital complaints include frequency, nocturia, urgency, incontinence and urinary tract infections. Atrophic changes of the vulva, vagina and lower urinary tract can have a large impact on the quality of life of the menopausal woman. However, hormonal and non-hormonal treatments can provide patients with the solution to regain previous level of function. Therefore, clinicians should sensitively question and examine menopausal women, in order to correctly identify the pattern of changes in urogenital atrophy and manage them appropriately.Climacteric 05/2009; 12(4):279-85. · 1.96 Impact Factor