Available via license: CC BY
Content may be subject to copyright.
Submit Manuscript | http://medcraveonline.com
Introduction
For the last ve years, new terminology has been introduced to
describe atrophic vaginitis, atrophic Volvo-vaginitis or postmenopausal
vulvo-vaginal atrophy; thus the new term genitourinary syndrome
of menopause (GSM), which is dened as “a set of symptoms and
signs associated with a decrease in estrogen and other sex steroids
that involve changes in the labia majora or minora, clitoris, vestibule/
introitus, vagina, urethra and bladder.” The modication was required
because the rst terms did not include most of the constellation of
signs and symptoms present during this specic moment in women´s
life, especially because they do not consider the symptoms associated
to the lower urinary tract. In addition, it has been seen that not
everyone is comfortable talking about the vulva and/or the vagina
(health professionals or patients), which is why the term atrophy has
an inadequate connotation.1,2 The prevalence of GSM in Colombia
is around 51.61%.2 It causes vaginal dryness, dyspareunia, vaginal
irritation, genital pruritus (burning sensation), sinusorrhagia and
urinary symptoms (most uncomfortable for women).1–3 71.87% of
symptomatic women have three vulvo-vaginal symptoms and/or
urinary tract symptoms;2 but only 64% complain of painful sexual
intercourse and loss of libido, which is why 58% avoid sexual
intercourse,4 especially coitus. The WHO estimates 1,200 million
women will be over 50 years of age by 2030.5 Consequently, if GMS
causes negative vaginal problems, as well as frequent emotional and
sexual disorders, leading to adverse effects on the quality of life of
postmenopausal women,2,6,7 it is critical that health professionals
understand menopause, and know how to prevent its catastrophic
effects.
The treatment and management of GMS should be individualized
for each woman, considering the severity of the symptoms, the effect
on the quality of life, the risk of recurrence and personal preferences.
The options highlight both hormonal and non-hormonal therapies,
with estrogen therapy being the rst therapeutic line for symptom
relief.8,9 The information that is available regarding the use of non-
hormonal therapies is endless, and the results vary. Policresulen
is a solution indicated for the topical treatment of inammations
or of cervico-vaginal tissue lesions. It coagulates the necrotic or
pathogenically altered tissue and promotes the scaliness of said
tissues. It is a polymolecular organic acid; a condensation polymer of
metacresol sulfonic acid bonded to methylene bridges with different
Int J Fam Commun Med. 2019;3(3):132‒136. 132
© 2019 De La Hoz. This is an open access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and build upon your work non-commercially.
Efcacy and tolerance of policresulen in the
treatment of the genitourinary syndrome of
menopause
Volume 3 Issue 3 - 2019
Franklin José Espitia De La Hoz
Ginecología y Obstetricia, Universidad Militar Nueva Granada,
Colombia
Correspondence: Franklin José Espitia De La Hoz, Ginecología
y Obstetricia, Universidad Militar Nueva Granada, Sexología
Clínica, Máster en Sexología, Educación y asesoramiento
sexual, Universidad de Alcalá de Henares, Uroginecología/
FUCS - Hospital de San José/Unicamp, Brasil, Clínica Sexológica,
Armenia, Quindío, Colombia, Email
Received: June 14, 2019 | Published: June 26, 2019
Abstract
Objective: To evaluate the efcacy and tolerance of policresulen in the treatment of
genitourinary syndrome of menopause
Materials and methods: Controlled clinical trial, randomized, masked “double-blind”.
321 women aged 40 or older, diagnosed with genitourinary syndrome of menopause, who
had engaged in sexual activity in the last six weeks, and had visited a Level III private
health care institution in Armenia, Quindío (Colombia), from February to December 2018
were included. Women under hormonal treatment and with absolute contraindications for
the use of policresulen were excluded. Women were randomly assigned to two treatments:
117 received policresulen and 114 placebos (control group). Efcacy and tolerance were
evaluated, as well as the adverse effects presented during the 12 weeks of follow-up. A non-
strict consecutive sampling was made.
Results: The dose of policresulen was effective for symptom control, showing an efcacy
of 76.92%, (n=90/117), versus 38.59%, (n=44/117) in the placebo group, with a statistically
signicant difference (p=0.003). Policresulen tolerance was adequate in 91.45% of women,
compared to 92.98% of placebos, without statistically signicant difference (p=0.375). The
incidence of adverse effects was as follows: local burning sensation (4.27%), discharge
of mucosal tissue fragments (2.56%) and vaginal candidiasis (1.7%) in the policresulen
group, compared with, 5%, 1.75% and 1.75%, respectively, in the placebo group. There
were fewer adverse effects in the placebo group, but there was no statistically signicant
difference between groups (89.74% vs. 92,1; p=0,27).
Conclusion: The use of policresulen in women with genitourinary syndrome of menopause
is effective for the management of the most frequent symptomatology. Although it is true
that it is not the rst therapeutic line of treatment, it should be considered in women for
whom estrogen therapy is contraindicated or in those who do not wish to receive it. There
was a low presence of adverse effects at the dose used, however, these were tolerable and
did not require the interruption of the medication.
Keywords: dyspareunia, menopause, atrophy, lubrication, Efcacy, drug tolerance
International Journal of Family & Community Medicine
Research Article Open Access
Efcacy and tolerance of policresulen in the treatment of the genitourinary syndrome of menopause 133
Copyright:
©2019 De La Hoz
Citation: De La Hoz FJE. Efcacy and tolerance of policresulen in the treatment of the genitourinary syndrome of menopause. Int J Fam Commun Med.
2019;3(3):132‒136. DOI: 10.15406/ijfcm.2019.03.00145
chain lengths, making it a large molecule, that cannot be absorbed
into the systemic circulation; it as a localized effect in the affected
tissue where it is applied, and does not affect healthy tissues. It
stimulates the regeneration and reepithelization processes, and has
astringent properties, granting it healing, anti-inammatory and anti-
hemorrhagic properties. In addition, due to its high acidity (pH<0.6)
it as a high bactericidal and self-sterilizing power, eliminating the
possibility of bacterial multiplication.10,11 This study seeks to learn
about the effectiveness and tolerability of policresulen; its objective
is to evaluate the efcacy and tolerance of policresulen in the
treatment of genitourinary syndrome of menopause (GSM), as a non-
hormonal alternative, in a sample of postmenopausal women from the
Department of Quindío, Colombia.
Materials and methods
Design and population Controlled, randomized, masked “double-
blind” clinical trial, conducted from February 1, 2018 to December
31, 2018 in Armenia, capital of the department of Quindío (located in
the central region of Colombia). The study was carried out at Clinica
Sexológica, a private healthcare reference center, an academic center,
that takes care of people pertaining to private and social security health
care plans, in Colombia. Sample size: considering a condence level
of 95%, with an error margin of 3% and an expected proportion of 5%,
the estimated calculated sample was of 203 women. Patient selection
was done through a simple random sample, with a table of random
numbers. The sampling was consecutive non-strict. Women older
than or equal to 40 years, diagnosed with genitourinary syndrome of
menopause, who had engaged in sexual activity in the last six weeks
were included. Women under hormonal treatment and with absolute
contraindications for the use of policresulen were excluded.
Procedure
Women were selected from the population of patients assigned
to the menopause and climacteric program of the institution. The
information was collected by nurses from the research team, duly
trained in the process of recruiting patients and completing forms.
Women were surveryed during their medical appointment with the
specialist, after verifying inclusion and exclusion criteria. If women
fullled the selection criteria and accepted to participate in the
study, they were informed about the objectives of the research and
were asked to ll out the informed consent and the condentiality
agreement for information management. Once women signed the
informed consent, they were given a self-report questionnaire where
socio-demographic characteristics, sexual and reproductive health
data, symptoms, background and clinical examination data were
recorded. The specialist evaluated the presence of GMS according
to the symptomatology reported by the woman. The diagnosis was
made with the nding of one or more of the following symptoms:
vulvo-vaginal symptoms (burning, decreased vaginal lubrication,
dyspareunia, pain, coital discomfort, itching, burning, postcoital
bleeding and vaginal dryness) or lower urinary tract symptoms
(dysuria, bladder tenesmus, nocturia, frequency, recurrent urinary
tract infections, urinary urgency, urinary incontinence, postcoital
infection and decreased urethral urine ow).1,2 Once the diagnosis
was made, the nature of their clinical condition was explained to each
woman, and therapeutic alternatives were offered (local policresulene
or the use of placebo). The placebo was characterized as a pure and
inactive substance, a water-based type of lubricant.
Intervention
All patients were prescribed treatment. They were randomized
to receive one of the two preparations (policresulen or placebo).
The medications were presented in identical containers; neither the
women nor the researcher knew which solution each woman received.
Each patient was given administration instructions and the quantity
required until the following appointment. The therapy assignment was
made based on a table of random numbers, in blocks of 6 subjects.
Evaluation
For eleven months, 231 women with a diagnosis of menopausal
genitourinary syndrome were recruited. All the patients included in the
research were evaluated during a twelve-week treatment period, with
four evaluation controls. They were followed up every four weeks
until completing the follow-up cycle. In each appointment they lled
in a questionnaire on efcacy, tolerance and adverse events potentially
related to the substance that had been administered. Likewise, they
were provided with the medication required for continuation of
the treatment. Patients were prescribed a full dosage of 5 grams of
policresulen. They were prescribed a daily vaginal gel application
for 4 weeks, at bedtime; and an application twice a week (three days
interval) as a maintenance therapy, until completing the 12 weeks. In
each follow-up visit, adherence to treatment was monitored, and the
patients had to rate the effectiveness by a percentage evaluation of the
main signs and symptoms of GMS [urinary symptoms, sinusorrhagia,
genital pruritus (burning sensation), irritation vaginal, dyspareunia
and vaginal dryness]] according to prevalence in recent Colombian
publications,2,3 and of their own symptoms upon admission.
Symptoms were classied according to severity as follows: Severe
(greater than 75%), Moderate (greater than 25% and less than 75%) and
Mild (less than 25%). The evaluation of the effectiveness was made
by means of rating the percentage of decrease of the symptoms, using
a subjective evaluation table designed for the purpose and that offered
the following reports: Excellent (decrease greater than 75%), Good
(decrease greater than 50% and less than 75%), Moderate (decrease
greater than 25% and less than 50%) and Poor (decrease less than
25%). The efcacy was established by the difference in improvement
for the values associated to a decrease in symptomatology in both
groups at the end of the treatment. Tolerance was evaluated in each
follow up visit by looking for the absence or presence of symptoms
or signs associate to adverse reactions; it was classied as Excellent
(there were no adverse effects), Good (one adverse effect), Regular
(two adverse effects) or Bad (three or more adverse effects). These
data were evaluated by the researcher, through direct questioning; the
responses of each follow up visit, as well as the adverse effects, were
recorded in the clinical history and in a special format designed by
the researchers.
Measured variables
Socio-demographic variables such as (age, race, marital status,
occupation, level of studies, height, weight, body mass index (BMI),
alcohol intake, smoking, sedentary lifestyle); age of menarche and
menopause, evolution of time of menopause, history of hysterectomy,
salpingectomy and gynecological or urological surgery; variables
of sexual and reproductive health: age of onset of sexual life,
masturbation, oral sex, vaginal or anal intercourse, average frequency
of monthly sexual relations, time of cohabitation with a partner, history
of sexual abuse or sexual violence in marriage and a couple with
Efcacy and tolerance of policresulen in the treatment of the genitourinary syndrome of menopause 134
Copyright:
©2019 De La Hoz
Citation: De La Hoz FJE. Efcacy and tolerance of policresulen in the treatment of the genitourinary syndrome of menopause. Int J Fam Commun Med.
2019;3(3):132‒136. DOI: 10.15406/ijfcm.2019.03.00145
sexual dysfunction were considered. The percentage of evaluation of
the efcacy and tolerance of the substances administered, the presence
of adverse effects, as well as the time of symptom improvement were
also evaluated.
Statistical analysis
The collected data were analyzed statistically using the Six Sigma
statistical program. The applied tests were the “t” of Student for
comparison of socio-demographic parameters, the Wilcoxon test for
the comparison of non-parametric paired data, the Mann-Whitney U
for the nonparametric data (unpaired), the test for χ2 and the ANOVA
(analysis of variance), taking in all cases the p value <0.05 as the limit
of statistical signicance.
Ethical aspects
The study was approved by the Ethics and Research Commission
of Clinica Sexólogica. The signature of the informed consent was
requested for participation in the study, and the condentiality of the
information was guaranteed.
Results
Of a total of 279 women, with symptomatology associated to the
genitourinary syndrome of menopause, 258 women were included
(92.47%) and seven (2.71%) refused to participate. Of the remaining
251 women who met the selection criteria, a total of 11 (4.38%) did
not provide all the required information, another 5 (1.99%) withdrew
before completing the 12-week follow-up and were rejected 4
(1.59%) due to poor treatment compliance. In this way, a total of 231
(92.03%) women were considered for the nal analysis; 117 received
policresulen and 114 received placebo. In the total population, the
mean age of the participants was 56.72±8.35 years (range between
40 and 84), and that of the couple was 59.86±7.42 years (range
between 42 and 93). They were mostly Hispanic, Catholic, employed,
middle class, stable union, high level of schooling, urban origin
belonging to private health care plans. The age of onset of menopause
was 49.31±8.37) years (range between 42 and 54), with a mean
menopause duration of 7.94±5.27 years (range between 3 and 12).
The socio-demographic characteristics were similar in both groups,
with no statistically signicant differences (Table 1). The mean age of
menarche was 12.58±0.79 years (range between 9 and 15 years). The
reported age for rst sexual intercourse was on average 18.62±4.18
years (range between 15 and 24) The age of the rst delivery was a
mean of 19.35±5.27 years (range between 15 and 27), with a median
of 3 children (range between 0 and 7). 29.43% (n=68/231) reported
more than 20 years living with a couple.
A total of 78.35% (n=181/231) of the participants stated they had
active sexual lives and 10.38% (n=24/231) used sex toys, 68.83%
expressed they felt pain during intercourse, 77.48% afrmed there had
been a loss of libido, while 59.74% expressed that they avoided sexual
intercourse using all kinds of excuses. Masturbation is considered a
common practice in 44.58% (n=103/231) of the participants. A total
of 98.26% manifested that sexual activity was important in their life;
41.12% afrmed that sex was fundamental in their life, yearning
for a coital frequency of 1 to 4 times per week (median 2 times a
week); however, 35.82% were concerned that their children were
aware they were sexually active. 93.07% considered sexual activity
as essential for marriage success. To the question, ¿how many times
did you have sex last month? (period dened as the period of the
previous thirty days), 41.12% (n=95/231) reported a median of 4
sexual intercourses per month (range between 0 and 9). The most
frequent sexual practice was vaginal intercourse (100%), and the least
frequent was anal intercourse (11.68%). 94.37% (n=218/231) of the
women stated that their partner had some sexual dysfunction. 17.74%
(n=41/231) reported having suffered some form of sexual violence
throughout their lives, while 22.51% (n=52/231) reported violence or
sexual abuse by the couple, after the onset of menopause, secondary
to the refusal to voluntarily consent to sexual activity. The prevalence
of the severity of the symptoms of GMS in the policresulen group
was Severe in 70.94% (n=83/117), 17.09%, (n=20/117) Moderate
and 11.96%, (n=14/117) Mild. In the placebo group it was Severe
in 69.29% (n=79/114), 16.66%, (n=19/117) moderate and 14.03%,
(n=16/114), mild with one p> 0.05, without statistically signicant
difference.
Table 1 Sociodemographic characteristics of women from Armenia, Quindío
with genitourinary syndrome of menopause
Policresulene
(n=117)
Placebo
(n=114) p
Age (years), mean±SD 56, 72; p=8, 35). 57, 32; p=7, 49). 0.43
Height (cms) 158; p=0, 76). 160; p=0, 85). 0.71
Weight (kg) 78.61; p=1, 8). 80.35; p=1, 5). 0.68
BMI 31.2; p=0, 59). 31, 3; p=0, 74). 0.93
Race
Hispanics% 56.41 50.87 0.57
Afrocolombians% 25.64 33.33 0.12
Indigenous% 17.94 15.78 0.45
Educational Level
Primary% 11.96 29.64 0.36
Secondary% 19.65 21.92 0.15
Technical% 43.58 40.35 0.18
Tertiary% 24.78 28.07 0.39
Civil Status
Divorced% 15.38 12.28 0.81
In union 41.88 43.85 0.75
Married% 35.04 37.71 0.61
Widowed% 7.69 6.14 0.83
Origin
Rural% 20.51 17.54 0.13
Urban% 79.48 82.45 0.26
Occupation
Housewife% 32.47 35.96 0.53
Employed% 52.99 56.14 0.47
Retired% 14.52 7.89 0.23
Addictions%
Smoking 23.07 27.19 0.41
Alcohol% 78.63 79.82 0.29
Sedentarism% 76.06 68.42 0.14
Efcacy and tolerance of policresulen in the treatment of the genitourinary syndrome of menopause 135
Copyright:
©2019 De La Hoz
Citation: De La Hoz FJE. Efcacy and tolerance of policresulen in the treatment of the genitourinary syndrome of menopause. Int J Fam Commun Med.
2019;3(3):132‒136. DOI: 10.15406/ijfcm.2019.03.00145
Related to the symptoms that affected the patients, the most frequent
symptom was vaginal dryness, followed by dyspareunia and vaginal
irritation in both groups (Figure 1). Regarding the relationship with the
vulvo-vaginal symptoms and lower urinary tract ndings associated
to GMS, it was observed that 71.87% of the symptomatic women of
the polcresulen group had 3, 22.91% had 4, and 5.2% presented 5 or
more symptoms, while in the placebo group it was observed 70.17%,
20.17% and 9.64%, respectively, without statistically signicant
difference (p>0.05). The mean length of the presence of symptoms, at
the time of treatment, was 12.65±4.79 months (range between 3 and
60). In total, 29.91%, (n=35/117) of the women of the policresulen
group and the 32.45%, (n=37/114) of those in the placebo group,
had received some type of hormonal treatment at some time life after
menopause. The evolution of the improvement and effectiveness of
the therapy, in relation to the baseline situation, in each follow-up
and at the end of the treatment is described in Table 2. At the end
of the study it was observed, that efcacy in the policresulen group
was 76.92%, (n=90/117), while in the placebo group it was 38.59%,
(n=44/117), with a statistically signicant difference (p=0.003). There
were signicant differences between the two groups regarding the
time for symptom reduction, being lower in the policresulen group
(median of 4 weeks vs 8 weeks), (p<0.05). In the policresulen group
tolerance was labeled as Excellent in 89.74% (n=105/117) and Good
in 1.7% (n=2/117), Regular in 2.56% (n=3/117) and Bad at 5.98%
(n=7/117), which implies a satisfactory tolerance in 91.45% of the
women, compared to 92.98% of the placebo, without statistically
signicant difference (p=0.375). At the end of the study, the incidence
of adverse effects was 10.25% (n=12/117) in the policresulen group,
compared to 7.89% (n=9/114) in the placebo group; the local burning
sensation being the most frequent (4.27%), followed by the discharge
of fragments of mucosal tissue (2.56%) (Table 3). In the placebo group
there were fewer adverse effects, with no differences in both groups
(89.74% vs. 92,1; p=0,27). In no case was there a need to interrupt the
treatment before end of the research study.
Figure 1 Symptoms of GSM reported in women from Armenia, Quindío.
Table 2 Percentage of the evolution of the improvement and effectiveness
of the therapy
Policresulene
(n=117)
Placebo
(n=114) p
Baseline 0 0 0
4 weeks 25.64% 13.15% 0.024
8 weeks 63.24% 29.82% 0.018
12 weeks 76.92% 38.59% 0.003
Table 3 Adverse effects
Policresulene
(n=117)
Placebo
(n=114) p
Vaginal dryness 0,85% (n=1) 0 0.11
Localized burning
sensation 4,27% (n=5) 3,5% (n=4) 0.54
Discharge of mucus tissue
fragments 2,56% (n=3) 1,75% (n=2) 0.75
Vaginal candidiasis 1,7% (n=2) 1,75% (n=2) 0.84
Erythema with papule 0,85% (n=1) 0,87; p=1). 0.93
Discussion
The results of this investigation show an efcacy of 76.92% in
the policresulen group (n=90/117), while the placebo group reported
38.59% (n=44/117), a statistically signicant difference (p=0.003).
Tolerance was labeled as Excellent in 89.74% (n=105/117) and Good
in 1.7%, which reported a satisfactory tolerance in 91.45% of the
women who received policresulen, compared to 92.98% of placebo,
without statistically signicant difference (p=0.375). At the end of
the study, the incidence of adverse effects was 10.25% (n=12/117) in
the policresulen group, compared to 7.89% (n=9/114) of the placebo
group; being the local burning sensation the most frequent one (4.27%
vs. 3.5%), followed by the discharge of mucosal tissue fragments
(2.56% vs. 1.75%), without statistically signicant differences
between groups (89.74% vs. 92,1; p=0,27). In no case was there a
need to interrupt the treatment before the end of the research study.
Signicant differences were found between the two groups regarding
the time for symptom reduction, being lower in the policresulen group
(median of 4 weeks vs 8 weeks), (p<0.05). Policresulen as a selective
effect on dead or pathologically altered tissues in the vagina, making
them coagulate with a subsequent elimination, without affecting
the healthy squamous epithelium. Its broad antimicrobial spectrum
eradicates the pathogens of the vagina (bacteria, trichomonas and
fungi), but increases the growth of Lactobacilli (Bacillus Döderlein)
responsible for maintaining the physiological acidity of the vagina. It
is useful to quickly diminish subjective complaints such as pruritus
and leucorrhea. Reepithelialization is favored both by reactive
hyperemia in the treated area and by the stimulation of the granulation
of healthy tissues.12
The characteristics of the efcacy of policresulen make it an
adequate alternative, in the treatment of the genitourinary syndrome
of menopause, for of women who have contraindications for estrogen
therapy have no interest in receiving said therapy, with higher rates of
satisfaction than ¾ parts of the participating population. In this study,
the feasibility and safety of the use of policresulen in postmenopausal
women was demonstrated, with minimum adverse effects, that did
not require any type of intervention or affected the continuation of
therapy, making it attractive, safe and easy to use. In a study conducted
in our country, Espitia et al.13 obtained an efcacy of 66.6% in the
improvement of the symptoms of GMS using a lubricant with similar
characteristics to our placebo, which is still lower than the 76,92%
reported by policresulen in this study, however it is a population with
similar socio-demographic characteristics, but with a smaller sample
size, which may indicate differences in the results obtained by these
researchers. The results of this study are comparable to the reports of
a recent investigation by Espitia et al.14 where it concludes that the
estriol used in combination with a lubricant, are effective to control
the symptoms of GMS in 87% of women, making makes policresulen
an attractive substance to consider as a choice in those women without
interest for hormonal therapy.
Efcacy and tolerance of policresulen in the treatment of the genitourinary syndrome of menopause 136
Copyright:
©2019 De La Hoz
Citation: De La Hoz FJE. Efcacy and tolerance of policresulen in the treatment of the genitourinary syndrome of menopause. Int J Fam Commun Med.
2019;3(3):132‒136. DOI: 10.15406/ijfcm.2019.03.00145
The characteristics of the non-hormonal therapies used in this study;
one a condensation polymer of metacresolsulfonic acid (policresulen)
and the other a water-based lubricant, suggest the possibility of a
new alternative within the therapeutic arsenal for the treatment of the
genitourinary syndrome of menopause; with higher satisfaction rates,
placebo, in syndromic management. The main strength of the study
is that it is the rst research of its kind in Colombia, in addition to
be the rst one to evaluate the use of policresulen in the treatment
of menopausal genitourinary syndrome, and to have had a sequential
sampling with a signicant participation of patients. The greatest
weakness is that the results could not be compared with other studies
of similar characteristics, since there is no scientic literature in this
regard, in addition to an approximation of the costs incurred in each
participant, which could be a limiting factor for its application in the
general community.
Conclusion
The use of policresulen in women with genitourinary syndrome
of menopause is effective for the management of the most
frequent symptomatology. Although it is true that it is not the rst
therapeutic line of treatment, it should be considered for women with
contraindications for estrogen therapy or for those who do not wish to
receive it. There was a low presence of adverse effects at the dose used,
however, these were tolerable and did not require the interruption of
the medication. Additional studies, in larger populations, are required
to establish the benet in women with estrogen-dependent cancer or
without interest in receiving estrogen therapy, as well as the costs that
this represents.
Financing
The research was nanced with the author’s own resources.
Acknowledgments
To all participating women for allowing consent and for being
part of the study; to my beautiful and admirable wife, Dr. Lilian
Orozco Santiago, for always supporting and following my crazy
investigations.
Conicts of interest
The author declares there is no conict of interest.
References
1. Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus
Conference Panel. Genitourinary syndrome of menopause: New
terminology for vulvo-vaginal atrophy from the International Society for
the Study of Women’s Sexual Health and the North American Menopause
Society. Menopause. 2014;21(10):1063–1068.
2. Espitia-De La Hoz FJ. Prevalence of genitourinary syndrome of
menopause and impact on sexuality of women in Quindío (Colombia),
2013-2016. Rev Colomb Obstet Ginecol. 2018;69(4):249–259.
3. Espitia-De La Hoz FJ, Orozco-Gallego H. Estriol vs estrógenos
conjugados de origen equino en el tratamiento del síndrome genitourinario
de la menopausia. Ginecol Obstet Mex. 2018;86:117-126.
4. Simon JA, Nappi RE, Kingsberg SA, et al. Clarifying Vaginal Atrophy’s
Impact on Sex and Relationships (CLOSER) survey: emotional and
physical impact of vaginal discomfort on North American postmenopausal
women and their partners. Menopause. 2014;21(2):137-142.
5. Panay N. Genitourinary syndrome of the menopause--dawn of a new era?
Climacteric. 2015;18(Suppl 1):13–17.
6. Moral E, Delgado JL, Carmona F, et al. Genitourinary syndrome of
menopause: Prevalence and quality of life in Spanish postmenopausal
women. The GENISSE study. Climacteric. 2018;21(2):167–173.
7. Karakoç H, Uçtu AK, Özerdoğan N. Genitourinary syndrome of
menopause: effects on related factors, quality of life, and self-care power.
Prz Menopause Rev. 2019;18(1):15–22.
8. Faubion SS, Sood R, Kapoor E. Genitourinary Syndrome of
Menopause: Management Strategies for the Clinician. Mayo Clin Proc.
2017;92(12):1842–1849.
9. Espitia-De La Hoz FJ, Orozco Gallego H. Abordaje diagnóstico y
terapéutico del síndrome genitourinario en la menopausia; actualización.
Rev Med UCR. 2017;117:67–84.
10. Scorticati CH, Levati HA, Cartelli E. Utilizacion del ácido metacresol-
sulfonico, en cirugía prostática. Rev Arg Urol Nefrol. 1973;42(1):84–85.
11. Espinosa DJ. Analytical review of multicenter studies with polycresulene
for hemorrhoidal pathologies. Acta Gastroenterol Latinoam.
2000;30(3):177–186.
12. Patetico AQ, Reyes LD, Rey-Matias CJ. Comparison of the operative
and post-operative outcome between episiorrhaphy with and without
application of policresulen solution. Philippine Obstetrical and
Gynecological Society (POGS). 2016;40(2):12–19.
13. Espitia-De La Hoz FJ, Orozco Gallego H, Echeverri Ocampo LM.
Terapia hormonal y no hormonal en la vaginitis atróca posmenopáusica:
cura y satisfacción a mediano y a largo plazo de los síntomas. Rev Col
Men. 2016;22:8–17.
14. Espitia-De La Hoz FJ, Orozco Gallego H. Evaluación de la ecacia
de dos terapias estrogénicas locales más un lubricante vaginal, para el
control de los síntomas del síndrome genitourinario de la menopausia.
Rev Investigaciones Andina. 2019;21:167–183.
