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: 3.36). 01/2012; 19(1):109-17. DOI: 10.1097/gme.0b013e31821f92df
Source: PubMed


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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    • "Recommending local estrogen replacement in perimenopausal and postmenopausal women with vulvodynia is the first step in addressing vulvar discomfort in this age group. Local estrogen therapy has been found to ameliorate the negative impact of vulvovaginal atrophy on the sexual health of postmenopausal women,40 and the combination of estrogen and local lidocaine effectively treats severe unprovoked postmenopausal vestibulodynia.41 It is my opinion that adequate estrogen replacement therapy in this age group requires both intravaginal therapy and topical estrogen therapy (compounded in a hypoallergenic base) to the vestibule. "
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    ABSTRACT: Chronic vulvar pain or discomfort for which no obvious etiology can be found, ie, vulvodynia, can affect up to 16% of women. It may affect girls and women across all age groups and ethnicities. Vulvodynia is a significant burden to society, the health care system, the affected woman, and her intimate partner. The etiology is multifactorial and may involve local injury or inflammation, and peripheral and or central sensitization of the nervous system. An approach to the diagnosis and management of a woman presenting with chronic vulvar pain should address the biological, psychological, and social/interpersonal factors that contribute to her illness. The gynecologist has a key role in excluding other causes for vulvar pain, screening for psychosexual and pelvic floor dysfunction, and collaborating with other health care providers to manage a woman's pain. An important component of treatment is patient education regarding the pathogenesis of the pain and the negative impact of experiencing pain on a woman's overall quality of life. An individualized, holistic, and often multidisciplinary approach is needed to effectively manage the woman's pain and pain-related distress.
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    ABSTRACT: Menopause and the climacteric period are associated with adverse risk factors for the development of vulvovaginal atrophyrelated sexual dysfunction. Sexual dysfunction is a common problem in postmenopausal women, often underdiagnosed, inadequately treated, frequently overlooked, and most often impairing the quality of life of these women. To provide clinicians with current information on vulvovaginal atrophy‑related sexual dysfunction in postmenopausal women. This study is a literature review on vulvovaginal atrophy‑related sexual dysfunction in postmenopausal women. Relevant publications were identified through a search of PubMed and Medline, selected references, journals, and textbooks on this topic, and were included in the review. The prevalence of female sexual dysfunction increases with age. It is a common multidimensional problem for postmenopausal women that alter the physiological, biochemical, psychological, and sociocultural environment of a woman. Menopause‑related sexual dysfunction may not be reversible without therapy. Estrogen therapy is the most effective option and is the current standard of care for vulvovaginal atrophy‑related sexual dysfunction in postmenopausal women. Sexual dysfunction is a common multidimensional problem for postmenopausal women and often impairs the quality of life of these women. Estrogen preparations are the most effective treatment. Selective estrogen receptor modulators, vaginal dehydroepiandrostenedione, vaginal testosterone, and tissue‑selective estrogen complexes are promising therapies, but further studies are required to confirm their role, efficacy, and safety.
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