New Innovations for the Treatment of Vulvovaginal Atrophy: An Up-to-Date Review

Abstract

Vulvovaginal atrophy (VVA) is a chronic progressive disease involving the female genital apparatus and lower urinary tract. This condition is related to hypoestrogenism consequent to menopause onset but is also due to the hormonal decrease after adjuvant therapy for patients affected by breast cancer. Considering the high prevalence of VVA and the expected growth of this condition due to the increase in the average age of the female population, it is easy to understand its significant social impact. VVA causes uncomfortable disorders, such as vaginal dryness, itching, burning, and dyspareunia, and requires constant treatment, on cessation of which symptoms tend to reappear. The currently available therapies include vaginal lubricants and moisturizers, vaginal estrogens and dehydroepiandrosterone (DHEA), systemic hormone therapy, and Ospemifene. Considering, however, that such therapies have some problems that include contraindications, ineffectiveness, and low compliance, finding an innovative, effective, and safe treatment is crucial. The present data suggest great efficacy and safety of a vaginal laser in the treatment of genital symptoms and improvement in sexual function in patients affected by VVA. The beneficial effect tends to be sustained over the long-term, and no serious adverse events have been identified. The aim of this review is to report up-to-date efficacy and safety data of laser energy devices, in particular the microablative fractional carbon dioxide laser and the non-ablative photothermal Erbium-YAG laser.

Hormonal Medications for Genitourinary Syndrome of Menopause

“…1 Vaginal dryness represents the most common symptom (reported by more than half to 83% of postmenopausal women, depending on the study), followed by dyspareunia (38% to 59%) and vaginal irritation (37% to 77%). 2 Urinary tract symptoms are common and include urinary urgency, frequency, urinary urgency, dysuria, and recurrent urinary tract infection.…”

“…It requires long-term treatment, with prevalence estimated at 24% to 84%, 1 and affects sexuality, relationships, decreased quality of life, lowered self-esteem, and social interaction 1 . Vaginal dryness represents the most common symptom (reported by more than half to 83% of postmenopausal women, depending on the study), followed by dyspareunia (38% to 59%) and vaginal irritation (37% to 77%) 2 . Urinary tract symptoms are common and include urinary urgency, frequency, urinary urgency, dysuria, and recurrent urinary tract infection.…”

Effects of Preoperative Preparation on the Vaginal Mucosa in Women with Genital Prolapse Associated with Genitourinary Menopausal Syndrome

“…According to United Nations projections, the number of people over 60 will exceed one billion by 2025, which will be 15% of the total population [1]. Genital prolapse (GP) is one of the most pressing problems of this category of patients, in whom its frequency is 50-60% and, as a rule, is combined with various urogenital disorders, increasing to 80% in postmenopause due to estrogen deficiency [2]. The presence of drooping and prolapse of the genitals itself affects the physical and psychoemotional state of the woman, and in combination with genitourinary menopausal syndrome leads to social maladaptation, as well as to a decrease in quality of life [3].…”

“…So in our study, a critical decrease in lactobacilli in the vagina in women with genital prolapse in postmenopausal women was demonstrated. Alkalinization of vaginal contents and insufficiency of the lactobacilli pool increase the likelihood of inflammatory diseases of the genital tract and urinary system, mainly with ascending infection.It is known that in postmenopausal age, against the background of hypoestrogenism, the number of lacto-and bifidobacteria in the vagina decreases, while the composition of the microflora becomes scarce with the dominance of obligate anaerobic bacteria[12,13]. It is possible that just such features of the bacteriological status of the vaginal epithelium of the operating area can be the cause of infectious and inflammatory complications after surgical treatment of HP.…”

The Utility of CO2 Laser Treatment of Pelvic Symptoms in Women with Previous Perineal Trauma during Delivery

“…This action triggers the body's natural healing response, leading to an increase in collagen production. As a result, there is a noticeable improvement in the skin's texture, tone, and elasticity, making it highly effective against wrinkles, fine lines, and sun damage [17][18][19][20][21][22][23]. In the realm of gynecology, the fractional microablative CO 2 laser has sparked interest due to its potential in treating various vaginal health conditions.…”