Envejecimiento del sistema urogenital y disfunción sexual femenina / Aging of the urogenital system and female sexual dysfunction

Resumen El sistema genitourinario presenta una serie de cambios micro y macroanatómicos desde el nacimiento, pasando por la pubertad, período reproductivo y por último con la menopausia, en la cual, se desarrolla un conjunto de síntomas sistémicos que incluyen los vasomotores, del sueño, cognitivos, del estado de ánimo y cambios sexuales, asociados a la presencia de disminución de la lubricación, estrechamiento y distensibilidad vaginal, atrofia vaginal, entre otros, que llevan a presentar una clínica de dispareunia, prurito, resequedad, además de síntomas urinarios. Su examinación conlleva la realización de una historia clínica, examen físico y ginecológico. Para confirmar los cambios se puede hacer una medición de pH y una citología para determinar un índice de maduración vaginal. Cuando estos síntomas se asocian a angustia y molestia se puede estar ante un caso de disfunción sexual, del cual se conocen factores de riesgo para su presencia como la edad como tal, problemas de pareja, estado de salud, autoestima, entre otros. Es por esto que a razón del tratamiento es importante hacer un abordaje interdisciplinario.

Abstract The genitourinary system presents a series of micro and macroanatomical changes from birth, through puberty, reproductive period and finally with menopause, in which a set of systemic symptoms are developed, including vasomotor, sleep, cognitive, mood and sexual changes, associated with the presence of decreased lubrication, narrowing and vaginal distensibility, vaginal atrophy, among others, leading to clinical symptoms of dyspareunia, pruritus, dryness, and urinary symptoms. Its examination involves the realization of a clinical history, physical and gynecological examination. To confirm the changes, a pH measurement can be made and a cytology to determine a vaginal maturation index. When these symptoms are associated with anguish and discomfort, there may be a case of sexual dysfunction, of which there are known risk factors for their presence such as age as such, couple problems, health status, self-esteem, among others. That is why, as to treatment, it is important to make an interdisciplinary approach.

Progress in research of sodium prasterone sulfate in vaginal atrophy / 药学实践杂志

Sodium prasterone sulfate (DHEAS) and dehydroepiandrosterone (DHEA) are endogenous steroid compounds, which are synthesized and secreted by adrenal gland.They are the precursors of steroid hormones,including sex hormone.Based on intracrine theory,the majority of postmenopausal women will have vaginal atrophy,which is caused by the absence of endogenous hormones,DHEAS or DHEA.Moderate supplementation of DHEAS can relieve the associated symptoms of vaginal atrophy.Many clinical researches have demonstrated that DHEAS can efficiently alleviate the related symptoms of vaginal atrophy.The concentration of androgen and estrogen in patients with long term use of DHEAS are still in the normal intracrine physiological range.Therefore,DHEAS may become the first drug for the treatment of vaginal atrophy in the future.

Effect of a gel containing pilocarpine on vaginal atrophy in castrated rats

OBJECTIVES: To evaluate the effect of Carbopol gel formulations containing pilocarpine on the morphology and morphometry of the vaginal epithelium of castrated rats. METHODS: Thirty-one female Wistar-Hannover rats were randomly divided into four groups: the control Groups I (n=7, rats in persistent estrus; positive controls) and II (n=7, castrated rats, negative controls) and the experimental Groups, III (n=8) and IV (n=9). Persistent estrus (Group I) was achieved with a subcutaneous injection of testosterone propionate on the second postnatal day. At 90 days postnatal, rats in Groups II, III and IV were castrated and treated vaginally for 14 days with Carbopol gel (vehicle alone) or Carbopol gel containing 5% and 15% pilocarpine, respectively. Next, all of the animals were euthanized and their vaginas were removed for histological evaluation. A non-parametric test with a weighted linear regression model was used for data analysis (p<0.05). RESULTS: The morphological evaluation showed maturation of the vaginal epithelium with keratinization in Group I, whereas signs of vaginal atrophy were present in the rats of the other groups. Morphometric examinations showed mean thickness values of the vaginal epithelium of 195.10±12.23 μm, 30.90±1.14 μm, 28.16±2.98 μm and 29.84±2.30 μm in Groups I, II, III and IV, respectively, with statistically significant differences between Group I and the other three groups (p<0.0001) and no differences between Groups II, III and IV (p=0.0809). CONCLUSION: Topical gel formulations containing pilocarpine had no effect on atrophy of the vaginal epithelium in the castrated female rats.

Tratamiento del síndrome genitourinario de la menopausia mediante láser fraccionado CO2: una opción terapéutica emergente / Treatment of genitourinary syndrome of menopause by CO2 fractional laser: an emerging therapeutic option

Estudios recientes han demostrado que el láser fraccionado es una opción terapéutica no hormonal efectiva, sencilla, bien tolerada y sin efectos adversos, para el tratamiento del Síndrome Genitourinario de la Menopausia. La reacción térmica originada produce la restauración del epitelio vaginal, un proceso de neocolagénesis y una mayor vascularización que favorece la llegada de nutrientes, reestableciéndose la estructura de la mucosa, su grosor y trofismo funcional, mejorando por tanto la sintomatología. No obstante, se precisan estudios a largo plazo, controlados, frente a estrógenos locales y otros tratamientos no hormonales para validar la duración de los efectos y la seguridad de las sucesivas aplicaciones. El objetivo de este trabajo es revisar la evidencia relacionada con esta terapia emergente.

Recent reported studies have demonstrated that non-invasive fractional laser is a valid, safe, effective and well tolerated therapeutic option, without adverse events to treat the Menopause Genitourinary Syndrome. The heat shock effect induces the increase of vaginal epithelium thickness, the new glycogen content and the vascular changes, improving the vaginal epithelium structure, functionality and menopausal symptoms. Nevertheless, duration of treatment effects and safety of repeated session are not clear enough. Further controlled long-term follow-up research on laser versus local estrogens and other non-hormonal therapies are needed. The objective of this paper is to review the scientific evidence related to this emergent treatment.

Dehiscencia y evisceración vaginal recidivante: a propósito de un caso / Recurrent vaginal dehiscence and evisceration: a case report

La dehiscencia de la cúpula vaginal, con o sin evisceración, es una complicación rara de la cirugía ginecológica. El principal factor de riesgo es el antecedente de una histerectomía, a lo que se añaden otros factores desencadenantes, entre los que destaca la atrofia vaginal. El diagnóstico de evisceración es fácil, al comprobar salida de material intestinal a través de la vagina, siendo más dificultoso el diagnóstico de dehiscencia, ya que puede acontecer con síntomas banales. El tratamiento supone una urgencia quirúrgica al existir riesgo de lesión intestinal y peritonitis, pudiéndose realizar diferentes vías de abordaje teniendo en cuenta sobre todo la clínica de la paciente y tras comprobar el estado del contenido eviscerado. Presentamos el caso de una paciente con varios factores de riesgo, que presentó dehiscencia de la cúpula vaginal con evisceración de intestino de manera reiterada, y a la que se le practicó tratamiento quirúrgico por diferentes vías de abordaje así como tratamiento médico.

Dehiscence of the vaginal vault with or without evisceration is a rare complication after gynaecological surgery. The main risk factor is a previous hysterectomy, with the addition of other trigger conditions, the most important is vaginal atrophy. The diagnosis of evisceration is easy by confirmation the loosing of intestinal contents through the vagina. Diagnosis of dehiscence is more difficult because its symptoms could be more generic. The treatment is an emergency surgery as there is a risk of intestinal injury and peritonitis. There could be different surgical approaches taking into consideration the patient's clinic symptoms and after checking the state of eviscerated tissues. We expose the case of a patient with several risk factors, who presented dehiscence of the vaginal vault with recurrent bowel evisceration, and who we performed surgical treatment by different approaches and medical treatment.

Black cohosh improves vaginal atrophy in postmenopausal women / 第二军医大学学报

Objective To investigate the efficacy of cimicifuga racemosa in reatment of postmenopausal vaginal atrophy. Methods Seventy 45-60 years old women, who had menopause for more than one year and symptoms of postmenopausal vaginal atrophy, were randomly divided into two groups: observation group(n = 40) and placebo group(n=30). The observation group was given cimicifuga racemosa (remifemin) 20 mg twice a day for 12 weeks. The placebo group was given one calcium carbonate and vitamin D3 tablet twice a day for 12 weeks. The serum levels of follicle stimulation hormone (FSH) and estradiol (E2) and thickness of endometrium were examined before and after treatment. The vaginal pH value, maturation degree of vaginal exfoliated cells, and atrophic vaginitis evaluating score were used to assess the therapeutic effects. The adverse effects were recorded. Results In the observation group there were no significant differences in FSH and E2 levels and endometrium thickness before and after treatment (P>0. 05). The vaginal pH value showed a decreasing tendency and the maturation degree of vaginal exfoliated cells showed an increasing tendency after treatment in the observation group, but there were no significant differences (P>0. 05). The atrophic vaginitis evaluating score was significantly higher before treatment compared with that after treatment (6. 0 ± 0. 6 vs 3. 3 ± 0. 6, P<0. 05). There were no adverse effects during the treatment. Conclusion The remifemin shows certain therapeutic effects for vaginal atrophy in postmenopausal women.

The short-term effect of black cohosh on vaginal atrophy and safety in postmenopausal women / 대한산부인과학회지

OBJECTIVE: To evaluate the short-term therapeutic effect of black cohosh on vaginal atrophy and safety in postmenopausal women. METHODS: A total of 80 postmenopausal women having moderate to severe degree of climacteric symptoms were randomly allocated to receive black cohosh combined preparation (n=40) or placebo (n=40) daily for 12 weeks. Fifty eight subjects completed this clinical study. The effect of black cohosh on vaginal atrophy in postmenopausal women was evaluated by measuring Maturation Value. Maturation Value was determined from vaginal smear at 0 and 12 weeks of treatment. Safety assessment included vital signs, physical examinations, adverse events, and routine laboratory parameters (hematology, biochemistry and urinalysis). It was carried out at the beginning, and after 4, 8, 12 weeks of treatment. RESULTS: The mean (+/-standard deviation) Maturation Value decreased 0.18 (0.47+/-0.32 to 0.29+/-0.23) in black cohosh group and 0.13 (0.43+/-0.30 to 0.30+/-0.21) in placebo group. There was no statistical difference in change of Maturation Value from the baseline between the groups after 12 weeks. No serious adverse events were seen. Adverse events were observed in 7 (17.5%) patients in black cohosh group and 6 (15%) patients in placebo group. Prevalence of the adverse events did not differ statistically in the two treatment groups. No significant effects were seen on blood pressure, heart rate, body temperature, physical findings and laboratory values. Black cohosh was well tolerated. CONCLUSION: Black cohosh did not exert estrogenic effects on the vaginal atrophy but appears to be a safe alternative medicine for postmenopausal short-term use.