Diagnosis, causes, and treatment of dyspareunia in postmenopausal women.

IMPORTANCE AND OBJECTIVES: Evaluation and treatment of dyspareunia remains a significant unmet need despite the availability of safe and effective treatments. The objectives of this review are to consider evaluation techniques, the medical causes, and treatment options for dyspareunia in postmenopausal women. METHODS: This narrative review used PubMed to search for English-language articles related to postmenopausal dyspareunia. Search terms included, but were not limited to, dyspareunia, genitourinary syndrome of menopause, sexual dysfunction, postmenopausal dyspareunia, posthysterectomy dyspareunia, and postcancer dyspareunia. FINDINGS: Many postmenopausal women with dyspareunia do not discuss their symptoms with their physicians. Healthcare clinicians should broach the topic of dyspareunia with their patients using oral or written questionnaires. In addition to a thorough medical history and physical examination, various tools can be used as further assessments, including vaginal pH, vaginal dilators, imaging, vulvar biopsy, vulvoscopy and photography, the cotton swab test, sexually transmitted infection screening, and vaginitis testing. Although dyspareunia in postmenopausal women is often due to the genitourinary syndrome of menopause, other conditions can also cause dyspareunia, including hypertonic pelvic floor, hysterectomy, cancer treatment, lichen conditions, vulvar cancer, vestibulodynia, and pelvic organ prolapse. Some of the treatments discussed include lubricants, moisturizers, vaginal estrogen, ospemifene, dehydroepiandrosterone, local testosterone therapy, cannabidiol, and fractional CO 2 laser treatments. In some cases, dyspareunia may need to be specifically addressed by pelvic floor physical or sex therapists. CONCLUSIONS: Dyspareunia is a common issue in postmenopausal women, which remains largely untreated. Women with dyspareunia require a thorough history, targeted physical examination, and coordination of multiple disciplines including medical clinicians, pelvic floor physical therapists, and sex therapists.

Pilot study of fractional CO2 laser therapy for genitourinary syndrome of menopause in gynecologic cancer survivors.

PURPOSE: The objectives of this study were to evaluate the feasibility and efficacy of fractional CO2 laser therapy in gynecologic cancer survivors. METHODS: This was a pilot, multi-institutional randomized sham-controlled trial of women with gynecologic cancers with dyspareunia and/or vaginal dryness. Participants were randomized to fractional CO2 laser treatment or sham laser treatment. The primary aim was to estimate the proportion of patients who had improvement in symptoms based on the Vaginal Assessment Scale (VAS). Secondary aims included changes in sexual function assessed using the Female Sexual Functioning Index (FSFI) and urinary symptoms assessed using the the Urinary Distress Inventory (UDI-6). RESULTS: Eighteen women participated in the study, ten in the treatment arm and eight in the sham arm. The majority of participants had stage I (n = 11, 61.1 %) or II (n = 3, 16.7 %) endometrial cancer with adenocarcinoma histology (n = 9, 50 %). In total, 15 (83.3 %) of the participants completed all treatments and follow-up visit. There was no difference in the change in the median VAS score from baseline to follow-up. However, there was an improvement in change in the median total FSFI score with treatment compared with sham (Δ 6.5 vs -0.3, p = 0.02). The change in the median UDI-6 score was lower in the treatment arm (Δ -14.6 vs -2.1, p = 0.17), but this was not statistically significant. There were no reported serious adverse events. CONCLUSIONS: Fractional CO2 laser therapy is feasible in gynecologic cancer survivors, with preliminary evidence of safety. In addition, there was preliminary evidence of improvement in sexual function compared with sham treatment. Clinicaltrial.gov Identifier: NCT03372720 (OSU-17261; NCI-2017-02051).

Vulvar and vaginal fractional CO2 laser treatments for genitourinary syndrome of menopause.

Many healthcare providers are offering women treatment with the fractionated CO2 laser for a myriad of gynecologic issues, including genitourinary syndrome of menopause (GSM). Because existing data are limited, providing guidance is challenging. This Practice Pearl addresses what we know and don't know about the use of the fractionated CO2 laser for the treatment of GSM.

Sexual Function Post-Breast Cancer.

The consequences of estrogen deprivation and therapeutic interventions such as radiation, chemotherapy and surgery have a significant negative impact on libido, sexual arousal, orgasmic function and the ability to have pleasurable intercourse. Evaluation and treatment of female sexual dysfunction is a significant unmet need in the breast cancer survivor in spite of the availability of safe and effective treatments.

Laser CO2 fraccionado vulvar y vaginal. Tratamientos para el síndrome genitourinario menopaúsico / Fractional CO2 laser vulvar and vaginal. Treatments for Menopausal Genitourinary Syndrome

Muchos proveedores de atención médica ofrecen a las mujeres tratamientos con el láser de CO2 fraccionado para una gran variedad de problemas ginecológicos, incluido el síndrome genitourinario de la menopausia (GSM). Debi- do a que los datos existentes son limitados, proporcionar orientación es un desafío. Esta comunicación aborda lo que sabemos y no sabe- mos sobre el uso del láser de CO2 fraccionado para el tratamiento de GSM.

Physical examination of the female cancer patient with sexual concerns: What oncologists and patients should expect from consultation with a specialist.

Answer questions and earn CME/CNE Sexual concerns are prevalent in women with cancer or cancer history and are a factor in patient decision making about cancer treatment and risk-reduction options. Physical examination of the female cancer patient with sexual concerns, regardless of the type or site of her cancer, is an essential and early component of a comprehensive evaluation and effective treatment plan. Specialized practices are emerging that focus specifically on evaluation and treatment of women with cancer and sexual function problems. As part of a specialized evaluation, oncologists and their patients should expect a thorough physical examination to identify or rule out physical causes of sexual problems or dysfunction. This review provides oncology professionals with a description of the physical examination of the female cancer patient with sexual function concerns. This description aims to inform anticipatory guidance for the patient and to assist in interpreting specialists' findings and recommendations. In centers or regions where specialized care is not yet available, this review can also be used by oncology practices to educate and support health care providers interested in expanding their practices to treat women with cancer and sexual function concerns. CA Cancer J Clin 2016;66:241-263. © 2016 American Cancer Society.

Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery.

BACKGROUND: Perioperative systemic lidocaine has been shown to have beneficial postoperative analgesic effects. The only previous study examining the use of lidocaine in the outpatient setting did not detect an opioid-sparing effect after hospital discharge. More importantly, it is unknown whether systemic lidocaine provides a better postoperative quality of recovery to patients undergoing ambulatory surgery. Our objective in the current study was to examine the effect of systemic lidocaine on postoperative quality of recovery in patients undergoing outpatient laparoscopic surgery. METHODS: The study was a prospective, randomized, double-blind, placebo-controlled clinical trial. Healthy female subjects were randomized to receive lidocaine (1.5 mg/kg bolus followed by a 2 mg/kg/h infusion until the end of the surgical procedure) or the same volume of saline. The primary outcome was the Quality of Recovery-40 questionnaire at 24 hours after surgery. A 10-point difference represents a clinically relevant improvement in quality of recovery based on previously reported values on the mean and range of the Quality of Recovery-40 score in patients after anesthesia and surgery. Other data collected included opioid consumption, pain scores, and time to meet hospital discharge. Data were compared using group t tests and the Wilcoxon exact test. The association between opioid consumption and quality of recovery was evaluated using Spearman ρ. P < 0.01 was used to reject the null hypothesis for the primary outcome. RESULTS: Seventy subjects were recruited and 63 completed the study. There were no baseline differences regarding subject and surgical characteristics between the study groups. Patients in the lidocaine group had better global quality of recovery scores compared with the saline group, median difference of 16 (99% confidence interval [CI], 2-28), P = 0.002. Patients in the lidocaine group met hospital discharge criteria faster than the saline group, mean difference of -26 minutes (95% CI, -6 to -46 minutes) (P = 0.03). After hospital discharge, subjects in the lidocaine group required less oral opioids, median difference of -10 (95% CI, 0 to -30) (oral milligrams morphine equivalents), than the saline group (P = 0.01). There was an inverse association between postoperative opioid consumption and quality of recovery (ρ = 0.64, P < 0.001). CONCLUSIONS: Systemic lidocaine improves postoperative quality of recovery in patients undergoing outpatient laparoscopy. Patients who received lidocaine had less opioid consumption, which translated to a better quality of recovery. Lidocaine is a safe, inexpensive, effective strategy to improve quality of recovery after ambulatory surgery.