[Acquired clitoral phimosis causing a periclitoral pseudocyst].

Clitoral phimosis or preputial fusion may occur as a result of atrophic vaginitis among other conditions. A 72-year-old woman presented with atrophic vaginitis, preputial fusion, and a painful periclitorial pseudocyst. We suggest that a minimal surgery approach in a manual retraction of the synarchies without making an incision is a gentle and effective surgical management of preputial fusion. Suturing the ends from each other combined with continuous topical prophylaxis will minimise the risk of recurrence of pseudo-cyst and prevent worsening scar tissue formation.

Prevention of recurrent lower urinary tract infections in postmenopausal women with genitourinary syndrome: outcome after 6 months of treatment with ospemifene.

Aim of this study was to evaluate the efficacy of ospemifene in the prevention of recurrent lower urinary tract infections in postmenopausal women with vulvovaginal atrophy. The study have a retrospective design. Thirty-nine patients were enrolled. Patients underwent clinical examination and urine culture. The urinary symptoms and the quality of life were evaluated with UTISA score, PUF and SF-36 questionnaires before and after treatment. All 39 patients received ospemifene 60 mg one tablet/daily for 6 months. Adverse effects and complications were assessed. Thirty-nine patients were enrolled in the study. Two patients experienced one new UTI episode and the mean number of positive urine culture decreased significantly after 6 months (3.65 ± 2.12 vs 0.25 ± 0.17, p < .0001). The mean number of urinary infection symptoms decreased significantly after treatment; dysuria reduced (4.76 ± 2.45 vs 0.89 ± 1.12). PUF score and SF-36 showed a statistically significant change (22.43 ± 5.89 vs 12.14 ± 3.21) and (52.86 ± 9.21 vs 83.43 ± 10.76). No adverse effects were reported and the total success rate was the 92.3% after 6 months at PGI-I. Ospemifene is a valid alternative with excellent tolerability for the UTIS prevention in postmenopausal patients.

Efficacy of an orally administered combination of hyaluronic acid, chondroitin sulfate, curcumin and quercetin for the prevention of recurrent urinary tract infections in postmenopausal women.

OBJECTIVE: To assess whether the orally administered combination of hyaluronic acid (HA), chondroitin sulfate (CS), curcumin and quercetin could be effective in preventing recurrent cystitis in postmenopausal women and whether its efficacy was conditioned by the concurrent use of local estrogen therapy. STUDY DESIGN: This was a prospective evaluation of 145 postmenopausal women consecutively recruited from the database of three different investigators. All women should have mild-to-moderate urogenital atrophy and a history of recurrent urinary tract infections (≥2 episodes within 6 months or ≥3 episodes within 12 months documented by positive urine cultures) during the last year. Patients were assigned to three different therapeutic regimens: the first group was treated only with vaginal estrogens, the second group only with HA, CS, curcumin and quercetin per os, and the third group was treated with HA, CS, curcumin and quercetin associated with local estrogens. We evaluated the number of patients with <2 infective episodes in the 6-month follow-up and <3 episodes in the 12-month follow-up (main aim definition) and the reduction of related symptoms through a Visual Analog Scale (VAS) and the Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale. Student's t-test and chi-squared test were used for data analysis as appropriate. RESULTS: At 6-month follow up, the main aim rate was 8%, 11.1% and 25% in the three groups, respectively (p<0.05 compared to baseline only in group 3). Although the reduction in the number of recurrent episodes became significant in all groups at 1 year follow-up, the main aim rate was almost double in women receiving both local estrogens and oral therapy (group 3) compared to those receiving single treatments. The improvement of related symptoms was significant in all groups at 12-month follow-up. CONCLUSIONS: In postmenopausal women, the combination of HA, CS, curcumin and quercetin per os was effective in preventing recurrent urinary tract infections, especially if administered with vaginal estrogen therapy.

Papel de ospemifeno en el tratamiento de la atrofia vulvovaginal en la mujer posmenopáusica / Role of ospemifene in the treatment of vulvar and vaginal atrophy in postmenopausal woman

A pesar de que los síntomas de atrofia vulvovaginal (AVV) tienen un impacto significativo en la vida de una mujer, el grado de insatisfacción con las terapias disponibles es elevado. Si además consideramos que muchas mujeres son reacias a aceptar los tratamientos vaginales o no pueden utilizarlos, se hace patente la necesidad médica no cubierta en el manejo de la AVV. Ospemifeno es el primer tratamiento oral que no contiene hormonas indicado para mujeres posmenopáusicas con AVV no candidatas a estrógenos locales, y el único modulador selectivo de los receptores estrogénicos (SERM) con actividad antagonista en la mama, neutral en el útero y agonista en los huesos y vagina. Ospemifeno restaura el epitelio vaginal mejorando significativamente los síntomas de sequedad vaginal y dispareunia, y la salud sexual. Además de un óptimo tratamiento, los profesionales deberían abordar proactivamente la salud vaginal como parte del cuidado de la mujer posmenopáusica, especialmente a la luz del escaso conocimiento que muestran las mujeres acerca de esta condición (AU)

Despite symptoms of vulvar and vaginal atrophy (VVA) can have a significant impact on a woman’s life, the level of dissatisfaction with available VVA treatments is high. If we also consider that many women are reluctant to accept vaginal treatments or are unable to use it, the unmet medical need in the management of VVA becomes evident. Ospemifene is the first oral treatment that does not contain hormones, for post-menopausal women with VVA who are not candidates for local estrogens, and the only SERM with antagonistic effect in breast, neutral in uterus, and agonistic in bone and vagina. Ospemifene restores the vaginal epithelium and show significant improvements in symptoms of vaginal dryness and dyspareunia and therefore in the woman’s sexual function. Besides an optimal treatment, professionals should proactively address the vaginal health as part of postmenopausal women care, particularly in view of survey results highlighting the poor understanding of this condition that women have (AU)

Does a diagnosis of atrophic vaginitis on Papanicolaou test signify the presence of inflammation?

OBJECTIVE: Vaginal atrophy in menopause shows increased parabasal cells on cytology. This may be accompanied by abundant neutrophils. A shift in maturation index in the absence of significant inflammation is more accurately termed "atrophic pattern." This study aims to determine whether a diagnosis of "atrophic vaginitis" or atrophic pattern on Papanicolaou test is a reliable indicator of what is present on the slide. METHODS: A retrospective review of Papanicolaou test slides from University Hospital Newark was performed. Cases that had been diagnosed as either atrophic vaginitis (n = 100) or atrophic pattern (n = 100) were selected. Exclusion criteria included any additional diagnosis of neoplasia. Slides were re-reviewed and scored based on abundance of neutrophils: 0 to 5, 6 to 10, or more than 10 neutrophils per high-power field (×40), with 10 fields per slide reviewed. Data were analyzed by χ analysis. RESULTS: Among 200 cases with atrophic vaginitis or atrophic pattern, the proportion of those diagnosed with atrophic vaginitis to those diagnosed with atrophic pattern increased across three neutrophil categories (P < 0.0001). CONCLUSIONS: A diagnosis of atrophic vaginitis on Papanicolaou test is reliably associated with increased numbers of neutrophils. A diagnosis of atrophic pattern is indicative of low numbers of neutrophils. As the Papanicolaou test diagnosis of atrophic vaginitis does not correlate with clinical symptoms, a single diagnostic term that does not suggest a disease process would more reliably communicate cytology findings to clinicians.

Vaginal estrogen for genitourinary syndrome of menopause: a systematic review.

OBJECTIVE: To comprehensively review and critically assess the literature on vaginal estrogen and its alternatives for women with genitourinary syndrome of menopause and to provide clinical practice guidelines. DATA SOURCES: MEDLINE and Cochrane databases were searched from inception to April 2013. We included randomized controlled trials and prospective comparative studies. Interventions and comparators included all commercially available vaginal estrogen products. Placebo, no treatment, systemic estrogen (all routes), and nonhormonal moisturizers and lubricants were included as comparators. METHODS OF STUDY SELECTION: We double-screened 1,805 abstracts, identifying 44 eligible studies. Discrepancies were adjudicated by a third reviewer. Studies were individually and collectively assessed for methodologic quality and strength of evidence. TABULATION, INTEGRATION, AND RESULTS: Studies were extracted for participant, intervention, comparator, and outcomes data, including patient-reported atrophy symptoms (eg, vaginal dryness, dyspareunia, dysuria, urgency, frequency, recurrent urinary tract infection (UTI), and urinary incontinence), objective signs of atrophy, urodynamic measures, endometrial effects, serum estradiol changes, and adverse events. Compared with placebo, vaginal estrogens improved dryness, dyspareunia, urinary urgency, frequency, and stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). Urinary tract infection rates decreased. The various estrogen preparations had similar efficacy and safety; serum estradiol levels remained within postmenopausal norms for all except high-dose conjugated equine estrogen cream. Endometrial hyperplasia and adenocarcinoma were extremely rare among those receiving vaginal estrogen. Comparing vaginal estrogen with nonhormonal moisturizers, patients with two or more symptoms of vulvovaginal atrophy were substantially more improved using vaginal estrogens, but those with one or minor complaints had similar symptom resolution with either estrogen or nonhormonal moisturizer. CONCLUSION: All commercially available vaginal estrogens effectively relieve common vulvovaginal atrophy-related complaints and have additional utility in patients with urinary urgency, frequency or nocturia, SUI and UUI, and recurrent UTIs. Nonhormonal moisturizers are a beneficial alternative for those with few or minor atrophy-related symptoms and in patients at risk for estrogen-related neoplasia. CLINICAL TRIAL REGISTRATION: PROSPERO International prospective register of systematic reviews, http://www.crd.york.ac.uk/PROSPERO/, CRD42013006656.

Recomendaciones de la Sociedad Española de Ginecología y Obstetricia sobre la prevención y el tratamiento de la atrofia vaginal / Recommendations of the Spanish Society of Obstetrics and Gynecology on the prevention and treatment of vaginal atrophy

La atrofia vaginal, causada por el déficit estrogénico, es responsable de la aparición de síntomas que afectan la calidad de vida. El tratamiento tendrá como objetivo restaurar la fisiología urogenital y aliviar los síntomas. Para síntomas como la sequedad vaginal o la dispareunia asociada con atrofia vaginal, la primera línea de tratamiento son los hidratantes (evidencia IA) y lubricantes vaginales (evidencia IIB). Si no proporcionan una adecuada mejora de los síntomas o ante síntomas moderados-intensos, se utilizarán estrógenos. Los estrógenos son los tratamientos más efectivos. En casos de solo atrofia vaginal, la elección será la terapia con estrógenos locales (TEL) (evidencia IA). En casos que coexistan con sintomatología vasomotora que afecte a la calidad de vida, la elección será la terapia hormonal sistémica (evidencia IA). Las dosis bajas de estrógenos son el tratamiento farmacológico hormonal de primera línea para la vaginitis atrófica (AU)

Vaginal atrophy, caused by estrogen deficiency, leads to the development of symptoms that affect quality of life. Treatment aims to restore the urogenital physiology and relieve symptoms. For symptoms such as vaginal dryness or dyspareunia associated with vaginal atrophy, the first line treatments are moisturizers (Evidence IA) and vaginal lubricants (Evidence IIB). If these treatments fail to provide sufficient improvement in symptoms or when the symptoms are moderate-to-intense, estrogen can be used. Estrogens are the most effective treatments. In patients with vaginal atrophy alone, the choice is local estrogen therapy (Evidence IA). In patients who also have vasomotor symptoms affecting quality of life, treatment consists of systemic hormone replacement therapy (Evidence IA). Low dose oestrogens are a first line pharmacological treatment for atrophic vaginitis (AU)

A self-report instrument that describes urogenital atrophy symptoms in breast cancer survivors.

Urogenital atrophy affects the lower urinary and genital tracts and is responsible for urinary, genital, and sexual symptoms. The accurate identification, measurement, and documentation of symptoms are limited by the absence of reliable and valid instruments. The Urogenital Atrophy Questionnaire was developed to allow self-reporting of symptoms and to provide clinicians and researchers an instrument to identify, measure, and document indicators of urogenital atrophy. A pilot study (n = 30) measured test-retest reliability (p < .05) of the instrument. Subsequently, a survey of women with (n = 168) and without breast cancer (n = 166) was conducted using the Urogenital Atrophy Questionnaire, Female Sexual Function Instrument, and Functional Assessment of Cancer Therapy, Breast, Endocrine Scale. Exploratory factor analysis (KMO 0.774; Bartlett's test of sphericity 0.000) indicated moderate-high relatedness of items. Concurrent (p > .01) and divergent validity (p < .000) were established. A questionnaire resulted that enables women, regardless of sexual orientation, partner status, and levels of sexual activity to accurately report symptoms.