Management of postmenopausal vulvovaginal atrophy: recommendations of the International Society for the Study of Vulvovaginal Disease.

OBJECTIVE: To develop a best practice document for the management of postmenopausal vulvovaginal atrophy (VVA). METHOD: Literature review carried out using clinical terms, treatments or interventions and comorbidity related to VVA. RESULTS: There is a wide variety of interventions that may produce temporal benefits for VVA. However, there are significant limitations in scientific publications concerning VVA and related issues, including variable outcome evaluations, variability in population age range, and small, often underpowered sample sizes. Therapeutic management of VVA should follow a sequential order, considering women's age, symptoms, general health as well as treatment preference. Beneficial options include lubricants, moisturizers, vaginal estrogens (estradiol, estriol, promestriene, conjugated estrogens), androgens, prasterone, and laser application. In women with general menopausal symptoms who are candidates for systemic hormone therapy, the lowest effective dose should be used. Oral ospemifene is an effective selective estrogen receptor modulator to treat VVA. Systemic androgens have a limited role. Although laser procedures are commonly used, at this moment the International Society for the Study of Vulvovaginal Disease does not endorse its use out of the setting of clinical trials. Pelvic floor muscle training improves blood flow and elasticity of the vulvovaginal tissue. In breast cancer survivors, moisturizers and lubricants are first line therapy. However, limited absorption of low/ultra-low doses of estrogens suggests safety, especially in women under treatment with aromatase inhibitors. As clinical practice and available preparations vary between countries this text should be adapted to local circumstances. CONCLUSIONS: There is a wide range of therapeutic options to individualize VVA treatments.

Clinical manifestations and evaluation of postmenopausal vulvovaginal atrophy.

INTRODUCTION: It is estimated that 50% of women will suffer a severe form of vulvovaginal atrophy (VVA) related to menopause. Equally, young women may temporarily present this clinical problem while receiving various pharmacological or endocrine treatments or radiotherapy. AIM: To determine clinical and diagnostic exams required to confirm the presence of VVA (also referred to as atrophic vaginitis, urogenital atrophy, or genitourinary syndrome of menopause) and rule out other genital or pelvic clinical conditions. MATERIALS AND METHODS: Literature review searches were carried out on the main scientific article search engines (PubMed, SciELO, Cochrane) using different clinical terms, treatments or interventions and comorbidity related to VVA. RESULTS: The development and severity of VVA depend mainly on the duration of hypoestrogenism. Hypoestrogenism causes changes in the urogenital tissue, generating signs and symptoms, such as dryness, burning, soreness, itching, and irritation of the genital skin. The diagnosis can be made through anamnesis (patient history), questionnaires, physical exam, and, sometimes, complementary exams. Objective vaginal assessment is essential and can be completed with the Vaginal Health Index, the Vaginal Maturation Index, or vaginal pH in the absence of infection or semen. The exclusion of other vulvovaginal organic pathology is essential to reach an accurate diagnosis and provide adequate treatment. CONCLUSIONS: The specialist should be able to identify VVA, rule out other pathologies that make a differential diagnosis and conduct proper management.

Papilomavirose humana em genital, parte I / Genital human papilomavirosis, part I

Nas últimas décadas, algumas doenças têm adquirido proporções epidêmicas mundialmente. Dentre essas pandemias, pode-se destacar a infecção genital pelo papilomavírus humano (HPV). A infecção pelo HPV geralmente é assintomática e, na maioria dos casos, é transitória, já queo sistema imunológico pode ser capaz de combater o processo infeccioso, resolvendo-o ou tornando-o inativo. Vários tipos do HPV são causadoresde lesões genitais, manifestando-se, por exemplo, como condiloma acuminado. Algumas lesões genitais podem associar-se à infecçãopersistente e ao desenvolvimento de neoplasias intraepiteliais e até de câncer, ao longo de anos. Há muito tempo procura-se uma terapia que sejaconsiderada definitiva para as doenças causadas pelo HPV. Atualmente, as opções vão da ablação da lesão até a sua destruição com agentes químicos ou físicos. Pela frequência com que a infecção genital pelo HPV se manifesta na população, suas múltiplas aparências clínicas e o avançoem novas opções de abordagem para essas doenças são focos constantes de pesquisas. Diversas modalidades de tratamento já estão disponíveis para as lesões genitais pelo HPV, desde as citodestrutivas até a excisão cirúrgica. A utilização de produtos autoaplicáveis e em domicílio pode ter bons resultados para o paciente. A disponibilidade de vacinas contra HPV para a população pode ser o início de nova era na prevenção primária da infecção por HPV. Todavia, os milhões de casos clínicos de infecção por HPV, sobretudo os de condiloma acuminado, serão responsáveis por muitos anos de trabalho árduo para tratar as pessoas já acometidas. Este artigo, parte I, propõe-se a fazer uma ampla revisão sobre os principais aspectos da etiopatogenia, da clínica, do diagnóstico, do tratamento e da profilaxia de lesões genitais por HPV.

In recent decades, some diseases have reached epidemic proportions worldwide. Among these pandemics, genital infection by Human Papillomavirus (HPV) can be highlighted. HPV infection is usually asymptomatic and, in most cases, is transient, since the immune system may be able to fi ght the infectious process by either solving it or inactivating it. Several types of HPV cause genital lesions, and can be manifested as, for example, a condyloma acuminata. Some genital lesions can be associated to persistent infection and development of intraepithelial neoplasia and even cancer in time. For many years, there has been a demand for a defi nite therapy to treat HPV. Nowadays, the options range from the ablation of the lesion to its destruction with chemical or physical agents. Based on the frequency with which genital HPV infection manifests itself in the population, its many clinical aspects and the advances of new options to approach these diseases, it has become a continuous research focus. Several types of treatment are available forgenital HPV lesions, ranging from the cytodestructive treatments to those carried out by surgical excision. The use of self and domestic applicableproducts can present good results for the patient. The availability of HPV vaccines for the population may be the beginning of a new era in the primary prevention of HPV infection. However, the millions of cases of HPV infection, especially the condyloma acuminatum will be responsible for many years of hard work treating those already infected. This article, Part I, attempts to carry out a comprehensive review on the main pathogenic, clinical, diagnostic, treatment and prophylactic aspects of HPV genital lesions.

Lesões intra-epiteliais cervicais de alto grau em pacientes infectados pelo HIV / High-grade cervical intraepithelial lesions among HIV infected patients

Estuda a prevalência de lesões intra-epiteliais cervicais de alto grau e a influência de variáveis clínicas, laboratoriais e comportamentais em pacientes infectadas pelo HIV

Anormalidades citológicas e a acurácia da citopatologia como método de rastreio nas mulheres HIV soro-positivas/AIDS / Citological abnormalities and the accuracy of cytology as the screening method in HIV seropositive/AIDS women

O número de mulheres infectadas pelo HIV tem aumentado e a sua consequente imunossupressäo, alterado a história natural do HPV. O HPV, em especial o de alto risco oncogênico, é considerado agente principal das lesöes precursoras do cäncer cérvico-uterino. Por isso,o grupo de mulheres soropositivas apresenta maior incidência de CIN

Prevalência das neoplasias intra-epiteliais cervicais e das lesöes induzidas pelo HPV no trato genital inferior em mulheres HIV soropositivas/Aids / Prevalence of cervical intraepithelial neoplasia and HPV induced lesions in the lower genital tract of HIV seropositive/AIDS women

O número crescente de mulheres vivendo com HIV/AIDS é um fato dominante na evoluçäo desta epidemia no País. Estudo da prevalência das neoplasias intra-epiteliais e das lesöes HPV induzidas em mulheres HIV soro positivas e com AIDS, a distribuiçäo destas les0es no trato genital inferior e seu grau histopatológico, correlacionando-os com a contagem de linfócitos T CD