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Impact of urinary incontinence and urogenital atrophy on the vulva
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Sushma Srikrishna, Linda Cardozo
Ospemifene, a selective estrogen receptor modulator (SERM) derived from toremifene, has also been shown to be effective in treating vulvar and vaginal atrophy (34,35). It has been recently approved at the dose of 60 mg orally, and is indicated for the systemic treatment of moderate to severe dyspareunia associated with vulvovaginal atrophy in women who are unable to tolerate or unwilling to take local or systemic estrogens. Another SERM, lasofoxifene, is under investigation.
Female Sexual Dysfunction
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Seth D. Cohen, Irwin Goldstein
FemAle sexuAl dysfunction (FsD) is recognized As A common medicAl problem in All Age groups. DAtA from the nAtionAl HeAlth And sociAl Life survey, A study thAt describes both the distribution of sexuAl prActices And the chAnges in these prActices under current conditions, found thAt sexuAl dysfunction is more prevAlent in women (43%) thAn in men (31%) [1]. shifren et Al. [2] evAluAted dAtA from the populAtion-bAsed PrevAlence of FemAle sexuAl Problems AssociAted with Distress And DeterminAnts of treAtment seeking study. This study estimAted the prevAlence of sexuAl problems And sexuAlly relAted personAl distress in u.s. women in Addition to the prevAlence of sexuAl disorders of desire, ArousAl, And orgAsm. They concluded thAt About 40% of those with A sexuAl disorder of desire, ArousAl, or orgAsm hAve concurrent depression. In 2014, there were over 25 FDA-Approved drugs for men's sexuAl heAlth; despite the significAnt number of women with bothersome FsD, there wAs only one drug thAt wAs FDA Approved in women. This drug, ospemifene, is licensed to treAt moderAte to severe dyspAreuniA in menopAusAl women [3]. We feel thAt it is of vitAl importAnce to Address femAle sexuAl problems systemAticAlly And will tAke you step-by-step through the presentAtion, diAgnosis, And treAtment of mAny FsD disorders in An orgAnized And complete fAshion. A bAsic understAnding of whAt sexuAl dysfunction meAns is A key for Any cliniciAn seeing FsD in their office. bAsed on the most current version of the DsM-v [4], sexuAl dysfunction is A heterogeneous group of disorders thAt Are chArActerized by A clinicAlly significAnt disruption in A person's Ability to respond sexuAlly or to experience sexuAl pleAsure. In this, the recognized FsD disorders Are femAle orgAsmic disorder, femAle sexuAl interest/ArousAl disorder, And genitopelvic pAin/penetrAtion disorder. to provide the best cAre to women struggling with FsD, cliniciAns must understAnd thAt sexuAl problems Are commonly AssociAted with significAnt personAl distress including A diminution of self-worth And self-esteem, A reduction in life sAtisfAction, And A decline in the quality of the relAtionship with her pArtner [5]. Thus, to provide the best overAll cAre for these pAtients, it is importAnt for cliniciAns to be fAmiliAr with the bAsic Aspects of AppropriAte women's sexuAl heAlth-cAre delivery. "sexuAl heAlth" refers to A stAte of physicAl, emotionAl, mentAl, And sociAl well-being relAted to sexuAlity [6]. Women hAve the right to A positive And respectful sexuAl relAtionship And to hAve pleAsurAble And sAfe sexuAl experiences, free of coercion, discriminAtion, And violence. Women hAve the right to sexuAl equity, the freedom from All
New developments in the management of vulvovaginal atrophy: a comprehensive overview
Published in Expert Opinion on Pharmacotherapy, 2023
Gilbert G.G. Donders, Francesca H.W.V. Donders
Newer treatment methods like using the hormones DHEA, ospemifene and E4 have recently been examined thoroughly and have been added to the treatment arsenal of VVA. Although more expensive in use, the oral formula of ospemifene might be beneficial for women who do not wish to use or apply vaginal products. For DHEA and ospemifene, we have now more reassuring efficacy and safety data, to the extent that we think that they can even be considered for patients with hormone dependent breast cancer and/or at risk for (recurrent) thrombo-embolic events. Further safety research is needed specifically in these patient groups to confirm these findings. For E4, similar advantages are promising, but specifically on VVA, more studies need to confirm its efficacy for this indication. The endometrial proliferation caused by doses of E4 that are high enough for resolving VVA, are of particular concern and need to be closely surveilled.
An overview of dehydroepiandrosterone (EM-760) as a treatment option for genitourinary syndrome of menopause
Published in Expert Opinion on Pharmacotherapy, 2020
Michelle Holton, Chelsea Thorne, Andrew T. Goldstein
Ospemifene is an oral selective estrogen receptor modulator that was approved by the FDA in 2013 in the treatment of moderate to severe dyspareunia and vulvovaginal atrophy secondary to menopause. There has been sufficient evidence that ospemifene has a comparable affect to vaginal estrogens in improving vaginal atrophy, with Ospemifene showing significant increase in the percentage of surface cells of the vaginal epithelium and a decrease in the percentage of parabasal cells and a decrease in vaginal pH [45,46]. Multiple studies have shown that ospemifene and has no significant impact on the proliferation of the endometrium. However, the FDA approved package insert contains a boxed warning for agonism of endometrial tissue. Additionally, a post hoc safety analysis suggesting that ospemifene has no significant impact on the breast, bone, and cardiovascular health in comparison to placebos [46–48]. In comparison to local estrogen therapies, ospemifene was shown to have greater treatment regimen adherence and a lower mean outpatient medical care costs compared to patients utilizing local estrogen therapies [49].
Usefulness of Ospemifene in the treatment of urgency in menopausal patients affected by mixed urinary incontinence underwent mid-urethral slings surgery
Published in Gynecological Endocrinology, 2019
Michele Carlo Schiavi, Ottavia D’Oria, Natalia Aleksa, Flaminia Vena, Giovanni Prata, Chiara Di Tucci, Delia Savone, Valentina Sciuga, Andrea Giannini, Maria Letizia Meggiorini, Marco Monti, Marzio Angelo Zullo, Ludovico Muzii, Pierluigi Benedetti Panici
Ospemifene is a SERM that selectively exerts agonist and antagonist effects depending on the receptors expressed in different tissues and has a demonstrated estrogen agonist effect on the vaginal and urethral epithelium, improving not only vaginal dryness but urgency and frequency too. Furthermore, as opposed to hormone therapy, Ospemifene has no effect on the breast tissue, therefore it can also be used in women with prior breast cancer who have completed treatment [5,30,31]. Our study showed an improvement in the quality of life in women treated with Ospemifene after surgery with MUS, without relevant perioperative and postoperative complications or side effects; in fact we found a decrease of number of voids, urgent micturition, and nocturia compared with women who only underwent surgery at 12 weeks after treatment. Urodynamic parameters particularly maximum cystometric capacity, first voiding desire, peak flow, and detrusor pressure at peak flow have improved significantly in women underwent both treatments compared to patients subjected to TOT procedure only with a significant increase of the OAB Questioners (OAB-Q) of the health-related quality of life (HRQL) score showing the decrease of urgent component after surgical intervention. However, patients undergoing surgery alone improved symptoms and some urodynamic parameters related to urgency.