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Sexual Health
Published in Carolyn Torkelson, Catherine Marienau, Beyond Menopause, 2023
Carolyn Torkelson, Catherine Marienau
Is vaginal estrogen safe for postmenopausal women? Yes! Please use it if you need it! Most women can use vaginal estrogen with little risk to their system. Even women with a history of breast cancer can use low-dose vaginal estrogen, once risks and benefits have been discussed. Between the years 1982–2012, the Nurses’ Health Study investigated the health effects of vaginal estrogen on registered nurses. An important finding was that the use of vaginal estrogen was not associated with a higher risk of cardiovascular disease or cancer.7
Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Methods of preventing ED include quitting smoking, a healthy diet, avoiding excessive alcohol, maintaining a healthy weight, physical activity, and avoiding illegal drugs. Retrograde ejaculation is not totally preventable. Men requiring treatment for an enlarged prostate must consider less invasive surgeries such as transurethral microwave thermotherapy or transurethral needle ablation. Control of medical conditions that cause nerve damage may also aid in prevention. Diabetes medications must be taken as prescribed and appropriate lifestyle changes must be implemented. Prevention of vaginal dryness because of decreased lubrication requires the use of vaginal moisturizers such as K-Y Liquibeads or Replens, oral probiotic supplements that enhance vaginal health, and increased soy into the diet. There are also low- dose vaginal estrogen creams, tablets, and rings.
Pessaries for Pelvic Organ Prolapse
Published in Teresa Tam, Matthew F. Davies, Vaginal Pessaries, 2019
Michael D. Moen, Anne F. Wright
Care of the pessary is a vital component to pessary care teaching (Figure 2.3). Patients need to know that cleaning the pessary requires only a mild soap and water. There is no need to sterilize the device by boiling it or using any type of chemicals like bleach. If a patient is comfortable with self-care (removal and reinsertion), the patient is encouraged to remove the device once or twice a month, leave it out overnight, and reinsert in the morning. If a patient prefers to return to the office to have a health care provider perform removal, cleaning, and reinsertion, this should be scheduled on a regular basis, roughly every 3 months but can be individualized based on the patient's specific situation and needs. At this visit, the provider will perform a vaginal exam checking for vaginal discharge, erosions, or ulcerations, and evaluating for vaginal atrophy. If a patient is found to have any type of vaginal ulceration, a recommendation will be made that the pessary be left out for approximately 2 weeks to allow the vagina to heal. The patient may also be advised to use vaginal estrogen cream as part of their routine to improve the vaginal mucosa and prevent breakdown from pessary placement. If a foul-smelling discharge is noted, it may represent bacterial vaginosis, and an antibiotic such as metronidazole can be prescribed (Table 2.1).
Urologic view in the management of genitourinary syndrome of menopause
Published in Climacteric, 2023
Regardless of the indication for vaginal estrogen therapy, it can be prescribed in the same manner. Vaginal estrogen is available as a cream, tablet, gel capsule and ring. There has been no evidence to suggest one type is more efficacious than another and prescribing can be based on patient preference and price [53]. Many providers will start with a 0.01% estradiol vaginal cream, which can be applied either by the included applicator or by applying 1 g (about a blueberry-sized amount) to the fingertip and inserting this into the vagina. Some patients note the cream can be messy and prefer a 4 or 10 μg tablet or gel capsule inserted into the vagina. There also exist vaginal estradiol rings; one ring is replaced every 3 months and can be removed for intercourse. In addition to using a product intravaginally, patients may also apply a small amount of the 0.01% estradiol cream to the urethral meatus and periurethral vestibular tissue if there is still significant dysuria or external GSM symptoms despite intravaginal application. Patients should apply 1 g vaginal estradiol two or three times per week. Some clinicians favor an onboarding period in which the treatment is used daily for 2 weeks and then patients decrease dosing to two or three times per week. Some patients may initially experience local irritation as well as breast tenderness, but both typically will improve within the first few weeks of using the medication.
The role of microbiota in the management of genitourinary syndrome of menopause
Published in Climacteric, 2023
G. Stabile, G. A. Topouzova, F. De Seta
According to the generally accepted international standards, the first-line recommendations for the treatment of mild and moderate manifestations of VVA are non-hormonal vaginal lubricants [22]. They should be used before intercourse or on a daily basis for a long-term effect (several times a week). This treatment option is also recommended for women for whom the use of vaginal estrogen preparations is unacceptable [24]. There are different types of lubricants which may be water, oil, silicone or hyaluronic acid based. Several plant oils have demonstrated efficacy without adverse events [25]. They may contain a bio-adhesive polycarbophil-based polymer, which attaches to mucin and epithelial cells on the vaginal wall and retains water. Vaginal lubricants and moisturizers can be used as needed in combination with other VVA treatments.
Effect of estrogen on vaginal complications of pessary use: a systematic review and meta-analysis
Published in Climacteric, 2022
F. Ai, Y. Wang, J. Wang, L. Zhou, S. Wang
Vaginal atrophy is considered to be one of the precipitating factors for these typical complications associated with pessary use in postmenopausal women [14,15]. Currently, even though vaginal estrogen is suggested to be used as a concurrent therapy in pessary users by most practitioners, there are still limited studies and controversial results to confirm the positive effect of local vaginal estrogen use on preventing pessary-related vaginal complications [16,17]. In a monocenter randomized study with a small number of participants, estrogen had no additional effect on pessary-related complications [18]. A retrospective cohort study conducted by Dessie et al. showed that the use of vaginal estrogen increased adherence to treatment and decreased vaginal discharge [19]. Recently, two RCTs also reported controversial results on the effect of vaginal estrogen use in postmenopausal women using a pessary for POP. Chiengthong et al. revealed no benefit of intravaginal estrogen in reducing bacterial vaginosis (BV), vaginal abrasions, vaginal bleeding and pain in postmenopausal women using a vaginal pessary for POP treatment [20]. de Albuquerque Coelho et al. showed that BV was less prevalent in the use of vaginal estrogen in women with POP using pessaries [21]. Therefore, it would be important to pool data to adequately assess whether it is feasible to recommend vaginal estrogen use to reduce pessary-related complications.