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Sexual Health
Published in Carolyn Torkelson, Catherine Marienau, Beyond Menopause, 2023
Carolyn Torkelson, Catherine Marienau
The estrogen vaginal ring is another way to improve vaginal health. It is placed into the vagina for 3 months. Estradiol is released from the ring on a continuous basis and provides the highest dose of all the commercially available products. This method is very convenient and improves the quality of life for women suffering with significant vaginal dryness/atrophy. The biggest negative is the cost, currently $500 for 3 months, and it is often not covered by insurance. Given likely out-of-pocket expenses, you could use compounding pharmacies for vaginal estradiol (E2) or estriol (E3) creams. Many compounding pharmacies (not FDA approved) will make up a vaginal cream that has the same product as a commercially available estrogen but costs up to two-thirds less and often has fewer chemical additives.
Adolescent contraception
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Hanna Goldberg, Jasmine Multani, Sari Kives
The vaginal ring has been well accepted by all ages in clinical trials, with 53% switching to the vaginal ring from another method, and 90% indicating that they would recommend it to others.138 The vaginal ring may have poor uptake in the adolescent population, as adolescents are typically uncomfortable with inserting contraceptive methods into the vagina. An empty tampon applicator can be used to insert the vaginal ring for those who are uncomfortable about using their fingers to do so.128 While the ring can remain in situ safely during intercourse and is only felt (but not thought to be bothersome) by 15% of women and 30% of partners, it can also be removed for up to 3 hours around intercourse and then rinsed with water and reinserted.138–140
Contraception
Published in James M. Rippe, Lifestyle Medicine, 2019
The vaginal ring has specific advantages over other methods of contraception. Monthly placement of the ring allows for ease of use and higher compliance with the method. The vaginal route of administration of hormo nes increases the bioavailability, as it bypasses the first-pass metabolism, resulting in lower doses of hormones required to achieve equal efficacy. The ring has the lowest serum levels of estrogen and progesterone of any combined contraceptive method. This may result in lower rates of side effects related to estrogen, such as breast tenderness and nausea. There is also less breakthrough bleeding and spotting compared with COCs.20,21 Like the patch, typical use efficacy has not yet been established for the ring, but perfect compliance with the ring is reported to be as high as 86–91%. Failure rates are similar to COC rates, being 0.3% with perfect use and 9% with typical use.22 Though the ring is conventionally placed for three weeks at a time, there are sufficient hormones within the ring to prevent ovulation for up to five weeks; therefore the ring can be used in a continuous fashion.21 If removed from the vagina for greater than three hours, it is recommended that backup contraception be used until the ring has been replaced for seven days.
First-in-human study to assess the pharmacokinetics, tolerability, and safety of single-dose oxybutynin hydrochloride administered via a microprocessor-controlled intravaginal ring
Published in Drug Delivery, 2023
Willem de Laat, Lisa Pagan, R. Karl Malcolm, Maarten Wiegerinck, Victor Nickolson, Bertine Huisman, Rik Stuurman, Michiel van Esdonk, Naomi Klarenbeek
The vaginal anatomy and physiology afford opportunities for noninvasive, chronic, local or systemic drug delivery through various formulations and medical devices (Iqbal & Dilnawaz, 2019). Polymeric vaginal rings for the controlled delivery of pharmaceutical compounds have been widely used, particularly as contraceptive devices or for the treatment of local infections, and are continually being improved (Malcolm et al., 2016; Monteiro et al., 2018). The drug release pattern depends upon the design of the device. For example, reservoir-type rings offer controlled drug release at near constant release rates, while matrix-type rings offer relatively large initial release rates followed by declining rates with time. There is currently no option for vaginal pulsatile drug administration or for users to control the timing of drug dosing (apart from the user removing and re-inserting the ring). Furthermore, not all drug compounds can be released effectively by polymeric rings, usually due to relatively high hydrophilicity (resulting in poor solubility in the ring polymer), poor diffusivity (due to large molecular volume of the drug compound), or reaction with the polymeric matrix (Delebecq & Ganachaud, 2012; Dallal Bashi et al., 2019, 2021). The next-generation MedRing vaginal ring has the potential to overcome these limitations.
The influence of hormonal contraception on depression and female sexuality: a narrative review of the literature
Published in Gynecological Endocrinology, 2022
Laura Buggio, Giussy Barbara, Federica Facchin, Laura Ghezzi, Dhouha Dridi, Paolo Vercellini
COCs are the most used type of hormonal contraception. Other birth-control formulations releasing estrogen-progestogens, such as the transdermal patch and the vaginal ring, have become available in the last years. Both vaginal ring and contraceptive patch showed mixed and variable effects regarding sexual function, and no firm conclusions on their sexual effects can be drawn [111]. Some authors reported a decrease in sexual function in women using vaginal rings compared with women using COCs [112,113]. On the other hand, other researchers have shown an improvement in several domains of female sexuality, such as libido, satisfaction with sex, frequency and intensity of orgasm, and sexual fantasies in women using vaginal rings vs. non-users [114]. Regarding the transdermal patch, Gracia et al. [112] reported a slight increase in sexual function scores compared to women using COCs.
Giving voice to the end-user: input on multipurpose prevention technologies from the perspectives of young women in Kenya and South Africa
Published in Sexual and Reproductive Health Matters, 2021
Alexandra M. Minnis, Emily Krogstad, Mary Kate Shapley-Quinn, Kawango Agot, Khatija Ahmed, L. Danielle Wagner, Ariane van der Straten
Participants recommended several improvements to overcome barriers with existing TRIO products by suggesting novel MPT dosage forms or adapting existing contraceptive delivery forms, including implants and IUDs (Figure 2). To overcome challenges with forgetting to take tablets, women recommended decreasing the dosing frequency to weekly or monthly. They also suggested making daily dosing in more discreet product forms, such as a milkshake or porridge that would integrate better into existing life patterns and, importantly, that would not be confused with an ARV for HIV treatment. To reduce injection pain, women suggested making the MPT a single injection that would last three months, or making the needle more like a “sponge [that] should be able to penetrate into the skin” (Age 26, FGD, South Africa). To make the ring more discreet and less likely to interfere with sex, women recommended making it like an IUD that would be inserted “deeper inside” the vagina or like an implant that would be inserted into the arm. Another suggested making a vaginal ring that looks more like jewellery and could be worn as a bangle on the arm.