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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).
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
Hormonal therapy remains the most effective therapy for urogenital atrophy. Consideration of hormonal therapy should be part of an overall strategy including lifestyle recommendations regarding diet, exercise, smoking cessation, and safe levels of alcohol consumption for maintaining the health of peri- and post-menopausal women. All local estrogen preparations (creams, pessaries, tablets, and vaginal rings) are effective at decreasing the signs and symptoms of vaginal atrophy. Vaginal moisturizers and lubricants as well as regular sexual activity may be helpful to such women wishing to avoid the use of hormonal therapy. The use of SERMs is another option in those women with atrophy-related symptoms who are unwilling or unable to take vaginal estrogen therapy, however a detailed discussion should be had with individual patients on the risks versus benefits before making final decisions on management.
Menopause
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Tina Sara Verghese, Jenny Williamson, Lynne Robinson
Oestrogen treatment can be used to reduce thinning of the vaginal and pelvic tissues. This may help to reduce or prevent symptoms of cystitis and may aid postoperative recovery after uro-gynaecological procedures. The different preparations of topical HRTs (creams, pessaries, tablets and the oestradiol vaginal ring) all appear equally effective for treating vaginal atrophy.
The role of microbiota in the management of genitourinary syndrome of menopause
Published in Climacteric, 2023
G. Stabile, G. A. Topouzova, F. De Seta
For the normal functioning of the balanced vaginal ecosystem, sufficient estrogen levels leading to an intact vaginal epithelium as well as a healthy vaginal microbiome are essential [6]. The immune response also influences this ecosystem [7]. The defensive vaginal lactobacillary flora is in a dynamic state. The abundance and bacterial type composition can change rapidly [8]. Vaginal atrophy is caused primarily by an estrogen deficiency. It acts on the vagina, vulva, urethra and trigone of the bladder via estrogen receptors on these structures. Estrogen helps to maintain the collagen content of epithelium and thus effects on thickness and elasticity; it helps to maintain acid mucopolysaccharides and hyaluronic acid, which keep epithelial surfaces moist. The breakdown of proliferated superficial cells liberates glycogen, which serves as a substrate for the Lactobacilli [9–11]. The change in circulating estrogen levels is reflected by changes in vaginal physiology and symptoms, resulting in decreased barrier and lubrication functions of the epithelium. The reduction of estrogen leads to a reduction of vaginal glycogen with a reduction of the vital substrate for the Lactobacilli and increased penetration by pathogens, inducing numerous other symptoms included in GSM [12].
Clinical manifestations and evaluation of postmenopausal vulvovaginal atrophy
Published in Gynecological Endocrinology, 2021
Faustino R. Pérez-López, Pedro Vieira-Baptista, Nancy Phillips, Bina Cohen-Sacher, Susana C. A. V. Fialho, Colleen K. Stockdale
VVA can occur in up to 40% of premenopausal women who experience hypoestrogenic effects as a result of chemotherapy, pelvic radiation, bilateral oophorectomy, progestin-only contraceptives, breastfeeding, or anti-estrogenic therapies (i.e. aromatase inhibitors, tamoxifen, gonadotropin-releasing hormone analogs) [7]. In situations other than menopause, like breastfeeding or the use of certain hormone treatments, vaginal atrophy usually resolves spontaneously when estrogen levels are restored [8]. The objectives of the present document are to review the clinical characteristics and evaluation of VVA under hypoestrogenic conditions and to identify outcomes that may be assessed in clinical practice. In the treatment of VVA, it is important to realize that VVA may co-exist with other vulvovaginal conditions, and these, if present, should be specifically dealt with.
Hormone replacement therapy and cervical cancer: a systematic review of the literature
Published in Climacteric, 2021
V. Vargiu, I. D. Amar, A. Rosati, G. Dinoi, L. C. Turco, V. A. Capozzi, G. Scambia, P. Villa
Furthermore, chemo-radiated patients usually refer to a worse QoL than those surgically treated, probably due to adverse effects of pelvic radiation therapy on the urogenital apparatus, as vaginal epithelial sloughing, ulcer formations, and necrosis, which can progress to vaginal mucosal thinning, fibrosis, and stenosis64. HRT helps in reducing vaginal atrophy, and even though vaginal epithelial response to estradiol is impaired in chemo-radiated patients, a positive correlation between the circulating estradiol level and vaginal epithelial thickness has been described65. Besides, topical estrogens are demonstrated to be highly effective at relieving vaginal atrophy in this specific subset of patients66. Therefore, local estrogen therapy, associated with systemic therapy, might play an important role.