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Kawai T, Harada M, Yamada K, Ugomori R, Osuga Y. The prevalence of vulvovaginal symptoms in Japanese women of reproductive and perimenopausal ages: A cross-sectional study across generations. J Obstet Gynaecol Res 2024; 50:914-919. [PMID: 38438124 DOI: 10.1111/jog.15917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/16/2024] [Indexed: 03/06/2024]
Abstract
AIM This cross-sectional study evaluated vaginal health and hygiene practices among reproductive and perimenopausal women in Japan using an online-based questionnaire. METHODS The questionnaire included 11 well-structured questions concerning vulvovaginal symptoms and hygiene care practices. Participants' responses were anonymized and analyzed descriptively. The relationships of age, family income, occupation, and childbearing with women's concerns regarding vaginal or vulvar problems were analyzed by chi-square tests. RESULTS About 80% of women in their 20s to 50s in Japan reported experiencing vulvovaginal symptoms. Women in their 40s had significantly fewer symptoms than women in their 20s (p = 0.04), and women in their 50s had significantly fewer symptoms than all other age groups (20s, 30s, and 40s) (p < 0.001). Among symptomatic women, 77.5% did not discuss their symptoms with anyone else and only 10% visited doctors. About 12.5% of women reported taking special care of their vagina or vulva regularly, whereas 38.2% expressed a desire to try some form of care but had not yet done so. Of the women who did not take special care of their vagina or vulva, 46.2% lacked knowledge about proper care, 42.2% did not want to spend money on care, 30.5% did not want to discuss care with others, and 21.3% were psychologically reluctant. CONCLUSION Determination of the prevalence of vulvovaginal symptoms among Japanese women can enhance understanding of this prevalent condition and its impact on women's health. These findings may help formulate effective public health interventions and promote better hygienic practices, thus improving the well-being of women in Japan.
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Affiliation(s)
- Takao Kawai
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miyuki Harada
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuki Yamada
- Biolier Business Department, Teijin Limited, Tokyo, Japan
| | - Rui Ugomori
- Biolier Business Department, Teijin Limited, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Thong C, Doyle A. Conceptual anatomy of the female genitalia using text mining and implications for patient care. MEDICAL HUMANITIES 2024; 50:86-94. [PMID: 38164575 DOI: 10.1136/medhum-2023-012747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
This article analyses the conceptual histories of words associated with female genital parts to explore how they may affect the lived experience of people with these parts and the quality of gynaecological care they receive. Specifically, we examine the implications of using the word 'vagina' to replace the word 'vulva', or indeed to indicate the entire female genitalia. This article does so through an analysis of existing scholarly work and through text mining methods such as word frequencies, most distinctive word collocates and word-embeddings drawn from literary and women's magazine corpora. We find that words indicating specific female genital parts are very infrequently mentioned in our corpora, which shows that there is a troubling lack of exposure and education in our socio-cultural context when it comes to the female genital anatomy. When they are mentioned, their usage reflects historical and patriarchal associations that have been primarily attached to the word 'vagina'. When it comes to the 'vagina' and 'vulva', the penis is the most prevalent association by far; whereas the most commonly occurring female genital parts are parts to do with reproduction-reinforcing a long-standing and disproportionate emphasis on the female genitalia's reproductive function. Our research also reveals a concerning emphasis on non-evidence-based female hygiene products, thus perpetuating the damaging stereotype of the dirty vagina. These findings may explain many negative patient outcomes such as stigma attached to seeking out timely gynaecological care, lack of informed medical consent and non-evidence-based practices exacerbated by problematic cultural depictions of the female genitalia. They can also explain the neglect of female sexual agency, pleasure and well-being. Understanding historical and contemporary usages of words for the female genitalia has important implications for the quality of patient care today and is a critical component of gender and reproductive justice.
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Affiliation(s)
- Carmen Thong
- English, Stanford University, Stanford, California, USA
| | - Alexis Doyle
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, Utah, USA
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Stair SL, Palmer CJ, Lee UJ. Wealth of Knowledge and Passion: Patient Perspectives on Vaginal Estrogen as Expressed on Reddit. Urology 2023; 182:79-83. [PMID: 37716457 DOI: 10.1016/j.urology.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To qualitatively analyze the knowledge, attitudes, and beliefs of women regarding genitourinary syndrome of menopause (GSM) and vaginal estrogen therapy as expressed on Reddit, a public, anonymous internet forum for discussion and information sharing. METHODS "r/menopause," a Subreddit with >30,000 subscribers, was queried for "vaginal estrogen" to collect postings related to vaginal estrogen in October 2022. Posts were analyzed qualitatively by 2 independent researchers. The principles of grounded theory were applied, and preliminary themes were generated. These themes were used to derive emergent concepts. RESULTS Sixty-seven unique posts with 1101 responses were analyzed. Qualitative analysis revealed 5 preliminary themes: (1) questions regarding medication usage, (2) medication side effects, (3) medication alternatives, (4) frustration with the medical system, and (5) seeking validation for symptoms and experiences. Three emergent concepts were derived: (1) women experience bothersome side effects from menopause, and they desire compassionate and effective medical treatment; (2) women are engaged and active participants in their health and health care decisions; and (3) women perceive that their concerns are not taken seriously and seek validation for their medical conditions. CONCLUSION Peri- and post-menopausal women have many questions and concerns about the condition of GSM and vaginal estrogen as treatment. They also have a broad range of frustrations including access to health care and questions about the usage of vaginal estrogen. By better understanding patient perspectives, physicians can better meet women's needs and improve care for GSM.
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Affiliation(s)
- Sabrina L Stair
- Section of Urology and Renal Transplantation, Virginia Mason Franciscan Health, Seattle, WA
| | - Cristina J Palmer
- Section of Urology and Renal Transplantation, Virginia Mason Franciscan Health, Seattle, WA
| | - Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason Franciscan Health, Seattle, WA.
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Foster P, Luebke M, Razzak AN, Anderson DJ, Hasoon J, Viswanath O, Kaye AD, Urits I. Stigmatization as a Barrier to Urologic Care: A Review. Health Psychol Res 2023; 11:84273. [PMID: 37670795 PMCID: PMC10477007 DOI: 10.52965/001c.84273] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Heavy societal stigma of certain conditions has created an environment where individuals may be hesitant to seek professional care. Urology is a specialized field that focuses on many of these conditions that society has deemed taboo to discuss. In this review, we address barriers that have prevented patients from seeking urologic care in order to better understand and elucidate important concerns within development of the physician-patient relationship. Recognizing these concerns can also assist in public health outreach approaches to motivate patients for seeking urologic care. The scope of this review was limited to three highly prevalent conditions affecting both men and women, including urinary incontinence, erectile dysfunction, and genitourinary syndrome of menopause.
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Affiliation(s)
| | | | | | | | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Alan D Kaye
- Department of Anesthesiology Louisiana State University Health
| | - Ivan Urits
- Department of Pain Medicine Southcoast Health
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Babbar K, Garikipati S. What socio-demographic factors support disposable vs. sustainable menstrual choices? Evidence from India's National Family Health Survey-5. PLoS One 2023; 18:e0290350. [PMID: 37590271 PMCID: PMC10434932 DOI: 10.1371/journal.pone.0290350] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/05/2023] [Indexed: 08/19/2023] Open
Abstract
For over a decade, improving menstrual hygiene among poor girls and women in low-and-middle-income-countries has been a prominent global goal. Towards this, governments in the Global South have worked to promote the uptake of disposable sanitary pads. Despite this, we continue to see a high prevalence of period poverty mainly because disposable pads require monthly purchasing that may be burdensome for many women. Not only are pads financially unsustainable but also represent a heavy environmental burden which has kindled an interest in re-usable innovations like menstrual cups that present a sustainable solution. However, there is little understanding of factors that promote the take-up of disposable vs. sustainable products at population levels. In this paper, we draw on India's National Family Health Survey-5 to understand the socio-demographic determinants of period product usage among girls and women, differentiated by their sustainability quotient. Our findings suggest that awareness of sustainable products and cultural factors are the key driver to promote their use. Women with exposure to menstrual cups either via education or mass media were more likely to use them. Belonging to urban areas and to disadvantaged social categories are other driving factors, at least partly because taboos of vaginal insertion are less of a concern among these groups. These findings suggest that improving the uptake of menstrual cups requires a paradigm shift in menstrual health policies from the promotion of disposable pads alone to spreading awareness of sustainable period choices among women via innovative use of mass media and community networks. Some micro-level evidence of change supports our conclusions.
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Affiliation(s)
- Karan Babbar
- Jindal Global Business School, OP Jindal Global University, Sonipat, India
| | - Supriya Garikipati
- School of Politics and International Relations, University College Dublin, Dublin, Ireland
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Palmeira-de-Oliveira R, Oliveira AS, Rolo J, Tomás M, Palmeira-de-Oliveira A, Simões S, Martinez-de-Oliveira J. Women's preferences and acceptance for different drug delivery routes and products. Adv Drug Deliv Rev 2022; 182:114133. [PMID: 35104506 DOI: 10.1016/j.addr.2022.114133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Abstract
To use or not to use, that is the first decision to take regarding a drug product. This mandatory step for adherence dictates product efficacy. The determinants for such decision do not only rely on the priority of the therapeutic or preventive strategy, but are related to a complex network of perceptions, preferences, personal and cultural backgrounds, and results from previous experiences. Women's preferences for dosage forms and even for drug delivery routes have been mainly studied in the fields of contraception and HIV prevention (and their related multipurpose approaches). Much less attention has been devoted to other therapeutic or preventive strategies. In a time when patient-centred approaches and shared decisions are increasingly valued, considering women's preferences and their main determinants is essential for product development and selection. Such products will be more likely to be chosen and used as intended, increasing efficacy, and reducing the overall costs related with these treatments. This knowledge shall be integrated in early stages of product development. This article reviews the state of the art related with women's preferences and acceptance for different dosage forms and drug delivery routes involved in women's health. The methodologies used for collecting these data and their major drawbacks are discussed. Results obtained from acceptability studies and the main determinants for selection of preventive and treatment drug products are discussed as tools for new developments in the field.
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Affiliation(s)
- Rita Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal.
| | - Ana Sofia Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Joana Rolo
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
| | - Mariana Tomás
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Ana Palmeira-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal; Labfit-HPRD Health Products Research and Development, Lda, Edifício UBIMEDICAL Estrada Municipal 506, 6200-284 Covilhã, Portugal; Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Sérgio Simões
- CNC - Center for Neuroscience and Cell Biology, Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - José Martinez-de-Oliveira
- CICS-UBI Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior Av. Infante D. Henrique, Covilhã, Portugal
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das Neves J, Notario-Pérez F, Sarmento B. Women-specific routes of administration for drugs: A critical overview. Adv Drug Deliv Rev 2021; 176:113865. [PMID: 34280514 DOI: 10.1016/j.addr.2021.113865] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 12/19/2022]
Abstract
The woman's body presents a number of unique anatomical features that can constitute valuable routes for the administration of drugs, either for local or systemic action. These are associated with genitalia (vaginal, endocervical, intrauterine, intrafallopian and intraovarian routes), changes occurring during pregnancy (extra-amniotic, intra-amniotic and intraplacental routes) and the female breast (breast intraductal route). While the vaginal administration of drug products is common, other routes have limited clinical application and are fairly unknown even for scientists involved in drug delivery science. Understanding the possibilities and limitations of women-specific routes is of key importance for the development of new preventative, diagnostic and therapeutic strategies that will ultimately contribute to the advancement of women's health. This article provides an overview on women-specific routes for the administration of drugs, focusing on aspects such as biological features pertaining to drug delivery, relevance in current clinical practice, available drug dosage forms/delivery systems and administration techniques, as well as recent trends in the field.
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Osmałek T, Froelich A, Jadach B, Tatarek A, Gadziński P, Falana A, Gralińska K, Ekert M, Puri V, Wrotyńska-Barczyńska J, Michniak-Kohn B. Recent Advances in Polymer-Based Vaginal Drug Delivery Systems. Pharmaceutics 2021; 13:884. [PMID: 34203714 PMCID: PMC8232205 DOI: 10.3390/pharmaceutics13060884] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
The vagina has been considered a potential drug administration route for centuries. Most of the currently marketed and investigated vaginal formulations are composed with the use of natural or synthetic polymers having different functions in the product. The vaginal route is usually investigated as an administration site for topically acting active ingredients; however, the anatomical and physiological features of the vagina make it suitable also for drug systemic absorption. In this review, the most important natural and synthetic polymers used in vaginal products are summarized and described, with special attention paid to the properties important in terms of vaginal application. Moreover, the current knowledge on the commonly applied and innovative dosage forms designed for vaginal administration was presented. The aim of this work was to highlight the most recent research directions and indicate challenges related to vaginal drug administrations. As revealed in the literature overview, intravaginal products still gain enormous scientific attention, and novel polymers and formulations are still explored. However, there are research areas that require more extensive studies in order to provide the safety of novel vaginal products.
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Affiliation(s)
- Tomasz Osmałek
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Anna Froelich
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Barbara Jadach
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Adam Tatarek
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Piotr Gadziński
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Aleksandra Falana
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Kinga Gralińska
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Michał Ekert
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, 60-780 Poznań, Poland; (A.F.); (B.J.); (A.T.); (P.G.); (A.F.); (K.G.); (M.E.)
| | - Vinam Puri
- Department of Pharmaceutics, William Levine Hall, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Life Sciences Building, New Jersey Center for Biomaterials, Piscataway, NJ 08854, USA; (V.P.); (B.M.-K.)
| | - Joanna Wrotyńska-Barczyńska
- Division of Infertility and Reproductive Endocrinology, Department of Gynecology, Obstetrics and Gynecological Oncology, Poznan University of Medical Sciences, 33 Polna St., 60-535 Poznań, Poland;
| | - Bozena Michniak-Kohn
- Department of Pharmaceutics, William Levine Hall, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Life Sciences Building, New Jersey Center for Biomaterials, Piscataway, NJ 08854, USA; (V.P.); (B.M.-K.)
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Optimization and Application of In Vitro and Ex Vivo Models for Vaginal Semisolids Safety Evaluation. J Pharm Sci 2019; 108:3289-3301. [DOI: 10.1016/j.xphs.2019.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/19/2019] [Accepted: 05/21/2019] [Indexed: 02/05/2023]
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Affiliation(s)
- Ranu Patni
- Division of Gynaecologic Oncology, Prayaas Clinic, Jaipur, Rajasthan, India.,Eternal Heart Care Centre and Apex Hospital, Jaipur, Rajasthan, India. E-mail:
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Fasola E, Bosoni D. Dynamic Quadripolar Radiofrequency: Pilot Study of a New High-Tech Strategy for Prevention and Treatment of Vulvar Atrophy. Aesthet Surg J 2019; 39:544-552. [PMID: 30052757 DOI: 10.1093/asj/sjy180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The well-being of the vulva and a woman's quality of life are strongly correlated. Dynamic quadripolar radiofrequency (DQRF), one of the newest nonsurgical light- and energy-based vulvar rejuvenation technologies, has been demonstrated to be an effective option in aesthetic gynecology. OBJECTIVES The aim of this study was to perform qualitative and semiquantitative evaluations of short-term changes in vulvar aesthetics to illustrate the efficacy of an accelerated DQRF vulvar rejuvenation program in women with mild to moderate vulvar atrophy. METHODS Twenty women with mild to moderate vulvar atrophy were prospectively screened and evaluated. Serial photographs documented the aesthetic impact of DQRF on the vulvar area over the 2-month study period. The overall aesthetic improvement was rated on a Global Aesthetic Improvement Scale modified to create a 10-point semiquantitative rating tool. Complications and side effects were recorded. RESULTS All women successfully underwent 3 planned DQRF procedures spaced 7-10 days apart. Signs and symptoms of vulvar atrophy and the range of aesthetic judgments of the vulvar area were improved in most women after the first DQRF session, and improvements in vulvar aesthetics were persistently highly significant 1 month after the end of the DQRF rejuvenation program. No complications or side effects occurred. CONCLUSIONS Improvements in the signs and symptoms of vulvar atrophy by DQRF rejuvenation of the labia majora confirm the efficacy and safety of this technically simple outpatient procedure. In women with mild to moderate atrophy, a rapid rejuvenation program of closely spaced sessions achieved significant improvements. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Elena Fasola
- Microsurgeon and General Secretary of the Italian Association of Functional and Esthetic Gynecology (AIGEF), Milan, Italy
| | - David Bosoni
- Collaborator, Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, Section of Obstetrics and Gynaecology, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
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Nappi RE, Martini E, Cucinella L, Martella S, Tiranini L, Inzoli A, Brambilla E, Bosoni D, Cassani C, Gardella B. Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women. Front Endocrinol (Lausanne) 2019; 10:561. [PMID: 31496993 PMCID: PMC6712495 DOI: 10.3389/fendo.2019.00561] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022] Open
Abstract
Vaginal health is an essential component of active and healthy aging in women at midlife and beyond. As a consequence of hormonal deprivation and senescence, the anatomy and function of urogenital tissues are significantly affected and vulvovaginal atrophy (VVA) may occur. In a high proportion of postmenopausal women, progressive and chronic VVA symptoms have a strong impact on sexual function and quality of life. The new definition of genitourinary syndrome of menopause (GSM) comprises genital symptoms (dryness, burning, itching, irritation, bleeding), sexual symptoms (dyspareunia and other sexual dysfunctions) and urinary symptoms (dysuria, frequency, urgency, recurrent urinary infections). Many variables (age, sexual activity and partnership status) influence the clinical impact VVA/GSM symptoms and attitudes of elderly women to consult for receiving effective treatments. Psychosocial factors play a critical role in sexual functioning, but the integrity of the urogenital system is as well important affecting many domains of postmenopausal women's health, including sexual function. Several international surveys have extensively documented the need to improve VVA/GSM management because of the strong impact on women's daily life and on couple's intimacy. Health care providers (HCPs) need to be proactive in the early recognition of VVA/GSM in order to preserve urogenital and sexual longevity, by using hormonal and non-hormonal strategies. The clinical diagnosis is based on genital examination to identify objective signs and on the use of subjective scales to rate most bothersome symptoms (MBS), especially vaginal dryness. Recent studies point to the importance of addressing VVA/GSM as a potential early marker of poor general health in analogy with vasomotor symptoms. Therefore, a standard of VVA/GSM care in elderly women is desirable to enhance physical, emotional and mental well-being.
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Affiliation(s)
- Rossella E. Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- *Correspondence: Rossella E. Nappi
| | - Ellis Martini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
| | - Laura Cucinella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Silvia Martella
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Lara Tiranini
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Alessandra Inzoli
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Emanuela Brambilla
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - David Bosoni
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, University of Pavia, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Chiara Cassani
- Obstetrics and Gynecology Unit, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Obstetrics and Gynecology Unit, IRCCS San Matteo Foundation, University of Pavia, Pavia, Italy
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Desbrieres J, Peptu C, Ochiuz L, Savin C, Popa M, Vasiliu S. Application of Chitosan-Based Formulations in Controlled Drug Delivery. SUSTAINABLE AGRICULTURE REVIEWS 36 2019. [DOI: 10.1007/978-3-030-16581-9_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Moreno MA, Córdoba S, Zampini IC, Mercado MI, Ponessa G, Alberto MR, Nader-Macias MEF, Sayago J, Burgos-Edwards A, Schmeda-Hirschmann G, Isla MI. Tetraglochin andina Ciald.: A medicinal plant from the Argentinean highlands with potential use in vaginal candidiasis. JOURNAL OF ETHNOPHARMACOLOGY 2018; 216:283-294. [PMID: 29307753 DOI: 10.1016/j.jep.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/29/2017] [Accepted: 01/02/2018] [Indexed: 06/07/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The Argentinean medicinal plant Tetraglochin andina Ciald, formerly classified as T. cristatum (Britton) Rothm is used in traditional medicine by inhabitants from Argentinean northwestern highlands (Puna) to treat candidiasis and as anti-inflammatory. AIM OF THE STUDY To assess the potential of the crude drug as an anti-Candida agent with anti-inflammatory properties. The bioactivity and phytochemical composition of a dry extract of the plant was investigated. MATERIAL AND METHODS The pharmacognostic description of the crude drug is carried out for the first time, including macroscopic and microscopic examinations of the different organs, physicochemical and extractive values (petroleum ether-, ethanol- and water-soluble). The dry extract from T. andina was evaluated as antifungal against pathogenic Candida sp. and Saccharomyces cerevisiae isolated from vaginal infections and reference strains, by the macrodilution and microdilution assays. The normal vaginal microbiome in women is characterized by the dominance of lactic acid-producing bacteria, mainly Lactobacillus spp. The effect of T. andina extract on Lactobacillus strains was also assayed. The inhibitory effect on proinflammatory enzymes (cyclooxygenase, lipoxygenase and phospholipase A2) and antioxidant capacity was studied. The chemical profile was analyzed by HPLC-ESI-MS. RESULTS The hydroalcoholic extract inhibited the growth of all yeasts with Minimal Inhibitory Concentration (MIC) values between 12.5 and 400 µg GAE/mL and the MIC values on Lactobacillus were higher than the MIC values against Candida isolates ( > 400 µg GAE/mL). These results indicate that the hydroalcoholic extract could be used without affecting the normal microbiota of vaginal fluid. The extract showed antioxidant activity and could modulate the inflammatory process by three pathways (sPLA2, COX-2, LOX). The plant extract contained high total phenolic levels (386.9±1.7 mg GAE/g dry extract) and flavonoid levels (260.4±2.7 mg GAE/g dry extract). Fifty phenolic compounds were identified by HPLC-ESI-MS. They were mainly hydrolysable and condensed tannins. The dry extract was chemically and biologically stable during one year at room temperature or 4 °C. CONCLUSIONS The presence of anti-Candida and anti-inflammatory activities in Tetraglochin andina extracts give support to their traditional use for treating conditions associated with microorganism infections and inflammatory process in humans. This plant preparation could be used to design phytopharmaceutical preparations to inhibit yeast growth and moderate the inflammatory and oxidative process.
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Affiliation(s)
- María Alejandra Moreno
- Laboratorio de Investigación de Productos Naturales (LIPRON), Instituto de Bioprospección y Fisiología Vegetal (INBIOFIV-CONICET), Facultad de Ciencias Naturales e IML, Universidad Nacional de Tucumán, San Lorenzo 1469 San Miguel de Tucumán, Tucumán, Argentina
| | - Susana Córdoba
- INEI-ANLIS 'Dr. Carlos G. Malbrán', Departamento de Micología, Av. Vélez Sarsfield 563, Ciudad Autónoma de Buenos Aires, Argentina
| | - Iris Catiana Zampini
- Laboratorio de Investigación de Productos Naturales (LIPRON), Instituto de Bioprospección y Fisiología Vegetal (INBIOFIV-CONICET), Facultad de Ciencias Naturales e IML, Universidad Nacional de Tucumán, San Lorenzo 1469 San Miguel de Tucumán, Tucumán, Argentina
| | - María Inés Mercado
- Instituto de Morfología Vegetal. Área Botánica. Fundación Miguel Lillo, Miguel Lillo 251, San Miguel de Tucumán, Tucumán, Argentina.
| | - Graciela Ponessa
- Instituto de Morfología Vegetal. Área Botánica. Fundación Miguel Lillo, Miguel Lillo 251, San Miguel de Tucumán, Tucumán, Argentina.
| | - María Rosa Alberto
- Laboratorio de Investigación de Productos Naturales (LIPRON), Instituto de Bioprospección y Fisiología Vegetal (INBIOFIV-CONICET), Facultad de Ciencias Naturales e IML, Universidad Nacional de Tucumán, San Lorenzo 1469 San Miguel de Tucumán, Tucumán, Argentina
| | - M E Fatima Nader-Macias
- Centro de Referencia de Lactobacillos (CERELA-CONICET), Chacabuco 145, San Miguel de Tucumán, Tucumán, Argentina
| | - Jorge Sayago
- Laboratorio de Investigación de Productos Naturales (LIPRON), Instituto de Bioprospección y Fisiología Vegetal (INBIOFIV-CONICET), Facultad de Ciencias Naturales e IML, Universidad Nacional de Tucumán, San Lorenzo 1469 San Miguel de Tucumán, Tucumán, Argentina
| | - Alberto Burgos-Edwards
- Laboratorio de Química de Productos Naturales, Instituto de Química de Recursos Naturales, Universidad de Talca, Casilla 747, 3460000 Talca, Chile
| | - Guillermo Schmeda-Hirschmann
- Laboratorio de Química de Productos Naturales, Instituto de Química de Recursos Naturales, Universidad de Talca, Casilla 747, 3460000 Talca, Chile
| | - María Inés Isla
- Laboratorio de Investigación de Productos Naturales (LIPRON), Instituto de Bioprospección y Fisiología Vegetal (INBIOFIV-CONICET), Facultad de Ciencias Naturales e IML, Universidad Nacional de Tucumán, San Lorenzo 1469 San Miguel de Tucumán, Tucumán, Argentina.
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Machado RM, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, Palmeira-de-Oliveira R. Vaginal semisolid products: Technological performance considering physiologic parameters. Eur J Pharm Sci 2017; 109:556-568. [PMID: 28887234 DOI: 10.1016/j.ejps.2017.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/01/2017] [Accepted: 09/04/2017] [Indexed: 11/29/2022]
Abstract
Vaginal semisolid products are frequently used to treat vaginal infections and atrophy-related symptoms of menopause. Formulations composition and the methods for their characterization, especially those developed concerning the target epithelia, are key tools to predict in vivo results at early stages of product development. However, recent studies on this subject have been almost exclusively focused on anti-HIV preparations. The aim of this work consists on improving traditional characterization methods by using physiological parameters in order to construct predictive tools to characterize a new ideal vaginal semisolid formulation whatever target it may have. Ten vaginal antimicrobial and hormonal products already available in the market were studied (Gino-Canesten®, Sertopic®, Dermofix®, Gyno-pevaryl®, Lomexin®, Gino Travogen®, Dalacin V®, Ovestin®, Blissel®, Colpotrophine®). Furthermore, Universal Placebo gel and Replens® were used for comparison. Products were characterized in terms of: pH and buffering capacity in a vaginal fluid simulant (VFS); osmolality - directly and upon dilution in VFS; textural parameters (firmness, adhesiveness and bioadhesion) using vaginal ex vivo porcine epithelium; and viscosity (including VFS dilution at 37°C and after administration on an ex vivo model). Interestingly, the majority of the tested commercial vaginal formulations did not present technological characteristics close to the ideal ones when tested under target biological conditions. The inclusion of such methodologic adaptations is expected to optimize cost-efficiency of new formulations development by predicting efficacy and safety profiles at early stages of product development.
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Affiliation(s)
- Rita Monteiro Machado
- CICS, UBI - Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal; Labfit, HPRD - Health Products Research and Development, Lda, Edifício UBIMEDICAL, Estrada Municipal 506, 6200-284 Covilhã, Portugal.
| | - Ana Palmeira-de-Oliveira
- CICS, UBI - Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal; Labfit, HPRD - Health Products Research and Development, Lda, Edifício UBIMEDICAL, Estrada Municipal 506, 6200-284 Covilhã, Portugal.
| | - José Martinez-de-Oliveira
- CICS, UBI - Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal; Child and Woman's Health Department, Centro Hospitalar Cova da Beira EPE, Quinta do Alvito, 6200-251 Covilhã, Portugal.
| | - Rita Palmeira-de-Oliveira
- CICS, UBI - Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Avenida Infante D. Henrique, 6200-506 Covilhã, Portugal; Labfit, HPRD - Health Products Research and Development, Lda, Edifício UBIMEDICAL, Estrada Municipal 506, 6200-284 Covilhã, Portugal; Pharmacy Department, Centro Hospitalar Cova da Beira EPE, Quinta do Alvito, 6200-251 Covilhã, Portugal.
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Buggio L, Lazzari C, Monti E, Barbara G, Berlanda N, Vercellini P. "Per vaginam" topical use of hormonal drugs in women with symptomatic deep endometriosis: a narrative literature review. Arch Gynecol Obstet 2017; 296:435-444. [PMID: 28664485 DOI: 10.1007/s00404-017-4448-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/26/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE We aim to provide a comprehensive overview of the role of the vagina as a route for drug delivery and absorption, with a particular focus on the use of vaginal hormonal compounds for the treatment of deep infiltrating symptomatic endometriosis. METHODS A MEDLINE search through PubMed was performed to identify all published studies in English language on vaginal hormonal treatments for symptomatic endometriosis. RESULTS Main advantages of the vaginal route include avoidance of the hepatic-first pass metabolic effect, the possibility of using lower therapeutic dosages, and the reduction of side effects compared with the oral administration. Studies on endometriosis treatment mainly focused on the use of vaginal danazol (n = 6) and the contraceptive vaginal ring (n = 2). One pilot study evaluated the efficacy of vaginal anastrozole in women with rectovaginal endometriosis. Most investigations evaluated the vaginal use of hormonal agents in women with deep infiltrating endometriosis/rectovaginal endometriosis. Overall, a substantial amelioration of pelvic pain symptoms associated with endometriosis was observed, particularly of dysmenorrhea. A significant reduction in rectovaginal endometriotic nodule dimensions measured at ultrasound examination was detected by some but not all authors. CONCLUSIONS The vaginal route represents a scarcely explored modality for drug administration. High local hormonal concentrations might achieve a greater effect on endometriotic lesions compared with alternative routes. Future studies should focus on the use of the vagina for delivering target therapies particularly in patients with deeply infiltrating rectovaginal lesions.
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Affiliation(s)
- Laura Buggio
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda, 12, 20122, Milan, Italy.
| | - Caterina Lazzari
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda, 12, 20122, Milan, Italy
| | - Ermelinda Monti
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda, 12, 20122, Milan, Italy
| | - Giussy Barbara
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda, 12, 20122, Milan, Italy
| | - Nicola Berlanda
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda, 12, 20122, Milan, Italy
| | - Paolo Vercellini
- Unità Operativa Dipartimentale Ginecologia Chirurgica e Endometriosi, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda, 12, 20122, Milan, Italy
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Duque-Estrada EDO, Rosa VP, Mosca MM, do Nascimento HL. Perceived Efficacy of Vaginal Dryness Relief: A Comparative Clinical Study between <i>Sodium hyaluronate vaginal gel</i><sup>1</sup> <i>vs. Promestriene cream</i><sup>2</sup>. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/asm.2017.71003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Simonis M, Manocha R, Ong JJ. Female genital cosmetic surgery: a cross-sectional survey exploring knowledge, attitude and practice of general practitioners. BMJ Open 2016; 6:e013010. [PMID: 27678547 PMCID: PMC5051499 DOI: 10.1136/bmjopen-2016-013010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/11/2016] [Accepted: 09/01/2016] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore general practitioner's (GP) knowledge, attitudes and practice regarding female genital cosmetic surgery (FGCS) in Australia. DESIGN Cross-sectional survey. SETTING Australia. SAMPLE GPs who attended a women's health seminar and GPs who subscribed to a non-governmental, national health professional organisation database that provides education to primary care professionals. METHOD A national online survey of GPs was conducted for the 10-week period, starting 1 week prior and 2 months after a Women's Health seminar was held in Perth on 8 August 2015. 31 questions prompted GPs' knowledge, attitudes and practice in managing patients asking about FGCS. RESULTS The survey was fully completed by 443 GPs; 54% had seen patients requesting FGCS. Overall, 75% (95% CI 71% to 79%) of GPs rated their knowledge of FGCS as inadequate and 97% (95% CI 94% to 99%) had been asked by women of all ages about genital normality. Of those who had seen patients requesting FGCS, nearly half (44%, 95% CI 38% to 51%) reported they had insufficient knowledge of risks of FGCS procedures and 35% (95% CI 29% to 41%) reported seeing females younger than 18 years of age requesting FGCS. Just over half (56%, 95% CI 51% to 60%) of the GPs felt that women should be counselled before making a referral for FGCS. More than half the GPs suspected psychological disturbances in their patients requesting FGCS such as depression, anxiety, relationship difficulties and body dysmorphic disorder. CONCLUSIONS GPs see women of all ages presenting with genital anatomy concerns and in those who request FGCS, GPs often suspected a range of mental health difficulties. GPs require greater education to support their patients who request FGCS.
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Affiliation(s)
- M Simonis
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
- Royal Australian College of General Practitioners, Expert Committee Quality Care, Melbourne, Victoria, Australia
| | - R Manocha
- Sydney Medical School Northern, The University of Sydney, Sydney, New South Wales, Australia
- Academic Department of Psychiatry, Kolling Institute, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - J J Ong
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Melbourne Sexual Health Centre, Carlton, Victoria, Australia
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19
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Nappi RE, Biglia N, Cagnacci A, Di Carlo C, Luisi S, Paoletti AM. Diagnosis and management of symptoms associated with vulvovaginal atrophy: expert opinion on behalf of the Italian VVA study group . Gynecol Endocrinol 2016; 32:602-606. [PMID: 27187159 PMCID: PMC5152549 DOI: 10.1080/09513590.2016.1183627] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Vulvovaginal atrophy (VVA) is a chronic disorder that commonly occurs in postmenopausal women, whose symptoms are recognized among the most frequent and bothersome symptoms associated with menopause. The principal therapeutic goal in managing VVA is to relieve symptoms as well as to restore the vaginal environment to a healthy state. However, despite its high prevalence and negative impact on quality of life, VVA is underreported by women, underrecognized by gynecologists, and therefore, undertreated. In the light of the new development of treatment options for VVA, we here provide an updated expert opinion on the management of VVA. In particular, we strongly recommend that HCPs proactively start an open discussion with their postmenopausal patients about urogenital symptoms. Treatment should be started as early as the first symptoms of VVA occur and should be maintained over time, due to the chronicity of the conditions. Many treatment options are now available and therapy should be individualized, taking the woman's preference in consideration.
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Affiliation(s)
- Rossella E. Nappi
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia,
Pavia,
Italy
- Address for correspondence: Rossella E. Nappi,
Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia,
Italy. E-mail:
| | - Nicoletta Biglia
- Obstetrics and Gynecology, University of Turin, School of Medicine Ospedale Mauriziano Umberto I,
Turin,
Italy
| | - Angelo Cagnacci
- Gynecology and Obstetrics, University of Modena and Reggio Emilia, Azienda Policlinico of Modena,
Modena,
Italy
| | - Costantino Di Carlo
- Gynecology and Obstetrics, Department of Neurosciences and Reproductive Sciences, University of Naples Federico II,
Naples,
Italy
| | - Stefano Luisi
- Obstetrics and Gynecology, Department of Molecular and Developmental Medicine, University of Siena, Policlinico “Le Scotte”,
Siena,
Italy
| | - Anna Maria Paoletti
- Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari,
AOU Cagliari,
Italy
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Mowat H, McDonald K, Dobson AS, Fisher J, Kirkman M. The contribution of online content to the promotion and normalisation of female genital cosmetic surgery: a systematic review of the literature. BMC Womens Health 2015; 15:110. [PMID: 26608568 PMCID: PMC4660671 DOI: 10.1186/s12905-015-0271-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 11/24/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women considering female genital cosmetic surgery (FGCS) are likely to use the internet as a key source of information during the decision-making process. The aim of this systematic review was to determine what is known about the role of the internet in the promotion and normalisation of female genital cosmetic surgery and to identify areas for future research. METHODS Eight social science, medical, and communication databases and Google Scholar were searched for peer-reviewed papers published in English. Results from all papers were analysed to identify recurring and unique themes. RESULTS Five papers met inclusion criteria. Three of the papers reported investigations of website content of FGCS providers, a fourth compared motivations for labiaplasty publicised on provider websites with those disclosed by women in online communities, and the fifth analysed visual depictions of female genitalia in online pornography. Analysis yielded five significant and interrelated patterns of representation, each functioning to promote and normalise the practice of FGCS: pathologisation of genital diversity; female genital appearance as important to wellbeing; characteristics of women's genitals are important for sex life; female body as degenerative and improvable through surgery; and FGCS as safe, easy, and effective. A significant gap was identified in the literature: the ways in which user-generated content might function to perpetuate, challenge, or subvert the normative discourses prevalent in online pornography and surgical websites. CONCLUSIONS Further research is needed to contribute to knowledge of the role played by the internet in the promotion and normalisation of female genital cosmetic surgery.
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Affiliation(s)
- Hayley Mowat
- Jean Hailes Research Unit, Monash University, Melbourne, Australia.
| | - Karalyn McDonald
- Jean Hailes Research Unit, Monash University, Melbourne, Australia.
| | - Amy Shields Dobson
- Institute for Advanced Studies in the Humanities, University of Queensland, Brisbane, Australia.
| | - Jane Fisher
- Jean Hailes Research Unit, Monash University, Melbourne, Australia.
| | - Maggie Kirkman
- Jean Hailes Research Unit, Monash University, Melbourne, Australia.
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Labrie F, Montesino M, Archer DF, Lavoie L, Beauregard A, Côté I, Martel C, Vaillancourt M, Balser J, Moyneur E. Influence of treatment of vulvovaginal atrophy with intravaginal prasterone on the male partner. Climacteric 2015; 18:817-25. [DOI: 10.3109/13697137.2015.1077508] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Palmeira-de-Oliveira R, Palmeira-de-Oliveira A, Martinez-de-Oliveira J. New strategies for local treatment of vaginal infections. Adv Drug Deliv Rev 2015; 92:105-22. [PMID: 26144995 DOI: 10.1016/j.addr.2015.06.008] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 06/15/2015] [Accepted: 06/24/2015] [Indexed: 01/07/2023]
Abstract
Vaginal infections are extremely prevalent, particularly among women of reproductive age. Although they do not result in high mortality rates, these infections are associated with high levels of anxiety and reduction of quality of life. In most cases, topical treatment of vaginal infections has been shown to be at least as effective as oral treatment, resulting in higher local drug concentrations, with fewer drug interactions and adverse effects. Furthermore, the emergence of microbial resistance to chemotherapeutics and the difficulties in managing infection recurrences sustain the need for more effective local treatments. However, conventional dosage forms have been associated with low retention in the vagina and discomfort. Formulation strategies such as the development of bioadhesive, thermogelling systems and microtechnological or nanotechnological approaches have been proposed to improve delivery of traditional drugs, and other treatment modalities such as new drugs, plant extracts, and probiotics are being studied. This article reviews the recent strategies studied to improve the treatment and prevention of the commonest vaginal infections-namely, vaginal bacteriosis, aerobic vaginitis, vulvovaginal candidosis, and trichomoniasis-through the intravaginal route.
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Palmeira-de-Oliveira R, Duarte P, Palmeira-de-Oliveira A, das Neves J, Amaral MH, Breitenfeld L, Martinez-de-Oliveira J. Women's experiences, preferences and perceptions regarding vaginal products: Results from a cross-sectional web-based survey in Portugal. EUR J CONTRACEP REPR 2014; 20:259-71. [DOI: 10.3109/13625187.2014.980501] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Palmeira-de-Oliveira R, Duarte P, Palmeira-de-Oliveira A, das Neves J, Amaral MH, Breitenfeld L, Martinez-de-Oliveira J. What do portuguese women prefer regarding vaginal products? Results from a cross-sectional web-based survey. Pharmaceutics 2014; 6:543-56. [PMID: 25337676 PMCID: PMC4279132 DOI: 10.3390/pharmaceutics6040543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/09/2014] [Accepted: 10/10/2014] [Indexed: 11/16/2022] Open
Abstract
Therapeutic outcomes of vaginal products depend not only on their ability to deliver drugs to or through the vagina but also on acceptability and correct use. Women's preferences, in turn, may vary according to age and cultural backgrounds. In this work, an anonymous online survey was completed by 2529 Portuguese women to assess their preferences for physical characteristics and mode of application of vaginal products, according to age. Additionally, intention to use and misconceptions about these issues were assessed. The majority of women of all age groups would use vaginal products to treat or prevent diseases, upon medical prescription. Women preferred vaginal products to be odorless and colorless gels, creams and ointments composed by natural origin drugs/excipients and applied by means of an applicator. Although the majority of women would prefer not to insert any product in the vagina, intention to use for self and recommendation to use for others was associated with previous experiences with vaginal products. General concerns and misconceptions related to use of vaginal products were rare. These data may contribute to the development of products that women are more prone to use.
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Affiliation(s)
- Rita Palmeira-de-Oliveira
- CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal.
| | - Paulo Duarte
- NECE-Research Unit in Business Sciences, Faculty of Human and Social Sciences, University of Beira Interior, 6200-209 Covilhã, Portugal.
| | - Ana Palmeira-de-Oliveira
- CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal.
| | - José das Neves
- INEB-Instituto de Engenharia Biomédica, University of Porto, 4150-180 Porto, Portugal.
| | - Maria Helena Amaral
- Laboratory of Pharmaceutical Technology, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal.
| | - Luiza Breitenfeld
- CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal.
| | - José Martinez-de-Oliveira
- CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal.
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Vaginal health in the United States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause 2014; 20:1043-8. [PMID: 23571518 DOI: 10.1097/gme.0b013e318287342d] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess US postmenopausal women's knowledge of and attitudes toward vaginal atrophy, using the Vaginal Health: Insights, Views & Attitudes survey. METHODS Data were obtained from 3,520 postmenopausal women (aged 55-65 y) in the United States, Canada, and Europe using a structured Internet-based questionnaire. Results for US women (n = 500) are presented. RESULTS Eighty percent of women had finished their menses more than 5 years previously, and 93% had experienced at least one menopausal symptom, although only 63% associated vaginal symptoms with menopause. Of those who had experienced "vaginal discomfort" (48%), vaginal dryness (85%) and pain during intercourse (52%) were most commonly reported. Eighty-two percent of women had experienced vaginal discomfort for 1 year or more. Most women (80%) considered vaginal discomfort to negatively impact their lives, particularly with regard to sexual intimacy (75%), ability to have a loving relationship (33%), and overall quality of life (25%); women also felt that it made them feel old (36%) and affected their self-esteem (26%). Of those with symptoms, 37% did not consult any healthcare professional, and 40% waited 1 year or more before doing so. Although 78% of those with vaginal discomfort used some form of treatment, this consisted mainly of lubricating gels and creams (65%); only 34% of women had used any form of hormone therapy. CONCLUSIONS Vaginal atrophy negatively impacts women's lives, but women lack knowledge of the subject and are hesitant to consult healthcare professionals, who should proactively initiate discussions regarding appropriate treatment options.
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Nappi RE, Palacios S. Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause. Climacteric 2014; 17:3-9. [DOI: 10.3109/13697137.2013.871696] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Veale D, Eshkevari E, Ellison N, Costa A, Robinson D, Kavouni A, Cardozo L. A comparison of risk factors for women seeking labiaplasty compared to those not seeking labiaplasty. Body Image 2014; 11:57-62. [PMID: 24239491 DOI: 10.1016/j.bodyim.2013.10.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 12/23/2022]
Abstract
Little is known about the factors associated with the desire for labiaplasty. We compared 55 women seeking labiaplasty with 70 women in a comparison group who were not seeking labiaplasty. Measures administered included the Perception of Appearance and Competency Related Teasing Scale, Childhood Trauma Questionnaire, Disgust Scale Revised, and the Genital Appearance Satisfaction scale with open-ended questions about their genitalia. Approximately a third of the labiaplasty group recalled specific negative comments in the past towards their labia, a proportion significantly greater than the three per cent in the comparison group. Participants reporting genital teasing also showed higher Genital Appearance Satisfaction scores than those who were not teased. However, women seeking labiaplasty were, compared to the comparison group, no more likely to have a history of neglect or abuse during childhood. There was no difference between the groups on disgust sensitivity or the perception of being teased in the past about their competence or appearance in general.
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Affiliation(s)
- David Veale
- The Institute of Psychiatry, King's College London and the South London and Maudsley NHS Foundation Trust, London, UK.
| | - Ertimiss Eshkevari
- The Institute of Psychiatry, King's College London and the South London and Maudsley NHS Foundation Trust, London, UK
| | - Nell Ellison
- The Institute of Psychiatry, King's College London and the South London and Maudsley NHS Foundation Trust, London, UK
| | - Ana Costa
- The Institute of Psychiatry, King's College London and the South London and Maudsley NHS Foundation Trust, London, UK
| | - Dudley Robinson
- Urogynaecology Unit, King's College London and King's College Hospital NHS Foundation Trust, UK
| | | | - Linda Cardozo
- Urogynaecology Unit, King's College London and King's College Hospital NHS Foundation Trust, UK
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Nappi RE. Counseling on vaginal delivery of contraceptive hormones: implications for women's body knowledge and sexual health. Gynecol Endocrinol 2013; 29:1015-21. [PMID: 23992246 DOI: 10.3109/09513590.2013.830100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Healthcare providers (HCPs) have an important role in helping women select the contraceptive method that best matches their needs and lifestyle. Recent surveys outline the need of women to be informed about all available choices, including the newest methods (particularly those not requiring daily administration), such as vaginal contraception. METHODS The most relevant publications on combined contraceptive vaginal ring are revised in the context of counseling as an opportunity to empower women in term of vaginal health and sexual functioning. RESULTS HCPs should explain the main characteristics of the combined contraceptive vaginal ring including the anatomical and physiological implications that make the vagina an ideal route of hormonal administration and the basic notions about functional modifications of the vagina during reproductive life. Clinical data on the vaginal ring should be summarized with regard to efficacy, tolerability, pharmacokinetics, cycle control and user acceptability, including recent findings on extra-contraceptive benefits (also compared to other hormonal contraceptives) on the vaginal flora and on sexual function. CONCLUSION Vaginal contraception offers various benefits and should always be discussed during contraceptive counseling. An open dialogue about vaginal contraception will also help enhance body knowledge and sexual health.
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Affiliation(s)
- Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Obstetrics and Gynecology, Research Center for Reproductive Medicine, IRCCS San Matteo Foundation, University of Pavia , Pavia , Italy
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Nappi RE, Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) – results from an international survey. Climacteric 2011; 15:36-44. [DOI: 10.3109/13697137.2011.647840] [Citation(s) in RCA: 270] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Nappi RE, Kokot-Kierepa M. Women's voices in the menopause: Results from an international survey on vaginal atrophy. Maturitas 2010; 67:233-8. [DOI: 10.1016/j.maturitas.2010.08.001] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 08/08/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
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Tsin DA, Castro-Perez R, Davila MR, Davila F. Postoperative patient attitudes and perceptions of transvaginal cholecystectomy. J Laparoendosc Adv Surg Tech A 2010; 20:119-21. [PMID: 20201686 DOI: 10.1089/lap.2009.0386] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A survey was conducted in order to dispel misconceptions about natural orifice transvaginal cholecystectomy. Forty-two patients were surveyed after having undergone that procedure. Those patients were asked questions related to 1) patient satisfaction, 2) whether they would recommend the procedure to others, and 3) dyspaurenia. The survey was done after a sexual abstinence period that varied from 30 to 40 days. We encountered no complications, and all patients liked the procedure and would recommend it to family and friends. No patient developed dyspaurenia. The postoperative responses were unanimous and positive for all questions. The result of this postoperative transvaginal cholecystectomy survey will help patients and surgeons ease their fears and social taboos and better communicate, and this will help patients to become aware of the option of transvaginal peritoneoscopy.
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Affiliation(s)
- Daniel A Tsin
- Department of Minimally Invasive Surgery, The Mount Sinai Hospital of Queens, Long Island City, New York 11102, USA.
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Abstract
OBJECTIVES To provide an overview of the alterations in sexuality and sexual function that occur in women with cancer. DATA SOURCES Research and review articles, books, clinical experience. CONCLUSIONS Although initial concerns of women with cancer may not focus on sexuality issues, most women want support in dealing with body changes. Cancer and cancer treatment for women can result in changes in sexuality and sexual function that may or may not improve over time. Sexual assessment can provide the basis for various approaches to intervention. IMPLICATIONS FOR NURSING PRACTICE Sexual assessment is an essential part of nursing practice across the trajectory of cancer. With this information, nurses can plan interventions tailored to address these important alterations in the lives of women with cancer.
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Affiliation(s)
- Mary K Hughes
- Psychiatry Department, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Neves JD, Santos B, Teixeira B, Dias G, Cunha T, Brochado J. Vaginal drug administration in the hospital setting. Am J Health Syst Pharm 2008; 65:254-9. [DOI: 10.2146/ajhp070093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- José das Neves
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Porto, Portugal, and Compounding Pharmacist and Clinical Pharmacist, Pharmacy Department, Santo António General Hospital (HGSA), Porto
| | - Bárbara Santos
- Abel Salazar Institute of Biomedical Sciences, Porto, and Clinical Pharmacist, Pharmacy Department, HGSA
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das Neves J, Pinto E, Teixeira B, Dias G, Rocha P, Cunha T, Santos B, Amaral MH, Bahia MF. Local Treatment of Vulvovaginal Candidosis. Drugs 2008; 68:1787-802. [DOI: 10.2165/00003495-200868130-00002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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