Diagnosis and management of symptoms associated with vulvovaginal atrophy: expert opinion on behalf of the Italian VVA study group

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.

Approach to sexual dysfunction in women with cancer

“…The external and internal genitalia should be inspected for evidence of edema, scarring, stenosis, atrophy, urogenital prolapse, bowel or bladder incontinence, infection and other potential causes of discomfort. In particular, the objective assessment of vaginal health might be performed by using a Vaginal Health Index taking into consideration vaginal elasticity, fluid volume, epithelial integrity and moisture, and the simple and objective vaginal pH evaluation 17. The vulvar evaluation includes the diagnosis vulvar dystrophy and dysplasia and the use of a Q-tip test to localize vulvar pain 18…”

Differentiated approach to the treatment of genitourinary syndrome in perimenopausal women

“…Studies are underway to investigate the effect of androgen therapy, in particular dehydroepiandrosterone, on the degree of manifestations of the CS, in particular, on the elimination of symptoms of VVA [8].…”

“…In contrast to vasomotor symptoms over time and the transition to postmenopause urogenital disorders only intensify. It is estimated that from 1 to 6 years after menopause 64-85% of women suffer from vaginal and vulvar atrophy [8]. The North American Menopause Society (NAMS) and the International Community for the Study of Female Sexual Health (ISSWSH) have proposed replacing the former name of the genitourinary syndrome of menopause "vulvovaginal atrophy" because this term is not fully describes the whole range of symptoms and is also descriptive and not acceptable to the media and the general public.…”

“…На відміну від вазомоторної симптоматики, з плином часу та переходом у постменопаузу урогенітальні розлади тільки посилюються. Підраховано, що в період від 1 до 6 років після менопаузи на вагінальну та вульварну атрофію страждають від 64 до 85% жінок [8]. Північноамериканське товариство менопаузи (North American Menopause Society, NAMS) та Міжнародне товариство з вивчення жіночого сексуального здоров'я (International Society for the Study of Women's Sexual Health, ISSWSH) запропонувало замінити попередню назву «вульвовагінальна атрофія» на ГСМ через те, що цей термін недостатньо повно охоплює весь спектр симптомів, а також має описовий характер і не є прийнятним для ЗМІ та широкого загалу.…”

“…Наразі ведуться активні розробки з дослідження впливу терапії андрогенами, зокрема дегідроепіандростерону, на ступінь проявів КС, в тому числі на усунення симптомів ВВА [8].…”