Involutive changes in the vulvovaginal area

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Abstract

Involutional changes in the vulvovaginal area involve a series of transformations leading to vulvovaginal atrophy (VVA) during menopause. Signs and symptoms most often observed in this syndrome: vaginal dryness (54.4–100%), dyspareunia (17.6–77.6%), burning (2.0–56.9%), itching (7.8–56.6%) and dysuria (5.9–36.1%). Other complaints include deformity of the vulva, irritation, and recurrent bacterial infections of the urinary tract or vagina, and yeast infection. Vaginal dryness, dyspareunia and irritation are the symptoms that most affect a woman's quality of life.

The article analyzes modern ideas about the genitourinary syndrome of menopause. The questions of the mechanisms of occurrence are considered, a description of the clinical picture is given. The issues of treatment of atrophy of the vulvovaginal region are discussed in detail, in particular, special attention is paid to physiotherapeutic methods of treatment.

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About the authors

Sergei I. Surkichin

Central State Medical Academy of Department of Presidential Affairs

Author for correspondence.
Email: surkichinsi24@mail.ru
ORCID iD: 0000-0003-0521-0333

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, Moscow

Larisa S. Kruglova

Central State Medical Academy of Department of Presidential Affairs

Email: surkichinsi24@mail.ru
ORCID iD: 0000-0002-5044-5265
SPIN-code: 1107-4372

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

Inna A. Apolikhina

National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakov

Email: surkichinsi24@mail.ru
ORCID iD: 0000-0002-4581-6295
SPIN-code: 6282-7435

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Roman Yu. Mayorov

Central State Medical Academy of Department of Presidential Affairs

Email: surkichinsi24@mail.ru
ORCID iD: 0000-0003-1911-6743
Russian Federation, Moscow

Marika Avin

Medical Center "Stolitsa"

Email: surkichinsi24@mail.ru
ORCID iD: 0000-0002-8317-0800
Russian Federation, Moscow

References

  1. Portman DJ, Gass ML, on behalf of the Vulvovaginal Atrophy Conference Panel: Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. Climateric. 2014;21:1063–1068. doi: 10.1097/GME.0000000000000329
  2. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20(9):888–902;quiz 903-4. doi: 10.1097/GME.0b013e3182a122c2
  3. Robinson D, Cardozo L, The pathophysiology and management of postmenopausal urogenital oestrogen deficiency. J Br Menopause Soc. 2001;7(2):67–73. doi: 10.1258/136218001100321263
  4. Ettinger B, Hait H, Reape KZ, Shu H. Measuring symptom relief in studies of vaginal and vulvar atrophy: the most bothersome symptom approach. Menopause. 2008;15(5):885–889. doi: 10.1097/gme.0b013e318182f84b
  5. Palacios S, Nappi RE, Bruyniks N, et al. The European Vulvovaginal Epidemiological Survey (EVES): prevalence, symptoms and impact of vulvovaginal atrophy of menopause. Climacteric. 2018;21(3):286–291. doi: 10.1080/13697137.2018.1446930
  6. Nappi RE, Seracchioli R, Salvatore S, et al. Impact of vulvovaginal atrophy of menopause: prevalence and symptoms in Italian women according to the EVES study. Gynecol Endocrinol. 2019;35(5):453–459. doi: 10.1080/09513590.2018.1563883
  7. Lester J, Pahouja G, Andersen B, Lustberg M. Atrophic vaginitis in breast cancer survivors: a difficult survivorship issue. J Pers Med. 2015;5(2):50–66. doi: 10.3390/jpm5020050
  8. Palma F, Xholli A, Cagnacci A, as the writing group of the AGATA study. The most bothersome symptom of vaginal atrophy: Evidence from the observational AGATA study. Maturitas. 2018;108:18–23. doi: 10.1016/j.maturitas.2017.11.007
  9. Nappi RE, Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) ― results from an international survey. Climacteric. 2012;15(1):36–44. doi: 10.3109/13697137.2011.647840
  10. Omi T, Numano K. The role of the CO2 laser and fractional CO2 laser in dermatology. Laser Ther. 2014;23(1):49–60. doi: 10.5978/islsm.14-RE-01
  11. Andelloux M. Products for sexual lubrication: understanding and addressing options with your patients. Nurs Womens Health. 2011;15(3):253–257. doi: 10.1111/j.1751-486X.2011.01642.x
  12. Kennedy SH, Rizvi S. Sexual dysfunction, depression, and the impact of antidepressants. J Clin Psychopharmacol. 2009;29(2):157–164. doi: 10.1097/JCP.0b013e31819c76e9
  13. Edwards D, Panay N. Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition? Climacteric.2016;19(2):151–161. doi: 10.3109/13697137.2015.1124259
  14. Nappi RE, Palacios S, Bruyniks N, et al.; investigators ES. The burden of vulvovaginal atrophy on women's daily living: implications on quality of life from a face-to-face real-life survey. Menopause. 2018;26(5):485–491. doi: 10.1097/GME.0000000000001260
  15. Kingsberg SA, Larkin L, Krychman M, et al. WISDOM survey: attitudes and behaviors of physicians toward vulvar and vaginal atrophy (VVA) treatment in women including those with breast cancer history. Menopause. 2019;26(2):124–131. doi: 10.1097/GME.0000000000001194
  16. De Landsheere L, Munaut C, Nusgens B, et al. Histology of the vaginal wall in women with pelvic organ prolapse: a literature review. Int Urogynecol J. 2013;24(12):2011–2020. doi: 10.1007/s00192-013-2111-1
  17. Gandhi J, Chen A, Dagur G, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and management. Am J Obstet Gynecol. 2016;215(6):704–711. doi: 10.1016/j.ajog.2016.07.045
  18. Phillips NA, Bachmann GA. Genitourinary syndrome of menopause: common problem, effective treatments. Cleve Clin J Med. 2018;85(5):390–398. doi: 10.3949/ccjm.85a.15081
  19. Lachowsky M, Nappi RE. The effects of oestrogen on urogenital health. Maturitas. 2009;63(2):149–151. doi: 10.1016/j.maturitas.2009.03.012
  20. Briggs P. Genitourinary syndrome of menopause. Post Reprod Health. 2020;26(2):111–114. doi: 10.1177/2053369119884144
  21. Athanasiou S, Pitsouni E, Antonopoulou S, et al. The effect of microablative fractional CO2 laser on vaginal flora of postmenopausal women. Climacteric. 2016;19(5):512–518. doi: 10.1080/13697137.2016.1212006
  22. Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85(1):87–94. doi: 10.4065/mcp.2009.0413
  23. Am FE. Genitourinary syndrome of menopause. Aust Fam Physician. 2017;46(7):481–484.
  24. Goldstein I. Recognizing and treating urogenital atrophy in postmenopausal women. J Womens Health (Larchmt). 2010;19(3):425–432. doi: 10.1089/jwh.2009.1384
  25. Jannini EA, Nappi RE. Couplepause: A new paradigm in treating sexual dysfunction during menopause and andropause. Sex Med Rev. 2018;6(3):384–395. doi: 10.1016/j.sxmr.2017.11.002
  26. Bachmann G. Urogenital ageing: An old problem newly recognized. Maturitas. 1995;22:S1–S5. doi: 10.1016/0378-5122(95)00956-6
  27. Palacios S, Mejía A, Neyro JL. Treatment of the genitourinary syndrome of menopause. Climacteric. 2015;18(Suppl 1):23–29. doi: 10.3109/13697137.2015.1079100
  28. ACOG Committee No. Opinion 659. The use of vaginal estrogen in womenwith a history of estrogen-dependent breast cancer. Obstet Gynecol. 2016;127(3):e93–96. doi: 10.1097/AOG.0000000000001351
  29. Bachmann GA, Komi JO. Ospemifene effectively treats vulvovaginal atrophyin postmenopausal women: results from a pivotal phase 3 study. Menopause. 2010;17(3):480–486. doi: 10.1097/gme.0b013e3181c1ac01
  30. Portman DJ, Bachmann GA, Simon JA. Ospemifene, a novel selective estrogen receptor modulator for treating dyspareunia associated with postmenopausal vulvar and vaginal atrophy. Menopause. 2013;20(6):623–630. doi: 10.1097/gme.0b013e318279ba64
  31. Ampt AJ, Roach V, Roberts CL. Vulvoplasty in New South Wales, 2001–2013: a population-based record linkage study. Med J Aust. 2016;205(8):365–369. doi: 10.5694/mja16.00512
  32. Barbara G, Facchin F, Buggio L, et al. Vaginal rejuvenation: current perspectives. Int J Womens Health. 2017;9:513–519. doi: 10.2147/IJWH.S99700
  33. Kaplan I. The CO2 surgical laser. Photomed Laser Surg. 2010;28:847–848.
  34. Gold M, Andriessen A, Bader A, et al. Review and clinical experience exploring evidence, clinical efficacy, and safety regarding nonsurgical treatment of feminine rejuvenation. J Cosmet Dermatol. 2018;17(3):289–297. doi: 10.1111/jocd.12524
  35. Salvatore S, Athanasiou S, Candiani M. The use of pulsed CO2 lasers for the treatment of vulvovaginal atrophy. Curr Opin Obstet Gynecol. 2015;27:504–508. doi: 10.1097/GCO.0000000000000230
  36. Salvatore S, Nappi RE, Zerbinati N, et al. A 12-week treatment with fractional CO2 laser for vulvovaginal atrophy: a pilot study. Climacteric. 2014;17(4):363–369. doi: 10.3109/13697137.2014.899347
  37. Samuels JB, Garcia MA. Treatment to external labia and vaginal canal with CO2 laser for symptoms of vulvovaginal atrophy in postmenopausal women. Aesthet Surg J. 2019;39(1):83–93. doi: 10.1093/asj/sjy087
  38. Quick AM, Zvinovski F, Hudson C, et al. Fractional CO2 laser therapy for genitourinary syndrome of menopause for breast cancer survivors. Support Care Cancer. 2020;28(8):3669–3677. doi: 10.1007/s00520-019-05211-3
  39. Sokol ER, Karram MM. An assessment of the safety and efficacy of a fractional CO2 laser system for the treatment of vulvovaginal atrophy. Menopause. 2016;23(10):1102–1107. doi: 10.1097/GME.0000000000000700
  40. Pitsouni E, Grigoriadis T, Tsiveleka A, et al. Microablative fractional CO2-laser therapy and the genitourinary syndrome of menopause: An observational study. Maturitas. 2016;94:131–136. doi: 10.1016/j.maturitas.2016.09.012
  41. Arroyo C. Fractional CO2 laser treatment for vulvovaginal atrophy symptoms and vaginal rejuvenation in perimenopausal women. Int J Women Health. 2017;9:591–595. doi: 10.2147/IJWH.S136857
  42. Athanasiou S, Pitsouni E, Falagas ME, et al. CO2 laser for the genitourinary syndrome of menopause. How many laser sessions? Maturitas. 2017;104:24–28. doi: 10.1016/j.maturitas.2017.07.007
  43. Eder SE. Early effect of fractional CO2 laser treatment in post-menopausal women with vaginal atrophy. Laser Ther. 2018;27(1):41–47. doi: 10.5978/islsm.18-OR-04
  44. Tovar-Huamani J, Mercado-Olivares F, Grandez-Urbina JA, et al. Efficacy of fractional CO2 laser in the treatment of genitourinary syndrome of menopause in Latin-American Population: First Peruvian experience. Lasers Surg Med. 2019;51(6):509–515. doi: 10.1002/lsm.23066
  45. Siliquini GP, Tuninetti V, Bounous VE, et al. Fractional CO2 laser therapy: a new challenge for vulvovaginal atrophy in postmenopausal women. Climacteric. 2017;20(4):379–384. doi: 10.1080/13697137.2017.1319815
  46. Becorpi A, Campisciano G, Zanotta N, et al. Fractional CO2 laser for genitourinary syndrome of menopause in breast cancer survivors: clinical, immunological, and microbiological aspects. Lasers Med Sci. 2018;33(5):1047–1054. doi: 10.1007/s10103-018-2471-3
  47. Perino A, Calligaro A, Forlani F, et al. Vulvovaginal atrophy: a new treatment modality using thermo-ablative fractional CO2 laser. Maturitas. 2015;80(3):296–301. doi: 10.1016/j.maturitas.2014.12.006
  48. Cruz VL, Steiner ML, Pompei LM, et al. Randomized, double-blind, placebo-controlled clinical trial for evaluating the efficacy of fractional CO2 laser compared with topical estriol in the treatment of vaginal atrophy in postmenopausal women. Menopause. 2018;25(1):21–28. doi: 10.1097/GME.0000000000000955
  49. Pieralli A, Fallani MG, Becorpi A, et al. Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors. Arch Gynecol Obstet. 2016;294(4):841–846. doi: 10.1007/s00404-016-4118-6
  50. Behnia-Willison F, Sarraf S, Miller J, et al. Safety and long-term efficacy of fractional CO2 laser treatment in women suffering from genitourinary syndrome of menopause. Eur J Obstet Gynecol Reprod Biol. 2017;213:39–44. doi: 10.1016/j.ejogrb.2017.03.036
  51. Salvatore S, Nappi RE, Parma M, et al. Sexual function after fractional microablative CO2 laser in women with vulvovaginal atrophy. Climacteric. 2015;18(2):219–225. doi: 10.3109/13697137.2014.975197
  52. Maggiore LU, Parma M, Candiani M, Salvatore S. Microablative fractional CO2 laser for vulvovaginal atrophy in women with a history of breast cancer. J Minim Invasive Gynecol. 2015;22(6S):S100. doi: 10.1016/j.jmig.2015.08.269
  53. Harris V, Dickison P, Lim A, Fischer G. Vulvo-vaginal rejuvenation: Fact or fiction? Fractional carbon dioxide laser for genitourinary syndrome of menopause. Australas J Dermatol. 2018;59(4):341–343. doi: 10.1111/ajd.12765
  54. Pagano I, Gieri S, Nocera F, et al. Evaluation of the CO2 laser therapy on vulvo-vaginal atrophy (VVA) in oncological patients: preliminary results. J Can Ther. 2017;8(5):452–463. doi: 10.4236/jct.2017.85039
  55. Samuels JB, Garcia MA. Treatment to external labia and vaginal canal with CO2 laser for symptoms of vulvovaginal atrophy in postmenopausal women. Aesthet. 2019;39(1):83–93. doi: 10.1093/asj/sjy087
  56. Gordon C, Gonzales S, Krychman ML. Rethinking the techno vagina: a case series of patient complications following vaginal laser treatment for atrophy. Menopause. 2019;26(4):423–427. doi: 10.1097/GME.0000000000001293
  57. Athanasiou S, Pitsouni E, Grigoriadis T, et al. Microablative fractional CO2 laser for the genitourinary syndrome of menopause: up to 12-month results. Menopause. 2019;26(3):248–255. doi: 10.1097/GME.0000000000001206
  58. Sokol ER, Karram MM. Use of a novel fractional CO2 laser for the treatment of genitourinary syndrome of menopause: 1-year outcomes. Menopause. 2017;24(7):810–814. doi: 10.1097/GME.0000000000000839
  59. Cruz VM, Wajsfeld T, Steiner MM, et al. Vaginal CO2 laser versus topical estriol treatment for vaginal atrophy in postmenopausal women: 1-year follow-up [20P]. Obstet Gynecol. 2019;133(Suppl 1):175–176. doi: 10.1097/01.AOG.0000558908.60309.79
  60. Food and Drug Admnistration. FDA warns against use of energy-based devices to perform vaginal ‘rejuvenation’ or vaginal cosmetic procedures [accessed on 16 September 2019]. FDA Safety Communication; 2018. Available from: https://www.iuga.org/news/fda-warns-against-use-of-energy-based-devices-to-perform-vaginal-rejuvenation-or-vaginal-cosmetic-procedures-fda-safety-communication
  61. Gambacciani M, Levancini M, Russo E, et al. Long-term effects of vaginal erbium laser in the treatment of genitourinary syndrome of menopause. Climacteric. 2018;21(2):148–152. doi: 10.1080/13697137.2018.1436538
  62. Gambacciani M, Levancini M, Cervigni M. Vaginal erbium laser: the secondgeneration thermotherapy for the genitourinary syndrome of menopause. Climacteric. 2015;18(5):757–763. doi: 10.3109/13697137.2015.1045485
  63. Gaspar A, Brandi H, Gomez V, Luque D. Efficacy of Erbium:YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause. Lasers Surg Med. 2017;49(2):160–168. doi: 10.1002/lsm.22569
  64. Bojanini JF. Treatment of genitourinary syndrome of menopause with Erbium:YAG laser: a prospective study of efficacy and safety of the treatment for women after menopause of natural origin and therapy-induced menopause in breast cancer survivors. J Laser Health Academy. 2016;2016(1):35–40.
  65. Gambacciani M, Levancini M. Short-term effect of vaginal erbium laser on the genitourinary syndrome of menopause. Minerva Ginecol. 2015;67(2):97–102.
  66. Areas F, Valadares AL, Conde DM, Costa-Paiva L. The effect of vaginal erbium laser treatment on sexual function and vaginal health in women with a history of breast cancer and symptoms of the genitourinary syndrome of menopause: a prospective study. Menopause. 2019;26(9):1052–1058. doi: 10.1097/GME.0000000000001353
  67. Gaviria JE, Korosec B, Fernandez J, Montero G. Up to 3-year follow-up of patients with vaginal relaxation syndrome participating in laser vaginal tightening. J Laser Health Academy. 2016;2016(1):6–11.
  68. Pagano T, De Rosa P, Vallone R, et al. Fractional microablative CO2 laser in breast cancer survivors affected by iatrogenic vulvovaginal atrophy after failure of nonestrogenic local treatments: a retrospective study. Menopause. 2018;25(6):657–662. doi: 10.1097/GME.0000000000001053
  69. Pagano T, De Rosa P, Vallone R, et al. Fractional microablative CO2 laser for vulvovaginal atrophy in women treated with chemotherapy and/or hormonal therapy for breast cancer: a retrospective study. Menopause. 2016;23(10):1108–1113. doi: 10.1097/GME.0000000000000672
  70. Caruth JC. Evaluation of the safety and efficacy of a novel radiofrequency device for vaginal treatment. Surg Technol Int. 2018;32:145–149.
  71. Vicariotto F, Raichi M. Technological evolution in the radiofrequency treatment of vaginal laxity and menopausal vulvo-vaginal atrophy and other genitourinary symptoms: first experiences with a novel dynamic quadripolar device. Minerva Ginecol. 2016;68(3):225–236.
  72. Vicariotto F, de Seta F, Faoro V, Raichi M. Dynamic quadripolar radiofrequency treatment of vaginal laxity/menopausal vulvo-vaginal atrophy: 12-month efficacy and safety. Minerva Ginecol. 2017;69(4):342–349. doi: 10.23736/S0026-4784.17.04072-2
  73. Alinsod RM. Transcutaneous temperature controlled radiofrequency for atrophic vaginitis and dyspareunia. J Minim Invasive Gynecol. 2015;22(6S):S226–S227. doi: 10.1016/j.jmig.2015.08.798
  74. ACOG Position Statement. Fractional laser treatment of vulvovaginal atrophy and U.S. Food and Drug Administration clearance [accessed on 16 September 2019]. The American College of Obstetricians and Gynecologists; Washington, DC, USA; 2016. Available from: https://www.menopause.org/docs/default-source/default-document-library/nams-responds-to-fda-mandate-on-vaginal-laser-manufacturers-08-01-2018.pdf
  75. Ruiz-Rodriguez R, Sanz-Sánchez T, Córdoba S. Photodynamic photorejuvenation. Dermatol Surg. 2002;28(8):742–744. doi: 10.1046/j.1524-4725.2002.02018.x
  76. Kohl E, Torezan LA, Landthaler M, et al. Aesthetic effects of topical photodynamic therapy. J Eur Acad Dermatol Venereol. 2010;24(11):1261–1269. doi: 10.1111/j.1468-3083.2010.03625.x
  77. Philipp-Dormston WG. Photodynamic therapy for aesthetic-cosmetic indications. G Ital Dermatol Venereol. 2018;153(6):817–826. doi: 10.23736/S0392-0488.18.05982-5
  78. Morton CA, Szeimies RM, Basset-Séguin N, et al. European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 2: emerging indications — field cancerization, photorejuvenation and inflammatory/infective dermatoses. J Eur Acad Dermatol Venereol. 2020;34:17–29. doi: 10.1111/jdv.16044
  79. Marmur ES, Phelps R, Goldberg DJ. Ultrastructural changes seen after ALA-IPL photorejuvenation: A pilot study. J Cosmet Laser Ther. 2005;7(1):21–24. doi: 10.1080/147641700510037725.
  80. Orringer JS, Hammerberg C, Hamilton T, et al. Molecular effects of photodynamic therapy for photoaging. Arch Dermatol. 2008;144(10):1296–1302. doi: 10.1001/archderm.144.10.1296
  81. Sakamoto FH, Lopes JD, Anderson RR. Photodynamic therapy for acne vulgaris: A critical review from basics to clinical practice: Part I. Acne vulgaris: when and why consider photodynamic therapy? J Am Acad Dermatol. 2010;63(2):183–193. doi: 10.1016/j.jaad.2009.09.056
  82. Rossi R, Bruscino N, Ricceri F, et al. Photodynamic treatment for viral infections of the skin. G Ital Dermatol Venereol. 2009;144(1):79–83.
  83. Zhang F, Li D, Shi L, et al. 5-ALA-photodynamic therapy in refractory vulvar lichen sclerosus et atrophicus. Int J Clin Exp Pathol. 2020;13(12):3100–3110.

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