Sequential treatment in vulvovaginal atrophy

Abstract

Vulvovaginal atrophy (VVA) is a chronic and progressive disease that affects sexuality and quality of life. VVA is preventable and treatable, but requires long-term and often sequential treatment. Sequential treatment consists of designing a strategy that uses one or more medications for a long enough time to achieve the desired benefits with minimal risk and maximum adherence. Currently available therapeutic options consist of topical over-the-counter products (including non-hormonal lubricants and moisturizers applied to the vagina), systemic hormone therapy and estrogens, and prescribed vaginal dehydroepiandrosterone (DHEA). In addition, we have a selective estrogen receptor modulator, ospemifene, and new energy-based treatments (laser and radiofrequency). There are clear differences between the treatments both in the mechanism of action and in the efficacy. Compliance is very low, and patients complain about the use of the vaginal route, often due to its low efficacy, or express fear of the long-term use of estrogens or the price of the treatments. We believe that, as a first option, and for physiological, preventive and efficacy reasons, we should consider the prescription of treatments that work on estrogen receptors. As a second option, there are vaginal moisturizers, which are effective on symptoms but do not prevent or improve conditions. Finally, techniques using heat, which although each time represent a clearer alternative, but on the other hand are the cost and the long-term safety data, give us a third option. Of course, we consider that vulvar moisturizers and lubricants can be used at any time.

摘要

外阴阴道萎缩（VVA）是一种影响性行为和生活质量的慢性进行性疾病。VVA是可以预防和治疗的, 但需要长期且经常是序贯治疗。序贯治疗指制定一个方案, 在足够长的时间内使用一种或多种药物, 以最小的风险和最大的依从性实现预期的益处。目前可用的治疗方案包括非处方局部产品（包括阴道用的非激素润滑剂和保湿剂）、全身激素治疗和雌激素, 以及处方的阴道用脱氢表雄酮（DHEA）。此外, 我们有一种选择性雌激素受体调节剂奥培米芬, 和新的基于能量的治疗（激光和射频）。两种治疗方法在作用机制和疗效方面都存在明显差异。依从性很低, 患者抱怨阴道用药, 通常是因为其疗效低, 或者对长期使用雌激素或治疗价格表示担忧。我们认为, 出于生理、预防和疗效的原因, 我们应该考虑将对雌激素受体有效的治疗处方作为第一选择。第二选择是阴道保湿霜, 它对症状有效, 但不能预防或改善病情。最后, 热技术的使用, 虽然每次都代表了一个更清晰的选择, 但另一方面需要考虑成本和长期的安全数据, 给了我们第三种选择。当然, 我们认为外阴保湿剂和润滑剂可以在任何时候使用。

Keywords:

• Vulvovaginal atrophy
• sequential treatment
• vaginal estrogens
• prasterone
• ospemifene
• vaginal moisturizers
• laser and radiofrequency

Potential conflict of interest

No potential conflict of interest was reported by the author.

Source of funding

Nil.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.