Validation of a clinical tool for vestibular trophism in postmenopausal women.

OBJECTIVE: This study aimed to develop and validate a clinical tool to assess vestibular trophism in women with genitourinary syndrome of menopause (GSM). METHODS: In this cross-sectional study, the principal investigator's center and three external reviewers assessed the vestibular images of postmenopausal women using a multi-item tool defined as vestibular trophic health (VeTH), which assessed five criteria: petechiae, pallor, thinning, dryness and redness. Dryness, dyspareunia, vulvar pain and the Vaginal Health Index (VHI) were also evaluated. RESULTS: Analysis of the intraclass correlation coefficient (0.76; confidence interval 0.62-0.82) and Cronbach's alpha coefficient (0.78; confidence interval 0.64) indicated an inter-rater reliability and reproducibility of VeTH in the 70 women enrolled in the study. The observed covariance between a high VeTH score and the symptom severity demonstrated a significant correlation, which was not evident between VeTH and the total VHI score. CONCLUSIONS: The vulvar vestibule is the main location of genital tenderness, primarily responsible for burning/pain and entry dyspareunia because of its capacity to develop an excess of nociceptors upon sexual hormone deprivation. Our study indicated that VeTH can be a reproducible tool for the morphological classification of vestibular trophism and bears a significant correlation with the severity of the symptoms.

Ospemifene plus fractional CO2 laser: a powerful strategy to treat postmenopausal vulvar pain.

This study is a single-center, retrospective analysis of postmenopausal women presenting with dyspareunia and vulvar pain, aiming to evaluate relative effectiveness of vestibular CO2 laser therapy as a treatment. Three monthly sessions of laser were performed to each patient and thereafter a three-months follow-up was stablished. A total number of 72 patients undergoing vestibular laser treatment were recruited from patient files in the period between 2016 and 2018. Among these, 39 women also received a concomitant treatment with ospemifene (60 mg/day) during the study period. There was a statistically significant reduction of all the symptoms in both groups up to the three month follow-up. Regarding dryness and dyspareunia, the relief tent to be more prominent in the ospemifene + laser group at all follow-ups and remained statistically significant at three-month follow-up. Specifically, vestibular dryness was significantly lower in the ospemifene + laser group compared with the laser treatment group (-87% vs - 34%, respectively), and the vestibular health score started declining faster in the ospemifene + laser group. Although, additional research is needed to understand the mechanism of action, our data shows that a combination regimen of laser and ospemifene may improve clinical effectiveness for long-term treatment of symptoms associated with the under-recognized genitourinary syndrome of menopause.

[Short-course treatment of vulvovaginal candidiasis: comparative study of fluconazole and intra-vaginal fenticonazole]. / Il trattamento "short course" della candidosi vulvovaginale acuta: studio comparativo tra il fluconazolo ed il fenticonazolo intravaginale.

AIM: The aim of this paper was to compare the efficacy of fluconazole 150 mg and intra-vaginal fenticonazole 600mg in short-course treatment of the acute episode of vulvovaginal candidiasis (VVC). METHODS: In a prospective study, 80 patients with clinical and mycological (SavvyCheck™ test) confirmed VVC were enrolled and divided randomly in two groups. Forty patients received oral fluconazole (150 mg), whereas 40 patients received intra-vaginal tablet fenticonazole (600 mg). Two sequential doses of azole agents were given 3 days apart (short-course treatment). Second and third visits were done for all patients seven and 30±5 days after treatment. RESULTS: At the second visit, 31 patients (77.5%) were cured clinically (Sobel score <4) in fluconazole group and 32 patients (80%) in fenticonazole group (P=0.876). The vulvovaginal pruritus was reduced in lower time in fenticonazole patients than in fluconazole group (mean 2.3 days versus 4.5 days, P=0.047). At the third visit, three patients in fluconazole group and two patients in fenticonazole group had clinical sign of VVC. CONCLUSION: Fluconazole and intravaginal fenticonazole are both effective to cure symptoms of VVC but fenticonazole appears to reduce the pruritus in less time.

The recurrent vulvovaginal candidiasis: proposal of a personalized therapeutic protocol.

Background. Recurrent vulvovaginal candidiasis (RVC) is an increasing challenge in clinical practice. Objective. The purpose of this study was to reduce the episodes of RVC through the intake of fluconazole 200 mg/dose with a personalized regimen at growing administration intervals with a probiotic. Method. 55 patients received a 200 mg fluconazole as an induction dose for 3 alternate days. Symptoms resolution after 10-14 days made the patients eligible to continue with a maintenance therapy of fluconazole weekly for one month, followed by 200 mg after 10, 15, 20 and 30 days. Patients were allowed to move on to the next level of maintenance therapy only if they were symptom free. Patients were also given a probiotic with Beta Glucan and Echinacea Purpurea. Results. Among the 55 patients enrolled, four (7%) have withdrawn after the induction phase. 51 patients completed the whole therapeutic maintenance period, and eight (15,6%) experienced a recurrence before the end of the therapy. Five women (9,8%) relapsed (two after 2 months and three after 6 months). Conclusion. The positive results of our study prove the effectiveness of an individualized protocol for a rather short period, with a slowly decreasing administration of fluconazole + probiotic.

Transcutaneous electrical nerve stimulation to treat vestibulodynia: a randomised controlled trial.

OBJECTIVE: To assess the efficacy of transcutaneous electrical nerve stimulation (TENS) in the treatment of vestibulodynia. DESIGN: Double-arm randomised placebo-controlled trial. SETTING: An outpatient department for vulval disease. POPULATION: Forty women with vestibulodynia, a vestibular discomfort mostly reported as a burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurological disorder. METHODS: Twice a week active TENS or sham treatment were delivered through a vaginal probe via a calibrated dual channel YSY-EST device. Women of both groups underwent 20 treatment sessions. MAIN OUTCOME MEASURES: Visual analogue scale (VAS), the short form of the McGill-Melzack Pain Questionnaire (SF-MPQ), the Marinoff Scale for dyspareunia and the Female Sexual Function Index questionnaire (FSFI) were assessed at baseline, at the end of treatment and at follow up 3 months after the end of treatment. RESULTS: The VAS and SF-MPQ scores (6.2 +/- 1.9 and 19.5 +/- 11.9 before treatment, respectively) improved significantly in the active TENS group (2.1 +/- 2.7, P= 0.004 and 8.5 +/- 10.7, P= 0.001, respectively), but not in the placebo group. The Marinoff dyspareunia scale and the FSFI also showed a significant improvement. CONCLUSIONS: TENS is a simple, effective and safe short-term (3 months) treatment for the management of vestibulodynia.

Tibolone in the treatment of menopause: compliance, efficacy and safety in a ten year experience.

AIM: To assess tibolone compliance, efficacy and safety in everyday clinical practice a non-randomized, prospective, cohort clinical study was carried out. METHODS: One hundred and fifty post-menopausal women aged 48 to 73 years were prescribed tibolone: 72 of them were treated for 36.4 months, 55 terminated treatment after less than 1 year, while 23 never took the tablets after seeking for menopause counseling and having agreed upon the treatment. We examined: endometrial thickness and histology, total cholesterol, triglycerides, fibrinogen, AST, ALT, gamma-gt, and the body weight. RESULTS: Side effects were the main causes of withdrawal (32%), and insufficient therapeutic effect and adverse events for a small number of cases (5.5% and 4.7% respectively), while various causes (fear of cancer, missing tablets, family doctor or other specialist's advice, remission of symptoms) were responsible for terminating treatment after extended periods. Laboratory findings showed a favorable trend; only the (GT showed slightly higher mean values, although within a normal range. On average, weight during treatment increased of 1.5 kg, and endometrial thickness grew of 1.3 mm in a mean time of 34.5 months of observation. An average of 2.3%/year increase of bone mineral density was reported, though bone mass didn't improve in some patients. CONCLUSIONS: Different causes of terminating treatment are related to the length of treatment, side effects being the main reason for early withdrawals, efficacy on symptoms or medical advice or fear of treatment for extended periods of time. Effectiveness on bone mass, safety as resulting from endometrial thickness and laboratory measures are confirmed. It is suggested to enhance follow-up accuracy and reinforce counseling as measures to improve compliance.

[Human papillomavirus of the female genital tract: prevalence in women attending a centre for early cancer detection]. / Il virus del papilloma umano genitale: note sulla prevalenza nell'utenza di un centro per la prevenzione dei tumori femminili.

AIM: The authors study the trend of cytologic human papillomavirus (HPV) detection in the period between 1980 and 2000 in women attending a clinic for genital cancer early detection. METHODS: Routine activity, besides pap smear, is based on clinical evaluation, colposcopy and target biopsy in the presence of a lesion. The cytological trend is compared with that of histologic and clinical findings of HPV lesions on the basis of data prospectively collected. RESULTS: About 5% of cytologic HPV detection is observed in the whole, with a pick of about 11% in the years 1992-1994, and values around 2-3% up to 1991 and after 1995. The finding does not change if the whole pap smear group is considered (46,862) or only the first pap smear per woman (16,810). A similar trend, but with a smaller pick, is observed in histologic findings, not in colposcopic findings. The clinical finding of condylomata is higher in the first period of observation, sloping down through the time intervals considered. Standardization on age or patient's recruiting does not change the evidence. CONCLUSION: The trend of the HPV parameters studied could represent an epidemiological model for HPV infection. The clinical epidemics is followed by a period of HPV cytological pick, which might be followed, at suitable time interval, by more cervical intraepithelial neoplasia/squamous intraepithelial lesions, according to the well known latency between infection and premalignant changes.

Treatment of vulvar vestibulitis with submucous infiltrations of methylprednisolone and lidocaine. An alternative approach.

OBJECTIVE: To assess the efficacy of submucous infiltrations of methylprednisolone and lidocaine into the vulvar vestibule for the treatment of vulvar vestibulitis. STUDY DESIGN: Twenty-two patients were referred for vulvar vestibulitis. Methylprednisolone and lidocaine were injected into the vulvar vestibule once a week for three weeks at decreasing doses (1, 0.5, 0.3 mL). Follow-up was performed monthly for three months, then at six and nine months. Fourteen women have had 12 months and 5 women, 24 months of follow-up. RESULTS: Fifteen women (68%) responded favorably to the treatment, seven (32%) with absence of symptoms and eight (36%) with a marked improvement. Seven patients (32%) failed to respond in spite of a fourth dose (0.3 mL) given after 30 days. No relapse was observed at nine months' follow-up, while a further 0.5 mL infiltration followed by quick remission of symptoms was needed after one year in five patients. Five patients completed the 24 months' follow-up, with no need for further treatment. CONCLUSION: Submucous infiltration allows methylprednisolone to be deposited in the submucosa, the site of the inflammatory reaction, while the depot formulation allows gradual and prolonged release of the drug. Seven patients (32%) failed to respond, suggesting either that they had a kind of vulvar vestibulitis syndrome where inflammation is less remarkable or failure of the infiltrated drug to become adequately diffused.