Triticum vulgare para el tratamiento del síndrome genitourinario de la menopausia, Armenia, Colombia / Triticum vulgare for the treatment of genitourinary syndrome of menopause, Armenia, Colombia

OBJETIVO: Evaluar la eficacia y la seguridad de Triticum vulgare en el tratamiento del síndrome genitourinario de la menopausia (SGUM). MÉTODO: Estudio cuasiexperimental (antes-después, con grupo control) en mujeres posmenopáusicas (amenorrea ≥ 36 meses, hormona estimulante del folículo > 40 U/l y estradiol < 25 pg/ml), sexualmente activas, con un índice de maduración vaginal (IMV) < 50 y pH ≥ 5, citología cervical negativa (Papanicolaou) y diagnóstico de SGUM, atendidas en el programa de climaterio y menopausia de una clínica privada de mediana complejidad, en Armenia, Quindío (Colombia). Se seleccionaron 207 mujeres con edad promedio de 55,19 ± 7,28 años. Se realizó un muestreo consecutivo. Se asignaron dos grupos: A (n = 105), que recibió T. vulgare, y B (n = 102), que recibió placebo. Se hizo seguimiento al inicio (basal) y 4, 8 y 12 semanas después, utilizando el IMV y el Índice de Función Sexual Femenina (IFSF). Los síntomas del SGUM se evaluaron con una escala visual analógica (EVA). Se aplicó estadística descriptiva. RESULTADOS: La puntuación media del IMV fue mayor en las semanas 4, 8 y 12 en todas las mujeres del grupo A (p = 0,01). Se observó una diferencia significativa en el promedio final de la puntuación del IMV de T. vulgare frente al placebo (p < 0,05). Al final del estudio, el grupo A mostró una mejoría significativa en la puntuación promedio del IFSF, en comparación con el grupo B (p < 0,001). Las puntuaciones de la EVA presentaron una disminución progresiva a lo largo del estudio, pero fueron comparables entre los dos grupos (p = 0,813). CONCLUSIONES: T. vulgare es una efectiva, segura e innovadora alternativa, no hormonal, para el tratamiento del SGUM. No se registraron eventos adversos, por lo que se demostró su seguridad.

OBJECTIVE: To evaluate the efficacy and safety of Triticum vulgare in the treatment of genitourinary syndrome of menopause. METHOD: Quasi-experimental study (before-after, with control group) in postmenopausal women (amenorrhea ≥ 36 months, FSH > 40 U/L and estradiol < 25 pg/ml), sexually active, with a vaginal maturation index (VMI) < 50 and pH ≥ 5, negative cervical cytology (Papanicolaou) and with a diagnosis of genitourinary syndrome of menopause (SGUM); who were treated in the climacteric and menopause program of a private clinic of medium complexity, in Armenia, Quindío (Colombia). 207 participants were selected, with a mean age of 55.19 ± 7.28 years. A consecutive sampling was carried out. Two groups were assigned: A (n = 105) with T. vulgare and B (n = 102) with placebo. Follow-up was done at baseline (baseline), four, eight and twelve weeks later, using the VMI and the female sexual function index (IFSF). Symptoms of SGUM were evaluated using a visual analog scale (VAS). Descriptive statistics were applied. RESULTS: The mean score of the IMV was higher in weeks 4, 8 and 12 in all the participants of group A (p = 0.01). A significant difference was observed in the final mean MVI score of T. vulgare versus placebo (p < 0.05). At the end of the study, group A showed a significant improvement in the mean IFSF score, compared to placebo (p < 0.001). The VAS scores showed a progressive decrease throughout the study but were comparable between the two groups (p = 0.813). CONCLUSIONS: T. vulgare is an effective, safe and innovative non-hormonal alternative for the treatment of SGUM. No adverse events were recorded, guaranteeing their safety.

Female Genital Itch.

Vulvar pruritus is a common complaint among young girls and women presenting to primary care physicians, gynecologists, and dermatologists. Female genital itch is especially disruptive because of its interference with sexual function and intimacy. Causes of vulvar itch are vast and may be inflammatory, environmental, neoplastic, or infectious, often with several causes coexisting simultaneously. Diagnosis may be difficult because of the unique anatomy and inherent properties of genital and perianal skin. Treatment is aimed at eliminating outside irritants, restoring epidermal barrier function, and suppressing inflammation.

A randomized, multicenter, double-blind study to evaluate the safety and efficacy of estradiol vaginal cream 0.003% in postmenopausal women with dyspareunia as the most bothersome symptom.

OBJECTIVE: Vulvovaginal atrophy (VVA) is characterized by vaginal changes, dyspareunia, and itching/irritation. Efficacy and safety of a lower-dose estradiol vaginal cream (0.003%) were evaluated in postmenopausal women with VVA-related dyspareunia. METHODS: This was a phase 3, randomized, double-blind, placebo-controlled study. Sexually active postmenopausal women with moderate-severe dyspareunia as the most bothersome symptom, ≤5% vaginal superficial cells, and vaginal pH >5.0 were randomized (1:1) to 0.003% estradiol vaginal cream (15 µg estradiol; 0.5 g cream) or placebo (0.5 g cream) applied daily for 2 weeks followed by three applications/week for 10 weeks. Coprimary outcomes were changes in dyspareunia severity, vaginal cytology, and vaginal pH from baseline to final assessment. Additional efficacy outcomes and safety were assessed. RESULTS: A total of 550 participants (average age, 58 y) were randomized. Compared with placebo, estradiol reduced dyspareunia severity (mean change from baseline ±â€ŠSD: -1.5 ±â€Š1.0 estradiol vs -1.2 ±â€Š0.9 placebo), decreased vaginal pH (-1.36 ±â€Š0.89 vs -0.53 ±â€Š0.92), and improved vaginal cytology (percentage superficial and parabasal cells 10.1 ±â€Š16.7 vs 1.4 ±â€Š6.1 and -48.5 ±â€Š45.1 vs -14.6 ±â€Š39.6; P < 0.001, all) at the final assessment. In addition, estradiol decreased dyspareunia severity at weeks 8 and 12, vaginal/vulvar irritation/itching at weeks 4 and 12, and dryness at week 12 versus placebo (P < 0.01, all). VVA severity, pH, and cytology improved at week 12 with estradiol versus placebo (P < 0.001, all). Vulvovaginal mycotic infections were more frequent with estradiol. One serious event leading to discontinuation occurred with estradiol. No deaths occurred. CONCLUSIONS: Lower-dose estradiol vaginal cream (0.003%) dosed three applications/week is an effective and well-tolerated treatment for VVA-related dyspareunia.

Itch in Special Skin Locations Management.

Itch management can be particularly complicated in some small areas like the scalp or the anogenital region for many reasons: the frequently poor diagnosis of the causes of itch in these areas, the dense innervation of these areas, and the symbolic value of these areas for the human psyche. The diagnosis of itchy scalp is easier than that of anogenital pruritus. Clinical examination and a careful inventory of all diseases of the patient and of the local environment are necessary. Localized treatments are frequently used at both sites, whereas specific pharmaceutical formulations are necessary for the pilose or the mucous environment. Nonetheless, systemic treatments or psychological interventions can be very useful.

Treatment of refractory vulvovaginal pruritus with naltrexone, a specific opiate antagonist.

OBJECTIVE: Chronic vulvovaginal pruritus can be refractory to standard treatment. Since opioids can induce itching and opioid receptor antagonists have been shown to suppress pruritus of different etiologies, we applied this treatment to patients with vulvovaginal pruritus refractory to conventional therapies. STUDY DESIGN: Five women between 24 and 54 years of age suffering from chronic vulvovaginal pruritus were treated with 50mg naltrexone orally once a day for 3 weeks. They documented itching episodes and possible side-effects. RESULTS: After 1 week of treatment the number of reported itching episodes decreased significantly to almost zero in all five patients. No further episodes of pruritus reoccurred during the following 2 weeks of treatment. CONCLUSION: Treatment with the opiate antagonist naltrexone offers an alternative treatment option for patients with chronic vulvovaginal pruritus after exclusion of gynecologic, internal, and neurological causes of these symptoms.

Management of lichen sclerosus with triamcinolone ointment: effectiveness in reduction of patient symptom scores.

OBJECTIVE: To determine whether topical triamcinolone ointment effectively reduces patient's symptoms for the management of lichen sclerosus (LS). MATERIALS AND METHODS: A retrospective chart review of LS patients seen during 2004 to 2008 in the Saint Louis University Vulvar Clinic was conducted. Inclusion criteria were biopsy-confirmed LS and age 18 years and older. Data were collected at the initial visit and at 6 to 10 weeks, 3 months, and 6 months of follow-up. Effectiveness was assessed using symptom scores on a Likert scale. Data were analyzed using either paired t tests or nonparametric Wilcoxon signed rank tests using a p value less than.05 to denote statistical significance. RESULTS: Of 41 women, 34 met inclusion criteria. Vulvar pruritus was the most frequently reported vulvar symptom, occurring in 32 (94.1%) of 34 women. Dyspareunia, vulvar burning, and vulvar pain were reported in 17 (54.8%) of 31, 22 (64.7%) of 34, and in 13 (38.2%) of 34 women, respectively. Statistically significant reductions in mean symptom scores between the initial and the 6- to 10-week follow-up visits were found for dyspareunia, vulvar burning, vulvar pruritus, and pain (p values < .05 to < .001) and at 3-month follow-up visits for dyspareunia, vulvar burning, and vulvar pruritus (p < .05). Complete symptom relief was reported for 8 (47.1%) of 17 women with dyspareunia, 19 (86.4%) of 22 women with vulvar burning, 23 (71.9%) of 32 women with vulvar pruritus, and 12 (92.3%) of 13 women with vulvar pain. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Topical triamcinolone ointment is an effective treatment for the management of LS based on the significant reduction of patient symptom scores. Inherent risks with long-term use of high-potency corticosteroids should prompt all practitioners to consider triamcinolone ointment as a safer long-term treatment for patients with LS.

Threadworm: an infrequent clinical finding in a genitourinary medicine clinic attendee presenting with ano-genital irritation.

A 24-year-old lady presented to an evening genitourinary (GU) clinic with a short history of vulval and anal irritation. On perianal examination, several threadworms were visible. Symptoms resolved with oral mebendazole and strict personal and environmental hygiene. Threadworm is a common and easily treatable cause of pruritus ani, yet is underreported in GU literature. If the history is suggestive, consider performing the diagnostic cellophane test and/or prescribing empirical treatment.

Effectiveness of treating non-specific pruritus vulvae with topical steroids: a randomized controlled trial.

OBJECTIVE: To determine the effectiveness of triamcinolone cream in the treatment of non-specific pruritus vulvae. METHODS: A total of 50 patients, aged between 8 and 55 years, with non-specific pruritus vulvae were consecutively included in a double-blind randomized controlled trial by their general practitioner in 25 general practices in the Netherlands. Analysis was by "intention to treat". An infectious cause was excluded by a vaginal and cervical swab. After randomization, 27 patients were treated with triamcinolone cream and 23 patients with a placebo cream. The effectiveness was assessed by: change in the severity of itch visual analogue scale (VAS) score; the percentage of patients with complete recovery; and changes in general health according to COOP/WONCA charts. RESULTS: The mean decrease in severity of itch was 2.08 points in the triamcinolone group compared to 3.26 points in the placebo group. Forty-two per cent of the women in the triamcinolone group completely recovered versus 35% in the placebo group. There was no difference in general health perception between the two groups. After 12 weeks, more than 80% in both groups reported recurrent vulval itch. CONCLUSION: No significant differences in effectiveness were found between the two groups, because both treatments were ineffective. We can conclude that triamcinolone cream is therefore not the treatment of first choice for non-specific pruritus vulvae.

Voiding dysfunction due to long-standing labial fusion in an elderly woman: a case report.

Labial adhesions or fusion in the elderly are rare, and only few cases are described in the English literature. We describe a case of near-complete labial fusion in an elderly woman presenting with voiding difficulty, its management and literature review.

Pimecrolimus 1% cream for pruritus in postmenopausal diabetic women with vulvar lichen simplex chronicus: a prospective non-controlled case series.

BACKGROUND: Pruritus vulvae may have a variety of causes, such as infections, dermatologic disorders or non-neoplastic/neoplastic vulvar diseases. OBJECTIVES: To investigate the efficacy and side effects of topical pimecrolimus 1% cream for pruritus vulvae. METHODS: Twelve postmenopausal diabetic women with vulvar lichen simplex chronicus were enrolled in this trial. Each patient was treated with pimecrolimus 1% cream which was applied twice daily in a thin layer to the vulvae for 3 months. Clinical examination and recording of patients' symptoms using a scoring system was performed by the same physician before, after 4 weeks and after 3 months of therapy. RESULTS: All of the patients completed the study. A substantial decrease in pruritus after treatment was reported by the patients at the 4th week (2.17+/-0.72, p<0.01) and 3rd month of treatment (0.42+/-0.92, p<0.001) when compared with the baseline score (3.75+/-0.45). Follow-up of the patients after 3 months of treatment showed that complete cure occurred in 10 patients (83.3%) and the pruritus was improved in two (16.7%) patients. CONCLUSIONS: Pimecrolimus 1% cream seems to be an effective and safe treatment modality for pruritus in postmenopausal women with vulvar lichen simplex chronicus.

Efficacy of topical pimecrolimus in the treatment of chronic vulvar pruritus: a prospective case series--a non-controlled, open-label study.

BACKGROUND: Chronic vulvar pruritus has been a most distressing physical and sociologic disorder for many patients, as well as for their physicians. Potent topical steroids are the conventional therapy for this distressing condition. Side effects or steroid resistance can be encountered. A second-line therapy is required. OBJECTIVES: A single-centre, non-controlled, open-label study was designed to assess the efficacy of topical pimecrolimus in the treatment of chronic vulvar pruritus. METHODS: Fifteen married adult women with symptoms of vulvar pruritus > or =4 months were included in the study. The patients did not have any relief with topical steroids. There were no objective physical findings. Topical pimecrolimus 1% cream (Elidel cream, Novartis) was applied twice daily to the vulvar region. Patients were followed up 4 weeks later. After the trial was stopped, the patients remained in regular review for 3 months. RESULTS: Thirteen patients tolerated pimecrolimus. They showed a clinical response within 2-4 weeks. Ten patients showed a complete response, three showed a partial response. After the trial had stopped, the patients with complete response were followed-up by telephone for another 3 months, and were found to be in remission. CONCLUSIONS: We found that topical pimecrolimus provides relief for chronic vulvar pruritus. Pimecrolimus can be chosen as the second-line therapy in patients with vulvar pruritus.

Chronic vulvovaginal pruritus treated successfully with GnRH analogue.

A Medline search shows that this is the first reported case where vulvovaginal pruritus was treated successfully with a GnRH analogue. The report describes a patient with chronic premenstrual vulvovaginal pruritus thought to be attributable to autoimmune progesterone dermatitis.

Vulvovaginal dryness and itching.

Dryness and itching in the vulvovaginal area is an increasing problem as our female population ages and becomes menopausal. This dryness and itching is often the result of estrogen deficiency, and there are typically two types of treatment: Specific Therapy (or hormone replacement therapy), and Nonspecific Therapy. Dermatologists should be able to sort out the causes of the itching and irritation, and understand the approaches to therapy.

Contact sensitivity in pruritus vulvae: patch test results and clinical outcome.

BACKGROUND: Persistent vulval pruritus is common and may not be associated with signs of a primary vulval dermatosis. Patients with established vulval disease may develop contact sensitivity as a secondary problem after the application of topical therapy. OBJECTIVE: A retrospective study was performed to establish the prevalence of allergic contact dermatitis in patients with pruritus vulvae. In addition, the results of patch testing in women with vulval lichen sclerosus were compared with those in patients with primary pruritus vulvae and essential vulvodynia. METHODS: Over a 5-year period, 121 women with vulval problems were patch tested to the European Standard Series, selected preservatives, perfumes, local anesthetics, medicaments, and a vulval battery. RESULTS: Fifty-seven patients (49%) had one or more relevant allergic positive reactions. Medicaments or their constituents were the most common allergens to give reactions. Seven of the 16 patients (44%) with lichen sclerosus had positive reactions. Symptoms resolved or improved significantly in 67 patients (55.4%) overall. Six of the seven women with lichen sclerosus who had positive reactions noted an improvement in their symptoms. Patients who had a relevant allergy were much more likely to improve than those whose tests were negative (p < 0.001). CONCLUSION: Patients with pruritus vulvae and lichen sclerosus are at high risk of contact sensitivity. Patch testing is useful in the management of these patients and many can be helped by allergen avoidance.