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Open accessJournal ArticleDOI: 10.1080/13697137.2020.1829584

CO2 laser and the genitourinary syndrome of menopause: a randomized sham-controlled trial

04 Mar 2021-Climacteric (Informa UK Limited)-Vol. 24, Iss: 2, pp 187-193
Abstract: This study aimed to clarify the efficacy of intravaginal CO2-laser treatment in postmenopausal women with genitourinary syndrome of menopause (GSM). This double-blind, randomized, sham-controlled t...

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Topics: Menopause (55%), Genitourinary system (53%), Lower urinary tract symptoms (52%) ... show more
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Journal ArticleDOI: 10.1080/09513590.2021.1943346
Abstract: Objective To develop a best practice document for the management of postmenopausal vulvovaginal atrophy (VVA). Method Literature review carried out using clinical terms, treatments or interventions and comorbidity related to VVA. Results There is a wide variety of interventions that may produce temporal benefits for VVA. However, there are significant limitations in scientific publications concerning VVA and related issues, including variable outcome evaluations, variability in population age range, and small, often underpowered sample sizes. Therapeutic management of VVA should follow a sequential order, considering women's age, symptoms, general health as well as treatment preference. Beneficial options include lubricants, moisturizers, vaginal estrogens (estradiol, estriol, promestriene, conjugated estrogens), androgens, prasterone, and laser application. In women with general menopausal symptoms who are candidates for systemic hormone therapy, the lowest effective dose should be used. Oral ospemifene is an effective selective estrogen receptor modulator to treat VVA. Systemic androgens have a limited role. Although laser procedures are commonly used, at this moment the International Society for the Study of Vulvovaginal Disease does not endorse its use out of the setting of clinical trials. Pelvic floor muscle training improves blood flow and elasticity of the vulvovaginal tissue. In breast cancer survivors, moisturizers and lubricants are first line therapy. However, limited absorption of low/ultra-low doses of estrogens suggests safety, especially in women under treatment with aromatase inhibitors. As clinical practice and available preparations vary between countries this text should be adapted to local circumstances. Conclusions There is a wide range of therapeutic options to individualize VVA treatments.

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Topics: Vaginal estrogen (57%), Population (51%), Ospemifene (51%)

1 Citations


Journal ArticleDOI: 10.1016/J.MATURITAS.2021.06.005
E Mension1, Inmaculada Alonso1, Marta Tortajada1, Isabel Matas1  +4 moreInstitutions (1)
20 Jun 2021-Maturitas
Abstract: Background Genitourinary syndrome of menopause (GSM) can have a great impact on the quality of life (QOL), and affects between 53.8% and 90% of postmenopausal women. The literature suggests that vaginal laser therapy could be an effective treatment for GSM symptoms, but its efficacy and safety have not been established and international societies do not endorse its use. Despite that, there has been an increase in the use of vaginal laser therapy globally over the last decade. Objective The objective of this review is to evaluate the literature which assesses the efficacy and safety of the vaginal laser therapy in the treatment of GSM. Methods A comprehensive literature search was conducted electronically using Embase and PubMed to retrieve studies assessing evidence for the efficacy and safety of vaginal laser therapy for GSM or vulvovaginal atrophy up to June 2021. Results A total of 64 studies were finally included in the review. There were 10 controlled intervention studies, 7 observational cohort and cross-sectional studies and 47 before-after studies without a control group. Conclusion Vaginal laser seems to improve scores on the Visual Analogue Scale (VAS), Female Sexual Function Index (FSFI) and Vaginal Health Index (VHI) in GSM over the short term. Safety outcomes are underreported and short-term. Further well-designed clinical trials with sham-laser control groups and evaluating objective variables are needed to provide the best evidence on efficacy.

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Topics: Clinical trial (51%)

1 Citations


Journal ArticleDOI: 10.1097/GME.0000000000001845
09 Aug 2021-Menopause
Abstract: IMPORTANCE The research of new therapeutic modalities, especially with energy-based devices, has been increasing nowadays for genitourinary syndrome of menopause (GSM) management. Microablative fractional CO2 laser has been used for pelvic floor dysfunction management. OBJECTIVE To conduct a systematic review and meta-analysis of randomized controlled trials to compare fractional CO2 laser therapy versus sham therapy for GSM management. EVIDENCE REVIEW We searched for the available randomized clinical trials in Cochrane Library, PubMed, ISI web of science, and Scopus during March 2021. We included randomized clinical trials that compared CO2 laser to sham among postmenopausal women with GSM diagnosis. We extracted the available data from included studies and pooled them in a meta-analysis model using RevMan software. Our main outcomes were total vaginal score assessment using the Vaginal Assessment Scale, sexual function using the Female Sexual Function Index, urinary symptoms using the Urogenital Distress Inventory-6, and satisfaction. FINDINGS Three studies met our inclusion criteria with a total number of 164 women. The CO2 laser was linked to a significant reduction in Vaginal Assessment Scale score when compared with the sham group (mean difference [MD] = -0.49, 95% CI [-0.75 to -0.22], P = 0.004). The CO2 laser was associated with a significant improvement in Female Sexual Function Index score in comparison with sham group (MD = 9.37, 95% CI [6.59-12.14], P < 0.001). In addition, a significant reduction in Urogenital Distress Inventory-6 score was reported among the CO2 laser group (MD = -6.95, 95% CI [-13.24 to -0.67], P = 0.03). More women were significantly satisfied among the CO2 laser group (risk ratio = 1.98, 95% CI [1.36-2.89], P = 0.004). CONCLUSIONS AND RELEVANCE CO2 laser therapy is a promising alternative for GSM management. Further randomized trials with larger sample sizes are required to confirm our findings.

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Journal ArticleDOI: 10.1016/J.FPUROL.2021.03.001
Abstract: Resume Introduction Lors de la derniere decennie, de nouveaux dispositifs de therapie vaginale non invasive ont fait leur apparition et ont ensuite pris un essor important en dermatologie et en medecine esthetique et elles commencent a s’appliquer en urologie et en gynecologie dans le cadre de la pelvi-perineologie. Il s’agit des techniques utilisant la radiofrequence, le laser ou la phototherapie (photobiomodulation). Differentes applications se dessinent et sont en cours d’evaluation (hyperactivite vesicale dans le cadre du syndrome genito-urinaire de la menopause (SGUM), incontinence urinaire a l’effort, beance vaginale). Methode Revue exhaustive de la litterature en utilisant les mots-cles : laser ; vagina ; radiofrequency ; Low Level Laser Therapy, urinary incontinence ; pelvic organ prolapse. Nous avons etudie la methodologie et les resultats des etudes comparatives (avec groupe controle et les essais randomises). Resultats Le laser et la radiofrequence appliques au vagin semblent ameliorer l’hyperactivite vesicale de certaines patientes presentant un syndrome genito-urinaire de la menopause. Le laser CO2 semble plus efficace que la procedure simulee pour traiter a court terme les symptomes d’incontinence urinaire a l’effort et l’atrophie vaginale. Un essai randomise a observe que le laser Er. semblait inefficace dans le traitement du prolapsus. Un essai randomise a montre une efficacite significative de la radiofrequence vaginale dans les symptomes de beance vaginale. Conclusion Ces nouvelles energies appliquees a la pelvi-perineologie pourraient permettre de prendre en charge de facon non invasive certaines patientes souffrant de diverses pathologies (vulvodynies, incontinence urinaire a l’effort, hyperactivite vesicale, SGUM, beance vaginale, etc). Toutefois, nous sommes dans l’attente de resultats d’essais randomises de plus grande ampleur et a long terme. Jusqu’a present, tres peu de complications ont ete rapportees avec ces techniques.

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References
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39 results found


Open accessJournal ArticleDOI: 10.17265/2159-5313/2016.09.003
28 Sep 2016-Philosophy study
Abstract: There has been a shift from the general presumption that “doctor knows best” to a heightened respect for patient autonomy. Medical ethics remains one-sided, however. It tends (incorrectly) to interpret patient autonomy as mere participation in decisions, rather than a willingness to take the consequences. In this respect, medical ethics remains largely paternalistic, requiring doctors to protect patients from the consequences of their decisions. This is reflected in a one-sided account of duties in medical ethics. Medical ethics may exempt patients from obligations because they are the weaker or more vulnerable party in the doctor-patient relationship. We argue that vulnerability does not exclude obligation. We also look at others ways in which patients’ responsibilities flow from general ethics: for instance, from responsibilities to others and to the self, from duties of citizens, and from the responsibilities of those who solicit advice. Finally, we argue that certain duties of patients counterbalance an otherwise unfair captivity of doctors as helpers.

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Topics: Nursing ethics (83%), Medical ethics (65%)

9,859 Citations


Journal ArticleDOI: 10.1080/009262300278597
Abstract: This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6- domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r=0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach’s alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p<0.001). Additionally, divergent validity with a scale of marital satisfactio...

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4,455 Citations


Journal ArticleDOI: 10.1002/NAU.1930140206
Abstract: This article describes short form versions of the Incontinence Impact Questionnaire (IIQ) and the Urogenital Distress Inventory (UDI). These instruments assess life impact and symptom distress, respectively, of urinary incontinence and related conditions for women. All subsets regression analysis was used to find item subsets that best approximated scores of the long form versions. The approach succeeded in reducing the 30-item IIQ and the 19-item UDI to 7- and 6-item short forms, respectively. The short form versions may be more useful than the long form versions in many clinical and research applications.

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Topics: Urinary incontinence (58%), Distress (52%)

1,200 Citations


Journal ArticleDOI: 10.1097/GME.0000000000000329
David Portman, Margery Gass1Institutions (1)
01 Oct 2014-Menopause
Abstract: BackgroundIn 2012, the Board of Directors of the International Society for the Study of Women’s Sexual Health (ISSWSH) and the Board of Trustees of The North American Menopause Society (NAMS) acknowledged the need to review current terminology associated with genitourinary tract symptoms rel

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Topics: Reproductive health (51%)

324 Citations


Journal ArticleDOI: 10.1016/J.MATURITAS.2009.03.021
20 Jun 2009-Maturitas
Abstract: Objective This article aims to summarise the available knowledge on the prevalence of sexual symptoms at the menopause and their impact on quality of life in elderly women. Sexual changes are analysed in the context of the menopause transition and beyond. Methods The medical literature was searched (1990–2008) with regard to menopause and sexuality using several related terms. Results The prevalence of sexual symptoms at the menopause differs across studies depending on several factors such as sample size, design, hormonal status and country. The most common sexual complaints are reduced sexual desire, vaginal dryness and dyspareunia, poor arousal and orgasm and impaired sexual satisfaction. Age and declining oestradiol levels have significant detrimental effects on sexual functioning, desire and responsiveness (arousal, sexual pleasure and orgasm) across the normal menopause transition, while reduced androgens levels played a role in hypoactive sexual desire disorder (HSDD), a symptom frequently diagnosed in surgically menopausal women. Conclusions Women attending menopause clinics are vulnerable to female sexual dysfunction (FSD) because of a complex interplay of individual factors variably affecting well-being. Surgically menopausal women may be more distressed by sexual symptoms. Giving women the opportunity to talk about sexual problems is a fundamental part of health care and may improve their quality of life.

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226 Citations


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