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Non-Estrogen Therapies May Be As Good for Vaginal Health

GSM (Genitorurinary Syndrome of Menopause), formerly called VVA is an under-recognized and under-treated vaginal condition that is common as a result of medication, postpartum, menopausal states, and breastfeeding.

Estrogen in all forms is a successful treatment for this condition, and studies indicate it is safe for virtually all women. But people want alternatives, and not all of the symptoms are resolved by estrogen in every woman.

The primary options as alternatives are vaginal dehydroepiandosterone (DHEA) called Intrarosa, ospemifene or Osphena, laser therapy, radiofrequency therapy, polycarbophil-based vaginal moisturizer (Replens is one), vaginal hyaluronic acid, and testosterone (needs to be compounded). None have been studied against each other. And if treatment isn’t successful, prevention of pain is possible with topical numbing solution.

Some of the research focused on the health of the tissues, others on less painful sex, other studies looked a decreasing urinary symptoms, and in Osphena trials they looked at decreasing the vaginal pH.

The Mayo Clinic conclusion is that education is very important, even before these conditions occur. Keeping vulvar and vaginal tissue healthy may require some lifestyle changes. Bikers can cause trauma to the fine nerves of the vulvar area. This can be avoided by specialized seats and more modest distances.

Women and their providers suffer from a lack of awareness. Come for an exam, we want to discuss.

If you have GSM you have an adverse effect on general enjoyment of life. Women will avoid intimacy with these vaginal conditions.

Signs that you may have this includes loss or scant pubic hair, loss of your labial vulvar fat pad, thinning or resorption of your labia minora, narrowing of the vagina and increased vaginal pH. Increased vaginal pH may mean more infections.

While estrogen is the preferred pharmacologic treatment, non-prescription therapies should always be tried first. At Women’s Health Practice we offer a full range on non-prescription therapies for this condition.

For breast cancer survivors there is a lack of safety data for use of estrogen, and in general non-hormonal treatments for these conditions is recommended.

Some women can be offered oral medication that also lowers their risk of breast cancers.

Laser therapies are cleared for a variety of reasons for use in medical therapies. Although there are research studies indicating effectiveness, right now the treatment of GSM of the vaginal is not specifically listed by laser companies as a reason for treatment. At Women’s Health Practice we aim to make these therapies widely available, and will work with patients who may not have medical coverage for these treatments.

The MonaLisa Touch carbon dioxide laser activates heat shock proteins that in turn activate tissue growth factors which results in increasing blood flow, collagen, thickening of the matrix around all the cells, and thus thickens, improves, and heals the vaginal tissue.

MonaLisa carbon dioxide treatment results in less vaginal dryness, less burning, less itching, less pain with urination, less painful sex, and beneficial effects on discharge. Treatment sequences are for three treatments about a month apart.

There have been very few reported adverse effects from MonaLisa Touch laser therapies. Longer term studies are still needed.

Vibrators can be used as therapy to stimulate vaginal health, function and blood flow, even in women without a partner.

If pain persists it is possible to use topical numbing before having sex. You need to come in for a prescription if you require this therapy.

There are a number of conditions that could be confused, and there are many therapies. Drtrupin.com


Suzanne Trupin, MD, Board Certified Obstetrician and Gynecologist and owner of Women's Health Practice, Hada Cosmetic Medicine, and Hatha Yoga and Fitness

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