title: Clinical profile of women with vulvar and vaginal atrophy who are not candidates for local vaginal estrogen therapy.
abstract: Vulvar and vaginal atrophy (VVA) is a chronic medical condition in postmenopausal women, which is predominantly due to a permanent cessation of ovarian estrogen production. Current available treatment options for VVA are over-the-counter (OTC) symptomatic relief products or local estrogen therapy (LET) aiming to treat this underlying atrophic condition. Recent surveys indicated that these products decrease sexual spontaneity, are messy and indiscrete. Ospemifene is an oral daily drug, which has proven to treat vaginal dryness and dyspareunia effectively. However, despite the comparable efficacy of ospemifene versus placebo to estrogen versus placebo, ospemifene is currently indicated for women, who are not candidates for LET. It is up to the gynecologist to make an appropriate therapeutic decision. There are potential candidates who have not been considered for ospemifene and yet would benefit from this treatment, such as breast cancer survivors, or patients unable to perform or that have problems performing vaginal insertion/application of estrogen based treatments, such as women that suffer from prolapse. Likewise, a patient's concern for hormone treatment safety, treatment regimens complexity or cross contamination with their partner are potential issues to consider when prescribing treatment for VVA in order to provide the best therapeutic option for patients who are generally not compliant with their current therapy.
authors.affiliation: Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, University of Pavia, Pavia, Italy - renappi@tin.it.
authors.forename: Rossella E
authors.initials: RE
authors.lastname: Nappi
authors.affiliation: Unit of Lower Genital Tract Disease, V. Buzzi University Hospital, Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Murina
authors.affiliation: Department of Gynecology, Obstetrics and Urological Sciences, &quot;Sapienza&quot; University of Rome, Umberto I Policlinic, Rome, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Perrone
authors.affiliation: Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Villa
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, University of Turin, Turin, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Biglia
mesh_terms: D001284:Atrophy; D004414:Dyspareunia / Q000188:drug therapy; D004967:Estrogens / Q000008:administration & dosage; D005260:Female; D006801:Humans; D055118:Medication Adherence; D017698:Postmenopause; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D013629:Tamoxifen / Q000031:analogs & derivatives* / Q000627:therapeutic use; D014623:Vaginal Diseases / Q000188:drug therapy* / Q000473:pathology; D014844:Vulva / Q000473:pathology
chemical_list: D004967:Estrogens; D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen; C119141:Ospemifene