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Clinical case scenarios
EMAS2017 / Maturitas 100 (2017) 93–202
(spine 0.869 g/cm2 (T-score −1.5) and, left hip 0.735 g/cm2 (Tscore −1.7)and neck 0. 602 (T-score −2.3). She has no personal or family history of fractures and reports asymptomatic menopause at 52 years old and she didn’t receive HRT. She eats healthy, does not smoke, does not drink more than 3 alcoholic drinks per week and exercises regularly. Medication: none Physical examination: normal physical examination.
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tinence, pelvic organ prolapses and vaginal atrophy. Breast cancer survivors frequently face serious difficulties in their sexuality due to GSM. Laser thermotherapy has shown high level of effectiveness in those who were not able to use local hormonal therapy. http://dx.doi.org/10.1016/j.maturitas.2017.03.326 EMAS Junior Mentorship Programme Jump01
http://dx.doi.org/10.1016/j.maturitas.2017.03.097 Ask the Expert: GSM and the menopause: Counceling, drugs and lasers. Discussion of clinical cases ATE18 Clinical case scenarios Rosella Nappi University of Pavia, Pavia, Italy
Effects of a new vaginal cream containing visnadine, prenylflavonoids and bovine colostrum on Vaginal Health Index Score and Female Sexual Function Index in post-menopausal sexually active women affected by vaginal dryness: A pilot study Antonio Simone Laganà 1,∗ , Francesca Basile 1 , Lily Stojanovska 2 , Vasso Apostolopoulos 2 , Salvatore Giovanni Vitale 1 , Rosario D’Anna 1 1
Julia, Breast cancer survivor, 47 yrs of age with severe dyspareunia. Maria, 45 yrs of age, premature menopause on MHT with rUTIs. Greta, 49 yrs of age, surgical menopause with female sexual dysfunction. Gloria, 56 yrs of age, natural menopause with vaginal dryness. http://dx.doi.org/10.1016/j.maturitas.2017.03.098 ATE19 Lasers in the treatment of genitourinary syndrome of menopause Ivan Fistonic´ Institute for Womens Health, Zagreb, Croatia Genitourinary Sndrome of Menopause (GSM) stands for the variety of menopausal symptoms associated with physical changes of the vulva, vagina, and lower urinary tract, related with estrogen deficiency and process of ageing as well. GSM is chronic and is likely to worsen over time, affecting up to 50% of postmenopausal women. Local vaginal estrogen administration is the treatment of choice for vulvovaginal atrophy, although lacking long time efficacy and safety. However, many women do not accept local hormonal therapy or have absolute contraindications, such as a personal history of estrogen-dependent tumors, particularly endometrial and breast cancer. Recently, results from studies that employ laser energy in the therapy of GSM, incontinence, vaginal distension syndrome and consequent reduced sexual performance. Micro-ablative carbon dioxide (CO2 ) laser induced a significant improvement of vaginal health in postmenopausal women improving dyspareunia related to vulvovaginal atrophy and sexual global performance as well. Simultaneously, non-ablative, thermal-only SMOOTH-mode erbium YAG laser pulses are used to produce vaginal collagen hyperthermia, followed by collagen remodeling and the synthesis of new collagen fibers, resulting in improved vaginal tissue tightness and elasticity. This erbium laser technology is used for treatments of vaginal laxity, stress urinary incontinence, pelvic organ prolapse and vaginal atrophy. Several clinical studies covering all four indications were conducted with the aim to prove the efficacy and safety of this novel technology. The results have shown that SMOOTH-mode erbium laser seems to be an effective and safe method for treating vaginal laxity, stress urinary incon-
University of Messina, Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood ‘G. Barresi’, Messina, Italy 2 Victoria University, Centre for Chronic Disease, College of Health and Biomedicine, Melbourne, Australia
Objective: To evaluate the effects of a new vaginal cream containing visnadine (0.30%), prenylflavonoids (0.10%) and bovine colostrum (1%) on Vaginal Health Index Score (VHIS) and Female Sexual Function Index (FSFI) in post-menopausal sexually active women affected by vaginal dryness. Patients and methods: We performed a prospective pilot study, enrolling 15 post-menopausal sexually active women affected by vaginal dryness. The mean age of participants was 56.8 ± 4.6 years with parity mean 1.6 ± 1. All women gave consent and underwent VHIS evaluation and FSFI test. Following baseline evaluation, women underwent 15 days of vaginal treatment with one application per day of the new vaginal cream. Following treatment, women were evaluated again using the same methods of the pre-treatment phase. Results: Following treatment there was significant improvement in elasticity (p = 0.03), fluid secretion type and consistency (p = 0.01), pH (p = 0.03), epithelization of vaginal mucosa (p = 0.04), moisture (p = 0.04) and total VHIS (p = 0.0001). Similarly, after the treatment there was also a significant improvement of lubrication (p = 0.01), orgasm (p = 0.01), satisfaction (p = 0.02), pain (p = 0.03) and total FSFI score (p = 0.004). No significant differences regarding desire (p = 0.57) and arousal (p = 0.61) were found. None of the women reported any local or systemic side effect during the treatment. Conclusion: We demonstrated a significant improvement of both VHIS and FSFI score in post-menopausal sexually active women after a treatment with vaginal cream containing visnadine, prenylflavonoids and bovine colostrum. Given that our results are based on a pilot study, we postulate that the treatment with this new vaginal cream may significantly reduce vaginal dryness in post-menopausal women and improve their sexual wellbeing. http://dx.doi.org/10.1016/j.maturitas.2017.03.265
(spine 0.869 g/cm2 (T-score −1.5) and, left hip 0.735 g/cm2 (Tscore −1.7)and neck 0. 602 (T-score −2.3). She has no personal or family history of fractures and reports asymptomatic menopause at 52 years old and she didn’t receive HRT. She eats healthy, does not smoke, does not drink more than 3 alcoholic drinks per week and exercises regularly. Medication: none Physical examination: normal physical examination.
123
tinence, pelvic organ prolapses and vaginal atrophy. Breast cancer survivors frequently face serious difficulties in their sexuality due to GSM. Laser thermotherapy has shown high level of effectiveness in those who were not able to use local hormonal therapy. http://dx.doi.org/10.1016/j.maturitas.2017.03.326 EMAS Junior Mentorship Programme Jump01
http://dx.doi.org/10.1016/j.maturitas.2017.03.097 Ask the Expert: GSM and the menopause: Counceling, drugs and lasers. Discussion of clinical cases ATE18 Clinical case scenarios Rosella Nappi University of Pavia, Pavia, Italy
Effects of a new vaginal cream containing visnadine, prenylflavonoids and bovine colostrum on Vaginal Health Index Score and Female Sexual Function Index in post-menopausal sexually active women affected by vaginal dryness: A pilot study Antonio Simone Laganà 1,∗ , Francesca Basile 1 , Lily Stojanovska 2 , Vasso Apostolopoulos 2 , Salvatore Giovanni Vitale 1 , Rosario D’Anna 1 1
Julia, Breast cancer survivor, 47 yrs of age with severe dyspareunia. Maria, 45 yrs of age, premature menopause on MHT with rUTIs. Greta, 49 yrs of age, surgical menopause with female sexual dysfunction. Gloria, 56 yrs of age, natural menopause with vaginal dryness. http://dx.doi.org/10.1016/j.maturitas.2017.03.098 ATE19 Lasers in the treatment of genitourinary syndrome of menopause Ivan Fistonic´ Institute for Womens Health, Zagreb, Croatia Genitourinary Sndrome of Menopause (GSM) stands for the variety of menopausal symptoms associated with physical changes of the vulva, vagina, and lower urinary tract, related with estrogen deficiency and process of ageing as well. GSM is chronic and is likely to worsen over time, affecting up to 50% of postmenopausal women. Local vaginal estrogen administration is the treatment of choice for vulvovaginal atrophy, although lacking long time efficacy and safety. However, many women do not accept local hormonal therapy or have absolute contraindications, such as a personal history of estrogen-dependent tumors, particularly endometrial and breast cancer. Recently, results from studies that employ laser energy in the therapy of GSM, incontinence, vaginal distension syndrome and consequent reduced sexual performance. Micro-ablative carbon dioxide (CO2 ) laser induced a significant improvement of vaginal health in postmenopausal women improving dyspareunia related to vulvovaginal atrophy and sexual global performance as well. Simultaneously, non-ablative, thermal-only SMOOTH-mode erbium YAG laser pulses are used to produce vaginal collagen hyperthermia, followed by collagen remodeling and the synthesis of new collagen fibers, resulting in improved vaginal tissue tightness and elasticity. This erbium laser technology is used for treatments of vaginal laxity, stress urinary incontinence, pelvic organ prolapse and vaginal atrophy. Several clinical studies covering all four indications were conducted with the aim to prove the efficacy and safety of this novel technology. The results have shown that SMOOTH-mode erbium laser seems to be an effective and safe method for treating vaginal laxity, stress urinary incon-
University of Messina, Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood ‘G. Barresi’, Messina, Italy 2 Victoria University, Centre for Chronic Disease, College of Health and Biomedicine, Melbourne, Australia
Objective: To evaluate the effects of a new vaginal cream containing visnadine (0.30%), prenylflavonoids (0.10%) and bovine colostrum (1%) on Vaginal Health Index Score (VHIS) and Female Sexual Function Index (FSFI) in post-menopausal sexually active women affected by vaginal dryness. Patients and methods: We performed a prospective pilot study, enrolling 15 post-menopausal sexually active women affected by vaginal dryness. The mean age of participants was 56.8 ± 4.6 years with parity mean 1.6 ± 1. All women gave consent and underwent VHIS evaluation and FSFI test. Following baseline evaluation, women underwent 15 days of vaginal treatment with one application per day of the new vaginal cream. Following treatment, women were evaluated again using the same methods of the pre-treatment phase. Results: Following treatment there was significant improvement in elasticity (p = 0.03), fluid secretion type and consistency (p = 0.01), pH (p = 0.03), epithelization of vaginal mucosa (p = 0.04), moisture (p = 0.04) and total VHIS (p = 0.0001). Similarly, after the treatment there was also a significant improvement of lubrication (p = 0.01), orgasm (p = 0.01), satisfaction (p = 0.02), pain (p = 0.03) and total FSFI score (p = 0.004). No significant differences regarding desire (p = 0.57) and arousal (p = 0.61) were found. None of the women reported any local or systemic side effect during the treatment. Conclusion: We demonstrated a significant improvement of both VHIS and FSFI score in post-menopausal sexually active women after a treatment with vaginal cream containing visnadine, prenylflavonoids and bovine colostrum. Given that our results are based on a pilot study, we postulate that the treatment with this new vaginal cream may significantly reduce vaginal dryness in post-menopausal women and improve their sexual wellbeing. http://dx.doi.org/10.1016/j.maturitas.2017.03.265