Search Results (60)

Background/Objectives: Genitourinary Syndrome of Menopause (GSM) negatively affects quality of life in postmenopausal women, causing sexual dysfunction, vaginal atrophy, and pelvic discomfort. Personalized medicine highlights the need for individualized, non-hormonal therapeutic options for women with contraindications to or preferences against hormonal treatment. Non-hormonal therapies, such as laser treatments, have emerged as potential alternatives, but evidence comparing intravaginal and extravaginal K-Laser therapy remains limited. This study aimed to evaluate the efficacy of intravaginal and extravaginal K-Laser therapy on the symptoms of Genitourinary Syndrome of Menopause (GSM) in postmenopausal women. Methods: In this single-center, randomized, single-blind, placebo-controlled trial, 57 postmenopausal women were randomly assigned to receive either intravaginal and extravaginal K-Laser Cube Plus 30 therapy (n = 36) or a simulated control treatment (n = 21). The primary outcome was sexual function, measured by the Female Sexual Function Index (FSFI). Secondary outcomes included vaginal pH and pelvic floor muscle function assessed via the PERFECT protocol. Outcomes were assessed at baseline and after 6 weeks. Results: Sixty-seven women were enrolled, and ten were lost to follow-up. The treatment group showed significant improvements over the control group in FSFI (mean difference = 6.38; p < 0.001), PERFECT protocol scores (mean difference = 0.78; p = 0.004), CPPQ-Mohedo (mean difference = 5.44; p < 0.001), and Menopause Rating Scale (mean difference = 6.50; p = 0.017). Significant reductions were also observed in vaginal dryness, vulvar dystrophy, and atrophy (p < 0.001). Conclusions: Intravaginal and extravaginal K-Laser therapy appears to be a safe and effective non-hormonal treatment for GSM and may support personalized management strategies. However, further well-designed randomized clinical trials with larger samples, longer follow-up of both laser-treated and control groups, and objective outcome measures are needed to provide higher-quality evidence regarding efficacy and identify the patients most likely to benefit. Full article

Purpose: Vasomotor, sexual, and musculoskeletal symptoms are common adverse effects of adjuvant endocrine therapy in breast cancer survivors. Social media use has not been investigated with altered symptom perception in patients receiving adjuvant endocrine therapy. This study aimed to investigate whether social media use or addiction independently predicts endocrine therapy-related symptom burden in breast cancer survivors. Methods: A cross-sectional survey study was conducted among 153 breast cancer survivors receiving adjuvant endocrine therapy. The Social Media Use Scale (SMUS) and Bergen Social Media Addiction Scale (BSMAS) were assessed using validated Turkish versions of each scale. Endocrine therapy-related toxicities (specifically hot flashes, vaginal dryness, loss of libido, and musculoskeletal pain severity) were evaluated using specific self-reported 5-point Likert scale items. Results: All of the patients were female and menopausal, either neutral or induced with ovarian function suppression. In the univariate analysis, the BSMAS score showed a weak positive correlation with vasomotor/sexual symptoms (r = 0.194; p = 0.017), but this association disappeared after adjustment for clinical variables. Younger age was associated with greater vasomotor/sexual symptoms in univariate testing. Neither the SMUS nor BSMAS independently predicted musculoskeletal symptom severity in univariate and multivariate models, while higher educational attainment remained the only independent predictor of musculoskeletal pain severity (OR = 1.96; 95% CI: 1.06–3.57; p = 0.031). Conclusions: This study is unique in investigating unstructured social media use and endocrine therapy-related physical symptoms. In this cohort, unstructured social media use was not associated with the endocrine therapy-related physical symptom burden. While these cross-sectional findings do not support social media behavior as a significant predictor, clinical assessments should continue to prioritize established determinants such as age and educational background. Full article

Background/Objectives: Pelvic radiotherapy (RT) for mid–low rectal and anal cancers frequently causes acute and late vaginal toxicity, including dryness, irritation, and dyspareunia, with a substantial impact on quality of life. Evidence supporting targeted interventions for radiation-induced vaginal mucosal changes remains limited. This exploratory retrospective study evaluated the association between daily use of Colpofix^® Ovules and temporal changes in patient-reported vaginal symptoms and Vaginal Health Index (VHI) scores in women undergoing pelvic RT. Methods: Twenty women treated with pelvic RT or chemoradiotherapy between 2024 and 2025 were included. Vaginal symptoms were assessed using a Numerical Rating Scale (NRS 0–10), and mucosal status was evaluated using the VHI (5–25). Assessments were performed at baseline (T0), end of RT (T1), 3 months (T2), and 6 months (T3). Due to the retrospective nature of the dataset, only aggregated summary values were available; analyses were therefore descriptive and aimed at characterizing temporal trends. Results: A clear and progressive reduction in vaginal dryness, irritation, reduced lubrication, and dyspareunia was observed from T0 to T3, with improvements already evident at T1 and further consolidation at T2–T3. VHI scores increased from a mean of 10.8 at baseline to 21.0 at 6 months, reflecting a consistent trend toward mucosal recovery across all domains. In the anal cancer subgroup, the trend toward improvement in dysuria did not meet conventional thresholds for statistical significance (p = 0.073). At T3, 90% of patients reported perceived benefit (55% marked, 35% mild). No adverse events attributable to Colpofix^® were documented. Conclusions: In this small retrospective cohort, daily use of Colpofix^® Ovules was associated with favorable temporal trends in both vaginal symptoms and VHI scores up to 6 months after pelvic RT. These exploratory findings support further prospective controlled studies to better define the potential role of Colpofix^® in managing vaginal mucosal changes during pelvic radiotherapy. Full article

Background and Objectives: Young women treated for breast cancer often face persistent sexual and reproductive challenges post-treatment, which frequently remain unaddressed during routine follow-up. This study evaluated health-related quality of life (HRQoL), sexual health, and fertility-related counselling in breast cancer survivors younger than 40 years. Materials and Methods: We performed a single-centre cross-sectional study including 65 women with non-metastatic breast cancer (at least 12 months post-primary treatment). Patients completed the EORTC QLQ-C30 and SHQ-22 questionnaires, along with a pilot-tested 7-item fertility preservation survey. Data were analyzed using descriptive statistics and non-parametric tests to compare treatment subgroups (e.g., endocrine therapy vs. others). Results: Overall quality-of-life scores were relatively preserved (median 66.67), with high functional scores. However, patients reported symptomatic distress, particularly fatigue and insomnia (both median 33.33). Sexual health was significantly impacted: communication with healthcare professionals was the most impaired domain (median score 100), followed by low libido (66.7) and vaginal dryness (66.7). Women receiving endocrine therapy reported significantly lower functional scores and a higher symptom burden compared to those not on endocrine treatment (p < 0.05). While 60% of patients received fertility information, only 16.9% underwent preservation procedures. Notably, a significant association was observed between reproductive health actions and sexual behaviour; women who had undergone fertility preservation procedures reported higher levels of sexual activity (p = 0.015). Conclusions: Despite relatively preserved functional status, young breast cancer survivors face significant symptomatic and sexual challenges. The profound lack of communication regarding sexual health and the gaps in fertility counselling highlight the need for a more integrative, multidisciplinary approach in survivorship care. Full article

Background: Sjögren’s disease (SjD) is a chronic systemic autoimmune disorder primarily characterized by lymphocytic infiltration of exocrine glands, leading to xerostomia and xerophthalmia. Beyond glandular involvement, the disease frequently presents with a broad spectrum of systemic and neuropsychiatric manifestations that significantly affect patients’ quality of life. Methods: A review of the literature was conducted to identify studies addressing neuropsychological symptoms in patients with SjD. Relevant publications describing cognitive dysfunction, mood disorders, sleep disturbances, fatigue, and sexual dysfunction, as well as potential underlying mechanisms and therapeutic approaches, were included and analyzed. Results: Available evidence indicates that neuropsychological symptoms are common among patients with SjD. Cognitive impairment, often described as “brain fog”, may involve deficits in memory, attention, and executive functioning. Depression and anxiety appear to occur more frequently than in the general population and may interact with chronic fatigue and sleep disturbances, contributing to functional impairment. While somatic causes of sexual dysfunctions such as vaginal dryness are well recognized, psychological and psychosexual aspects, including reduced sexual desire, have received comparatively little attention. The pathogenesis of these manifestations is likely multifactorial and may involve immune-mediated processes, cytokine dysregulation, neuroendocrine alterations, microvascular changes, and psychosocial factors. Conclusions: Neuropsychological manifestations represent a significant component of the overall disease burden in SjD. Increased awareness and multidisciplinary management strategies may help improve symptom recognition, patient care, and quality of life. Full article

Background: Long-term survivors (LTS) after gynecological cancer may be cured but still face physical and psychological challenges. This multicenter study aimed to assess the long-term side effects, the received follow-up care, and the personal perspectives of survivors. Methods: Between 2019 and 2025, LTS from four European countries within the ENGOT (European Network of Gynecological Oncological Trial Groups) and GCIG (Gynecologic Cancer InterGroup) networks were recruited. Long-term survival was defined as surviving at least five years after the first diagnosis. LTS completed a questionnaire with 81 questions (patient’s characteristics, oncological history, current health status, lifestyle factors). Analyses were mainly descriptive. Results: A total of 677 LTS were enrolled, with a median age of 64.0 years (range: 26–92) and a median survival time of 7 years (range: 5–38). A total of 46.6% were diagnosed with cervical cancer, 32.9% with endometrial cancer, 4.4% with ovarian cancer, and 16.1% with other types of gynecological cancer. Moreover, 36.9% still suffer from physical and psychological symptoms, most frequently being lymphedema (36.2%), hot flashes (22.4%), difficulties with concentration (21.1%), fatigue (20.9%), vaginal dryness (20.1%), and urinary incontinence (18.9%). Median overall health status was ranked (scale 1–5; 1 = very good, 5 = very poor) as 2, while 13.5% rated their health as poor/very poor. Current symptoms were associated with poorer health status (p < 0.001) and a history of recurrent disease (p = 0.001). In addition, 13.6% reported not receiving follow-up care. CA-125 was determined in 80.8% of ovarian LTS, as well as in 30.7% of cervical and 28.9% of endometrial LTS. Pap smear follow-up was reported by 50.5% of endometrial LTS. A total of 33.7% did not exercise at all or exercised less than an hour per week, 13.4% smoke tobacco, and 51.2% drink alcohol more often than once a month. Conclusions: Our findings highlight the need for patient-centered follow-up care, addressing both long-term side effects and education on lifestyle and prevention. Follow-up procedures that do not follow guidelines should be avoided. Full article

Background: The vagina undergoes important changes across the life course that are shaped not only by hormonal transitions but also by shifts in the vaginal microbial environment. Despite growing interest in the vaginal microbiome, research has disproportionately centered reproductive-aged populations, leaving the aging vagina comparatively understudied. Objective: This article examines the aging vagina through a life-course lens, with emphasis on microbial and clinical transitions associated with midlife and older adulthood. Key Content: The article highlights menopause-related changes and approaches for reducing stigma and missed clinical opportunities. Particular attention is given to menopause-related declines in estrogen, reduced glycogen availability, increased vaginal pH, and accompanying changes in microbial balance, as well as their relationship to dryness, irritation, genitourinary symptoms, and susceptibility to adverse outcomes. The article also provides health professionals with a practical educational framework for symptom recognition, patient communication, vaginal health assessment, menopause-related education, stigma reduction, and prevention of missed clinical opportunities. Conclusions: Positioning the aging vagina within life-course and microbial-health frameworks can strengthen prevention, improve symptom recognition, and support more age-inclusive, informed, and responsive care for older women. Full article

Background/Objectives: Compounded vaginal creams are widely used for conditions such as hormone replacement therapy, vaginal dryness, low libido, vaginal infections, etc. Recent research highlights the potential of using anhydrous bases to extend shelf life, particularly when combined with self-emulsifying and mucoadhesive properties that improve mucosal retention and enhance drug bioavailability. This study provides in vitro and ex vivo evaluation of an anhydrous vaginal base. Methods: Key quality indicators such as irritation potential, leakage potential, pH compatibility, mucoadhesion, and self-emulsification were assessed using the chorioallantoic membrane Hen’s Egg Test, MTT assay, texture analysis, and fluorescence microscopy. Results: The anhydrous vaginal base demonstrated high cell viability (>78%) and non-irritant potential (IS = 2.5) in in vitro assays. It maintained physiological vaginal pH (4.56 ± 0.05), showed strong mucoadhesive properties comparable to commercial products, and exhibited minimal leakage. Ex vivo studies confirmed its prolonged retention on vaginal tissues. The anhydrous vaginal base formed stable emulsions upon contact with vaginal fluid simulant, effectively distributing both lipophilic and hydrophilic compounds. Conclusions: Compared to water-containing bases, an anhydrous vaginal base shows advantages: longer retention time and lower leakage; adaptability to varying vaginal fluid levels; and efficient dispersion of both hydrophilic and lipophilic active pharmaceutical ingredients. These features support its potential use in compounded vaginal products, minimizing stability risks and enhancing patient compliance and therapeutic outcomes. Full article

Background/Objectives: Endometrial cancer is one of the most common malignancies of the female reproductive system. Fortunately, risk-adapted therapy offers a promising chance of recovery, even from locally advanced disease. In particular, older patients with higher risk factors benefit markedly from adjuvant radiotherapy with or without chemotherapy. Nevertheless, this also carries a risk of higher cumulative toxicity thereafter. Although this phenomenon has been observed in older patients, it has not yet been adequately evaluated. Methods: This retrospective study compared the clinical features of patients receiving adjuvant radiotherapy with or without sequential chemotherapy or radiotherapy with concomitant chemotherapy between 2011 and 2023. The cohort was divided into two groups: patients over 65 years old and those under 65. Results: 100 patients received adjuvant radiotherapy at our center between 2011 and 2023. The mean age of patients was 66.87 years. We observed that neither diabetes, obesity, concurrent, sequential chemotherapy, nor para-aortic field irradiation was associated with an increased incidence of acute radiogenic side effects such as cystitis, diarrhea, proctitis, radiodermatitis, nausea, or vaginal dryness according to CTCAE ≥ 2 (all p > 0.50). No difference was found between the two groups in terms of the incidence of radiotherapy-associated toxicity. Conclusions: We found no increase in toxicity in elderly patients after adjuvant radiotherapy with or without chemotherapy. Full article

Background and Objectives: Genitourinary syndrome of menopause (GSM), previously known as vulvovaginal atrophy, is a chronic, progressive hypoestrogenic condition affecting vulvovaginal, urinary and sexual health in women. Common symptoms include vaginal dryness, itching, dyspareunia, urinary urgency and recurrent urinary tract infections (UTIs). Despite the high prevalence, GSM is underdiagnosed and undertreated, thereby negatively impacting women’s quality of life. To illustrate the practical aspects of GSM diagnosis and provide evidence-based management, we present a case-based narrative review synthesizing recently published, high-quality evidence. Materials and Methods: Evidence was drawn from multiple sources through targeted searches of databases, and included the 2025 AUA/SUFU/AUGS guideline (AUA), the 2024 NICE network meta-analyses (NICE), a 2025 systematic review/meta-analysis in breast-cancer survivors, the 2020 Menopause Society GSM Position Statement, the 2018 NAMS/ISSWSH breast cancer consensus, several primary source citations and other high quality peer-reviewed publications. Results: Five illustrative composite case vignettes of GSM are presented to highlight the evaluation strategy and evidence-supported treatment choices. Nonhormonal options are the first line treatments for mild GSM symptoms, either with or without the addition of vaginal estrogen therapy. For moderate to severe GSM, low-dose vaginal estrogen, vaginal DHEA, and ospemifene are all effective FDA-approved options. In breast cancer survivors, individualized decisions with oncology input are warranted. Maximal caution and a shared decision-making approach is required for women using Aromatase Inhibitors (AIs) for breast cancer risk reduction when choosing treatments for GSM. Conclusions: Treating GSM improves vaginal, sexual and urinary outcomes and quality of life of women. Clinicians need to proactively screen for GSM and offer evidence-based treatment options. The treatment decisions in breast cancer survivors are nuanced, requiring a shared-decision approach. Full article

Breast cancer entails profound physical, emotional, and relational changes that persist beyond biomedical treatment and may substantially affect women’s body image, sexuality, and engagement in daily occupations. This descriptive phenomenological qualitative study examined the lived experiences of eight Spanish breast cancer survivors through in-depth semi-structured interviews conducted after completion of oncological treatment. Transcripts were analyzed using discourse analysis with iterative interpretation. Three interrelated findings were identified: (1) bodily changes linked to mastectomy and adjuvant therapies disrupted continuity with the previously known body, eliciting estrangement, vulnerability, and grief for the former bodily self; (2) sexuality emerged as a particularly vulnerable domain, shaped by diminished desire, vaginal dryness and pain, shame, altered self-perception, and the need to renegotiate intimacy within the couple; and (3) coping and meaning-making were strengthened by psychological support, efforts to emotionally protect family members, and, notably, peer support and helping other women as key sources of resilience. These findings highlight the need for integrated, culturally sensitive, person-centered survivorship care that explicitly addresses sexuality, body image, and emotional well-being. Occupational therapy may contribute by supporting embodied identity reconstruction, participation in meaningful occupations, and the reconfiguration of intimacy after breast cancer. Full article

Background/Objectives: Genitourinary syndrome of menopause (GSM) is a common and under-diagnosed condition that significantly affects the quality of life of post-menopausal women. Conventional treatments, especially those based on estrogens, have limitations, which has prompted the search for alternative therapies in the field of regenerative medicine. In this context, intradermal injectable collagen, with regenerative and analgesic properties, could represent an innovative option. This study aims to evaluate the efficacy and safety of multipoint intradermal injections of collagen (MD-Tissue) in the treatment of GSM refractory to conventional first-line therapy. Methods: A retrospective study was conducted in 20 patients diagnosed with GSM. Intradermal injections of collagen were administered in the vulvovaginal region. Clinical outcome was assessed using the Visual Analog Scale (VAS) for baseline pain and dyspareunia, the Vaginal Health Index (VHI), the Vulvar Health Index (vHI), the Vulvovaginal Symptoms Questionnaire (VSQ) and the Clinical Global Impression scale (CGI). Results: Three months after end of injections, baseline pain measured using the VAS was significantly reduced from a mean of 5.9 to 0.8 (p < 0.001), and pain during intercourse decreased from 8.7 to 2.0 (p < 0.001). Significant improvements were also observed in the tissue parameters of VHI and vHI. In the VSQ, 100% of patients reported improvement in at least one domain, including itching, dryness, burning, and social and sexual impact. According to the CGI scale, 80% reported feeling ‘much better’ and 20% ‘moderately better’. No relevant adverse effects were reported. Conclusions: Intradermal vulvovaginal collagen injections appear to be a safe and potentially effective intervention in improving pain and other symptoms of GSM, within the regenerative medicine approach. These preliminary results justify prospective studies, with larger sample sizes and long-term follow-up, to confirm and consolidate clinical utility. Full article

Background and Objectives: Vulvo-vaginal atrophy (VVA), a prevalent condition among postmenopausal women, significantly impairs quality of life through symptoms like vaginal dryness, dyspareunia, and burning. Non-hormonal treatments, such as CO₂ laser therapy, have shown promise in managing VVA symptoms with minimal side effects. The addition of adjunctive treatments may enhance efficacy and mitigate possible adverse effects. To evaluate the combined efficacy and safety of CO₂ laser therapy and a collagen-based cream in treating VVA and to explore their potential impact on the vaginal microbiome. Materials and Methods: This was a single-center, randomized, interventional. Sixty postmenopausal women diagnosed with VVA were randomized into two groups: a control group receiving laser-only treatment and a treatment group receiving laser therapy with daily collagen-based cream application. Primary outcome measures included symptom improvement on the Visual Analog Scale (VAS) for VVA-associated symptoms. Secondary outcomes involved microbiome composition analysis. Results: Both groups showed significant symptom improvement, with the combination therapy group demonstrating superior reductions in burning, dyspareunia, and vaginal dryness (p < 0.05). Microbiome analysis revealed increased levels of beneficial species (Lactobacillus iners and Lactobacillus crispatus) and decreased pathogenic bacteria (Gardnerella vaginalis and Atopobium vaginae) in the treatment group, though these changes were not statistically significant. Mild side effects, such as burning and swelling in the first days following the treatment, were less frequent in the combination therapy group, likely due to the anti-inflammatory effects of the collagen-based cream. Conclusions: This study provides evidence supporting the use of CO₂ laser therapy with collagen-based cream as an effective and well-tolerated treatment for VVA in postmenopausal women, achieving significant symptom relief. The combined therapy approach holds potential for enhanced efficacy and reduced side effects compared to laser-only treatment, offering a promising alternative for women ineligible for hormone-based therapies. Full article

Genitourinary syndrome of menopause (GSM), which includes vulvovaginal atrophy (VVA) and other bothersome genitourinary symptoms, affects over half of postmenopausal women and has a considerable impact on quality of life. This study aimed to evaluate the efficacy and safety of an injectable combination of hyaluronic acid and amino acids for treating GSM-related symptoms. In this prospective, multicenter study, 84 women aged 46–60 with moderate to severe VVA confirmed by gynecological examination received three intradermal treatments at 21-day intervals, targeting the vestibule, introitus, lower vaginal wall, and labia majora. Symptom severity was assessed using a visual analog scale (VAS), while tolerability and satisfaction were evaluated via a five-point Likert scale. Quality of life was measured using the Satisfaction With Life Scale (SWLS). Assessments were conducted at baseline, after each injection, and at 3- and 6-month follow-up visits. After three months, significant improvements were noted in vaginal dryness, itching, burning, and dyspareunia (all p < 0.001). Patient satisfaction increased from 59.0% to 80.7%, and SWLS scores rose from 4.57 ± 1.76 to 6.53 ± 1.10, reflecting enhanced quality of life. The treatment was well tolerated and demonstrated a favorable safety profile. These findings suggest that this injectable formulation may represent an effective, non-hormonal option for women with VVA, particularly those who are not candidates for hormone therapy. Full article

The vulvovaginal microbiome is a complex and dynamic ecosystem of microorganisms. The potential effects of common personal lubricants on its balance, which have implications for reproductive health, are still unknown. This study longitudinally assessed the impact of two commercially available lubricants on the composition and stability of the vaginal and vulvar bacteriome. Paired vaginal and vulvar swabs were collected at baseline and after repeated lubricant use, and the bacteriome was assessed using 16S rRNA gene amplicon sequencing. Alpha and beta diversity were assessed using Shannon entropy and Bray–Curtis dissimilarity, respectively. The results showed that the vaginal bacteriome was dominated by Lactobacillus and Firmicutes, while vulvar communities were more diverse and had higher abundances of Prevotella, Finegoldia, and Peptoniphilus. Both alpha and beta diversity measures indicated that the vaginal and vulvar bacteriome remained largely stable even after repeated lubricant use. Minor and non-significant changes in genus-level composition were observed, particularly in the vulvar samples. A moderate but significant correlation (Mantel r = 0.274, p = 0.001) was also observed between the vaginal and vulvar bacteriome. Overall, this study shows that short-term, repeated use of the water-based lubricant and the silicone-based lubricant tested in this study does not significantly disrupt the vaginal or vulvar bacteriome. Full article