Women’s Genitourinary Disorders



Women’s Genitourinary Disorders


Macrene Alexiades



BACKGROUND

Women’s genitourinary disorders, historically treated using hormone replacement with variable efficacy, have additional potential therapeutic options with developments in the application of laser and energy device-based treatments to these prevalent concerns. The genitourinary disorders potentially amenable to vaginal treatment devices include (1) atrophic vaginitis also known as vulvovaginal atrophy or urogenital atrophy, (2) urinary incontinence (UI), and (3) pelvic prolapse or vulvovaginal atrophy. Collectively, these conditions have been termed the genitourinary syndrome of menopause (GSM).1 They affect women who are postmenopausal postovarectomy, undergoing treatment for breast cancer, postradiation, and breastfeeding; GSM is estimated to affect 50% of postmenopausal women.1 Clinical trials are underway to address Food and Drug Administration (FDA) concerns and attain clearance in treating these common conditions that significantly adversely affect the physiologic and sexual function of a large segment of the population.2,3

Under circumstances of diminishing estrogen, as in postmenopause, postovarectomy, antiestrogen therapy, and breastfeeding, many changes occur in the vulvovaginal tissues that produce symptoms negatively impacting quality of life.4 Vulvovaginal atrophy and laxity, UI, and sexual dysfunction are common sequelae of the effects of diminished or absent estrogens, which are often progressive and unlikely to resolve without intervention. It is estimated that up to 50% of postmenopausal women suffer from symptoms of atrophic vaginitis or vulvovaginal atrophy.4,5

Since 2014, the term GSM has been adopted to encompass a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids syndrome, including genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of
lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria, and recurrent urinary tract infections.1

For over 40 years, gynecologists and plastic surgeons have employed devices to ablate genitourinary tissues. Focused carbon dioxide (CO2) laser has been used for incision and vaporization; defocused CO2 laser for tissue contraction; and ablative CO2 for genital wart ablation.5 Diode lasers have been used for myomectomy; photodynamic therapy with laser for lichen sclerosus; and radiofrequency (RF) for lower genital tract rejuvenation.6 However, in recent years, the number of devices and their applied uses in women’s genitourinary health have multiplied at a rapid rate.7


PRESENTATION

Patients who are postmenopausal, breastfeeding, breast cancer survivors, postovarectomy, or on estrogen inhibitors present with urogenital symptoms. These include vaginal dryness, burning or irritation, urine leakage, painful intercourse, chronic discharge, and pain on urination.




PATHOGENESIS

In the presence of endogenous estrogens, the dominant regulators of vaginal physiology, the vagina is characterized by a thickened rugated vaginal surface, abundant blood flow, and lubrication. The effects of estrogens include upregulating vascular perfusion, increasing epithelial thickness, reducing vaginal pH, and promoting secretions. Estrogen is also a factor in maintaining vaginal tissue elasticity. Spontaneous or induced menopause is associated with diminished estrogen, resulting in a diminution of epithelial thickness, connective tissue and vascularity of the lamina propria, increased pH levels, and an elevation in vaginal pH. These alterations correlate clinically with increased tissue fragility and higher risk of vaginal and urinary infections, irritation, dryness, urogenital pain, and vaginal tissue trauma. The vaginal tissue becomes progressively more atrophic, less elastic, and paler with loss of rugation; the surface becomes friable with petechiae, ulcerations, and bleeding with friction.5

Jun 29, 2020 | Posted by in Dermatology | Comments Off on Women’s Genitourinary Disorders
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