Treating vulvovaginal atrophy/genitourinary syndrome of menopause: how important is vaginal lubricant and moisturizer composition?

D Edwards, N Panay, D Edwards, N Panay

Abstract

Vaginal dryness is a common condition that is particularly prevalent during and after the menopause, and is one of the symptoms of vulvovaginal atrophy/genitourinary syndrome of menopause. The impact of vaginal dryness on interpersonal relationships, quality of life, daily activities, and sexual function can be significant, but is frequently underestimated. Furthermore, barriers exist to treatment-seeking, and this condition is often underreported and undertreated. Greater education about vaginal dryness and the range of available treatments is essential to encourage more women to seek help for this condition. Personal lubricants and moisturizers are effective at relieving discomfort and pain during sexual intercourse for women with mild to moderate vaginal dryness, particularly those who have a genuine contraindication to estrogen, or who choose not to use estrogen. However, there is a distinction between lubricants and moisturizers, and notable differences between commercially available products. Women should be advised to choose a product that is optimally balanced in terms of both osmolality and pH, and is physiologically most similar to natural vaginal secretions. A series of recommendations for the use of vaginal lubricants and moisturizers, either on their own or in combination with systemic or topical hormone replacement therapy, is presented.

Keywords: Cytotoxicity; genitourinary syndrome of menopause; lubricant; moisturizer; osmolality; vaginal dryness; vulvovaginal atrophy.

Figures

Figure 1.
Figure 1.
Osmolality (a) and pH (b) of a panel of personal lubricants and moisturizers available world-wide. Black bars represent hyperosmolar preparations that exceed the ideal osmolality threshold of 380 mOsm/kg recommended by the World Health Organization for a personal lubricant (most of which also exceed the real-world recommended threshold of 1200 mOsm/kg), and which therefore have the potential to cause irritation and/or damage to vaginal or rectal mucosa. In healthy adults, normal vaginal and rectal pH ranges are 3.8–4.5 and ∼7.0, respectively. Gray bars represent preparations that are considered outside of these thresholds. Osmolality and pH testing methods are described in the online Supplemental Material S1 (http://dx.doi.org/10.3109/13697137.2015.1124259).

References

    1. Dunn KM, Croft PR, Hackett GI. Sexual problems: a study of the prevalence and need for health care in the general population. Fam Pract. 1998;15:519–24.
    1. Leiblum SR, Hayes RD, Wanser RA, Nelson JS. Vaginal dryness: a comparison of prevalence and interventions in 11 countries. J Sex Med. 2009;6:2425–33.
    1. Palacios S. Managing urogenital atrophy. Maturitas. 2009;63:315–18.
    1. Panay N, Fenton A. Vulvovaginal atrophy – a tale of neglect. Climacteric. 2014;17:1–2.
    1. Portman DJ, Gass ML, Vulvovaginal Atrophy Terminology Consensus Conference Panel Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society. Climacteric. 2014;17:557–63.
    1. Panay N. Genitourinary syndrome of the menopause – dawn of a new era. Climacteric. 2015;18(Suppl 1):13–17.
    1. Braunstein S, van de Wijgert J. Preferences and practices related to vaginal lubrication: implications for microbicide acceptability and clinical testing. J Womens Health (Larchmt) 2005;14:424–33.
    1. Jozkowski KN, Herbenick D, Schick V, Reece M, Sanders SA, Fortenberry JD. Women's perceptions about lubricant use and vaginal wetness during sexual activities. J Sex Med. 2013;10:484–92.
    1. Andelloux M. Products for sexual lubrication: understanding and addressing options with your patients. Nurs Womens Health. 2011;15:253–7.
    1. Cordeau D, Courtois F. Sexual disorders in women with MS: assessment and management. Ann Phys Rehabil Med. 2014;57:337–47.
    1. Kennedy SH, Rizvi S. Sexual dysfunction, depression, and the impact of antidepressants. J Clin Psychopharmacol. 2009;29:157–64.
    1. Sutton KS, Boyer SC, Goldfinger C, Ezer P, Pukall CF. To lube or not to lube: experiences and perceptions of lubricant use in women with and without dyspareunia. J Sex Med. 2012;9:240–50.
    1. Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol. 1996;87:55–8.
    1. Seehusen DA, Baird DC, Bode DV. Dyspareunia in women. Am Fam Physician. 2014;90:465–70.
    1. Berman JR, Adhikari SP, Goldstein I. Anatomy and physiology of female sexual function and dysfunction: classification, evaluation and treatment options. Eur Urol. 2000;38:20–9.
    1. Lev-Sagie A. Vulvar and vaginal atrophy: physiology, clinical presentation, and treatment considerations. Clin Obstet Gynecol. 2015;58:476–91.
    1. Kingsberg SA, Wysocki S, Magnus L, Krychman ML. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. J Sex Med. 2013;10:1790–9.
    1. Goldstein AT, Burrows LJ.
    1. Sturdee DW, Panay N. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric. 2010;13:509–22.
    1. The North American Menopause Society Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20:888–902.
    1. Chen J, Geng L, Song X, Li H, Giordan N, Liao Q. Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial. J Sex Med. 2013;10:1575–84.
    1. Bachmann GA, Nevadunsky NS. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician. 2000;61:3090–6.
    1. Sinha A, Ewies AA. Non-hormonal topical treatment of vulvovaginal atrophy: an up-to-date overview. Climacteric. 2013;16:305–12.
    1. Lammerink EA, de Bock GH, Schroder CP, Mourits MJ. The management of menopausal symptoms in breast cancer survivors: case-based approach. Maturitas. 2012;73:265–8.
    1. Derzko C, Elliott S, Lam W. Management of sexual dysfunction in postmenopausal breast cancer patients taking adjuvant aromatase inhibitor therapy. Curr Oncol. 2007;14(Suppl 1):S20–40.
    1. Pruthi S, Simon JA, Early AP. Current overview of the management of urogenital atrophy in women with breast cancer. Breast J. 2011;17:403–8.
    1. Simon JA, Kokot-Kierepa M, Goldstein J, Nappi RE. Vaginal health in the United States: results from the Vaginal Health: Insights, Views & Attitudes survey. Menopause. 2013;20:1043–8.
    1. Barlow DH, Cardozo LD, Francis alUrogenital ageing and its effect on sexual health in older British women. Br J Obstet Gynaecol 199710487–91.
    1. Herbenick D, Reece M, Hensel D, Sanders S, Jozkowski K, Fortenberry JD. Association of lubricant use with women's sexual pleasure, sexual satisfaction, and genital symptoms: a prospective daily diary study. J Sex Med. 2011;8:202–12.
    1. World Health Organization .
    1. Willhite LA, O’Connell MB. Urogenital atrophy: prevention and treatment. Pharmacotherapy. 2001;21:464–80.
    1. Herbenick D, Reece M, Schick V, Sanders SA, Fortenberry JD. Women's use and perceptions of commercial lubricants: prevalence and characteristics in a nationally representative sample of American adults. J Sex Med. 2014;11:642–52.
    1. Cribby S, Taylor M, Reid G. Vaginal microbiota and the use of probiotics. Interdiscip Perspect Infect Dis. 2008;2008:256490.
    1. Raz R. Urinary tract infection in postmenopausal women. Korean J Urol. 2011;52:801–8.
    1. Adriaens E, Remon JP. Mucosal irritation potential of personal lubricants relates to product osmolality as detected by the slug mucosal irritation assay. Sex Transm Dis. 2008;35:512–16.
    1. Agarwal A, Deepinder F, Cocuzza M, Short RA, Evenson DP. Effect of vaginal lubricants on sperm motility and chromatin integrity: a prospective comparative study. Fertil Steril. 2008;89:375–9.
    1. Dezzutti CS, Brown ER, Moncla alIs wetter better? An evaluation of over-the-counter personal lubricants for safety and anti-HIV-1 activity. PLoS One 20127e48328.
    1. Fuchs EJ, Lee LA, Torbenson alHyperosmolar sexual lubricant causes epithelial damage in the distal colon: potential implication for HIV transmission. J Infect Dis 2007195703–10.
    1. Cunha AR, Machado RM, Palmeira-de-Oliveira A, Martinez-de-Oliveira J, das Neves J, Palmeira-de-Oliveira R. Characterization of commercially available vaginal lubricants: a safety perspective. Pharmaceutics. 2014;6:530–42.
    1. Bledzka D, Gromadzinska J, Wasowicz W. Parabens. From environmental studies to human health. Environ Int. 2014;67:27–42.
    1. Karpuzoglu E, Holladay SD, Gogal RM., Jr. Parabens: potential impact of low-affinity estrogen receptor binding chemicals on human health. J Toxicol Environ Health B Crit Rev. 2013;16:321–35.
    1. Nohynek GJ, Borgert CJ, Dietrich D, Rozman KK. Endocrine disruption: fact or urban legend? Toxicol Lett. 2013;223:295–305.
    1. Harvey PW, Everett DJ. Significance of the detection of esters of p-hydroxybenzoic acid (parabens) in human breast tumours. J Appl Toxicol. 2004;24:1–4.
    1. Moench TR, Mumper RJ, Hoen TE, Sun M, Cone RA. Microbicide excipients can greatly increase susceptibility to genital herpes transmission in the mouse. BMC Infect Dis. 2010;10:331.
    1. Fashemi B, Delaney ML, Onderdonk AB, Fichorova RN. Effects of feminine hygiene products on the vaginal mucosal biome. Microb Ecol Health Dis. 2013;24 doi: 10.3402/mehd.v24i0.19703.
    1. Brotman RM, Ravel J, Cone RA, Zenilman JM. Rapid fluctuation of the vaginal microbiota measured by Gram stain analysis. Sex Transm Infect. 2010;86:297–302.
    1. Kabara JJ, Orth DS. Preservative-Free and Self-Preserving Cosmetics and Drugs. Principles and Practice. New York: Marcel Dekker, Inc.; 1997.
    1. Dayal MB, Wheeler J, Williams CJ, Barnhart KT. Disruption of the upper female reproductive tract epithelium by nonoxynol-9. Contraception. 2003;68:273–9.
    1. Phillips DM, Zacharopoulos VR. Nonoxynol-9 enhances rectal infection by herpes simplex virus in mice. Contraception. 1998;57:341–8.
    1. Phillips DM, Taylor CL, Zacharopoulos VR, Maguire RA. Nonoxynol-9 causes rapid exfoliation of sheets of rectal epithelium. Contraception. 2000;62:149–54.
    1. Cone RA, Hoen T, Wong X, Abusuwwa R, Anderson DJ, Moench TR. Vaginal microbicides: detecting toxicities in vivo that paradoxically increase pathogen transmission. BMC Infect Dis. 2006;6:90.
    1. Dhondt MM, Adriaens E, Remon JP. The evaluation of the local tolerance of vaginal formulations, with or without nonoxynol-9, using the slug mucosal irritation test. Sex Transm Dis. 2004;31:229–35.
    1. Phillips DM, Sudol KM, Taylor CL, Guichard L, Elsen R, Maguire RA. Lubricants containing N-9 may enhance rectal transmission of HIV and other STIs. Contraception. 2004;70:107–10.
    1. Achilles SL, Shete PB, Whaley KJ, Moench TR, Cone RA. Microbicide efficacy and toxicity tests in a mouse model for vaginal transmission of Chlamydia trachomatis. Sex Transm Dis. 2002;29:655–64.
    1. Begay O, Jean-Pierre N, Abraham alIdentification of personal lubricants that can cause rectal epithelial cell damage and enhance HIV type 1 replication in vitro. AIDS Res Hum Retroviruses 2011271019–24.
    1. Steiner AZ, Long DL, Tanner C, Herring AH. Effect of vaginal lubricants on natural fertility. Obstet Gynecol. 2012;120:44–51.
    1. Anderson L, Lewis SE, McClure N. The effects of coital lubricants on sperm motility in vitro. Hum Reprod. 1998;13:3351–6.
    1. Frishman GN, Luciano AA, Maier DB. Evaluation of Astroglide, a new vaginal lubricant: effects of length of exposure and concentration on sperm motility. Fertil Steril. 1992;58:630–2.
    1. Kutteh WH, Chao CH, Ritter JO, Byrd W. Vaginal lubricants for the infertile couple: effect on sperm activity. Int J Fertil Menopausal Stud. 1996;41:400–4.
    1. Sandhu RS, Wong TH, Kling CA, Chohan KR. In vitro effects of coital lubricants and synthetic and natural oils on sperm motility. Fertil Steril. 2014;101:941–4.
    1. Mowat A, Newton C, Boothroyd C, Demmers K, Fleming S. The effects of vaginal lubricants on sperm function: an in vitro analysis. J Assist Reprod Genet. 2014;31:333–9.
    1. Amelar RD, Dubin L, Schoenfeld C. Sperm motility. Fertil Steril. 1980;34:197–215.
    1. World Health Organization .
    1. Peek JC, Matthews CD. The pH of cervical mucus, quality of semen, and outcome of the post-coital test. Clin Reprod Fertil. 1986;4:217–25.
    1. Rossato M, Balercia G, Lucarelli G, Foresta C, Mantero F. Role of seminal osmolarity in the reduction of human sperm motility. Int J Androl. 2002;25:230–5.
    1. Connor CJ, Eppsteiner EE. Vulvar contact dermatitis. Proc Obstet Gynecol. 2014;4:1.
    1. Majerovich JA, Canty A, Miedema B. Chronic vulvar irritation: could toilet paper be the culprit? Can Fam Physician. 2010;56:350–2.
    1. Wolf LK. Studies raise questions about safety of personal lubricants. Chem Eng News. 2012;90:46–7.

Source: PubMed

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