Management of genitourinary syndrome of menopause in breast cancer survivors:An update

There is increasing attention about managing the adverse effects of adjuvant therapy(Chemotherapy and anti-estrogen treatment)for breast cancer survivors(BCSs).Vulvovaginal atrophy(VVA),caused by decreased levels of circulating estrogen to urogenital receptors,is commonly experienced by this patients.Women receiving antiestrogen therapy,specifically aromatase inhibitors,often suffer from vaginal dryness,itching,irritation,dyspareunia,and dysuria,collectively known as genitourinary syndrome of menopause(GSM),that it can in turn lead to pain,discomfort,impairment of sexual function and negatively impact on multiple domains of quality of life(QoL).The worsening of QoL in these patients due to GSM symptoms can lead to discontinuation of hormone adjuvant therapies and therefore must be addressed properly.The diagnosis of VVA is confirmed through patient-reported symptoms and gynecological examination of external structures,introitus,and vaginal mucosa.Systemic estrogen treatment is contraindicated in BCSs.In these patients,GSM may be prevented,reduced and managed in most cases but this requires early recognition and appropriate treatment,but it is normally undertreated by oncologists because of fear of cancer recurrence,specifically when considering treatment with vaginal estrogen therapy(VET)because of unknown levels of systemic absorption of estradiol.Lifestyle modifications and nonhormonal treatments(vaginal moisturizers,lubricants,and gels)are the first-line treatment for GSM both in healthy women as BCSs,but when these are not effective for symptom relief,other options can be considered,such as VET,ospemifene,local androgens,intravaginal dehydroepiandrosterone(prasterone),or laser therapy(erbium or CO2 Laser).The present data suggest that these therapies are effective for VVA in BCSs;however,safety remains controversial and a there is a major concern with all of these treatments.We review current evidence for various nonpharmacologic and pharmacologic therapeutic modalities for GSM in BCSs and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research.We include recommendations for an approach to the management of GSM in women at high risk for breast cancer,women with estrogen-receptor positive breast cancers,women with triplenegative breast cancers,and women with metastatic disease.

A Comparative Study of Smugel and KY Jelly Vaginal Lubricating Gels

Objective To assess the safety of Smugel compared with KY Jelly vaginal lubricating gel in baboon （Papio anubis） vagina. Methods Ten sexually mature olive female baboons were used in this study. Vaginal pH, blood chemistry, vaginal flora, vaginal and cervical histology were evaluated at baseline and after administration of15 ml of either Smugel or KY Jelly gel twice a week for 5 weeks to each randomized treatment group. Results Basal vaginal pH was 5.8± 0. 8. There was no significant difference in the vaginal pH of Smugel compared with KY Jelly treated animals or baseline data （P〉0. 05）. Similarly, analysis of blood chemistry parameters revealed no significant differences. The most frequently isolated microorganisms both at baseline and during treatment included Corynebacterium glucuronolyticum, C. renale group, Lactococcus raffinolactis, Leuconostoc lactis, Lactobacillus acidophilus, L. fermentum, L. salivarius, Staphylococcus aureus, S. xyloxus, S. hyicus, Aerococus viridians, Escherichia coli and Candida albicans. No detectable histological changes were observed in the vaginal or cervical sections examined. Conclusion Smugel, compared with KY Jelly did not induce any adverse event that may facilitate transmission of sexual transmitted infection （STI） pathogens including HIV.