What are the ASCO treatment guidelines for vaginal and/or vulvar atrophy in cancer survivorship?

Updated: Feb 28, 2018
  • Author: Winston W Tan, MD, FACP; more...
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Answer

Answer

For women with symptoms of vaginal and/or vulvar atrophy (eg, dryness), ASCO recommends the following stepwise approach [21] :

  • Lubricants for all sexual activity or touch, in addition to vaginal moisturizers to improve vulvovaginal tissue quality (applied 3-5 times/wk)
  • For unresponsive or more severely symptomatic cases, low-dose vaginal estrogen can be used; for women with hormone-positive breast cancer who are symptomatic and not responding to conservative measures, low-dose vaginal estrogen can be considered after a thorough discussion of risks and benefits.
  • Lidocaine can also be offered for persistent introital pain and dyspareunia.
  • Women with a history of breast cancer who are on aromatase inhibitors and have not responded to previous treatment may be offered vaginal dehydroepiandosterone.
  • The selective estrogen receptor modulator ospemifene may be offered to postmenopausal women without a history of breast cancer who are experiencing dyspareunia, vaginal atrophy, or other vaginal pain.

To deliver estrogen therapy for vaginal dryness in menopausal women with hormonally sensitive tumors, NCCN recommends use of rings and suppositories over creams, based on limited dated in breast cancer survivors suggesting that minimal systemic absorption occurs. Additional treatment recommendations include topical testosterone and referral to a specialist for management. [13]


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