Advances in the Treatment of Vulvovaginal Atrophy

Jill M Krapf; Zoe R Belkin; Andrew T Goldstein


Expert Rev of Obstet Gynecol. 2013;8(5):457-465. 

In This Article

Expert Commentary

As women are living longer, healthier lives, the importance of vulvovaginal health and maintenance of intimacy is being highlighted in the popular media, and is finally making its way into the doctor's office. The Internet has especially provided an open, 'anonymous' forum for discussion of formerly taboo topics of women's sexual health, function and desire. As patients present to clinicians, it is essential to be able to identify vulvovaginal atrophy, differentiate this condition from vulvar dermatoses and provide acceptable treatment options based upon risk profile.

Treatment of vulvovaginal atrophy was once limited to vaginal lubricants, moisturizers and estrogen-containing regimens, which many clinicians felt uncomfortable recommending due to safety concerns addressed in the Women's Health Initiative trials. However, with increased reassurance of safety of existing therapies and advances in novel treatment options, practitioners are becoming better equipped to offer options that may be more acceptable to a wide range of patients. With these treatment choices comes the importance of educating patients on proper administration, as many of these therapies have different dosing, timing and application regimen. Lastly, attention to the vulva is critical in treating atrophy. As atrophic dyspareunia frequently radiates from the vulvar vestibule, treating the vagina alone will not alleviate symptoms of dryness and discomfort in the vestibule. Furthermore, although currently still experimental, treatment with androgens in addition to estrogen may be greatly beneficial in relieving vulvovaginal atrophy associated with sexual dysfunction.