| Abstract [eng] |
Aim: Review the etiology, epidemiology, diagnostics and treatment options of vulvovaginal atrophy that occurs following oncogynecologic treatment. Objectives: 1) Describe etiology; 2) Investigate prevalence and risk factors; 3) Describe diagnostic methods; 4) Investigate treatment methods; 5) Review new treatments. Methods: Literature review was conducted using the PubMed and MEDLINE databases. Results: 10 clinical trials in epidemiology review showed prevalence varying from 19% to 91%, potentially attributed to variances in diagnostic techniques and time since radiotherapy. Treatment review included 33 trials (11 laser, 5 non-hormonal, 4 phytoestrogens, 3 radiofrequency, 3 injections, 2 vitamins D and E, 2 local oxytocin, 1 local tamoxifen, 1 pelvic muscle training, 1 dilatators). Conclusions: Vulvovaginal atrophy stems from iatrogenic menopause and radiotherapy-induced vaginal mucosa thinning; Prevalence varies (19%-91%) with risk factors such as age, combined treatment, external radiotherapy, radiotherapy dosage and aromatase inhibitor use; Suggested diagnostic criteria include (1) perception of dryness or/and other subjective symptoms; (2) vaginal pH >5 and lowered Vaginal Maturation Index (3) at least one objective sign; Treatments mirror those for natural menopause; Safety concerns revolve around estrogen therapy and hormone sensitive cancer recurrence, though low-dose local estrogen therapy appears safe. Early use of non-hormonal remedies post-radiotherapy may prevent symptoms; Laser, radiofrequency, and injections show promise with minimal side effects and hormone-independent mechanisms. Most studies suggest that these methods have a beneficial impact on at least one aspect of vulvovaginal atrophy. Enhanced positive outcomes are achieved through the combination of these methods. |
