Vaginal treatments

1. VAGINAL MOISTURISERS

• Vaginal moisturisers can, in some individuals, offer relief from symptoms of vaginal dryness.
• These should be used regularly, for example daily, and not just before intercourse.
• Options include YES, SYLK and Regelle. These are available on prescription and are less likely to cause irritation compared to some other over the counter preparations.
• Simple emollients such as Epaderm and Cetraben may be helpful.
• Hyalofemme contains hyaluronic acid, which may help dryness.

2. VAGINAL LUBRICANTS

• Vaginal lubricants are intended for use with sexual or any penetrative activity.
• Women should be advised that oil-based lubricants can have a negative impact on condom integrity.
• Options include YES and SYLK (lubricant versions).

3. OSPEMIFENE

• Ospemifene is a selective oestrogen receptor modulator that has an oestrogen like effect in the vagina.
• Pre-clinical data indicates that Ospemifene acts as an agonist in the vagina, partial agonist in the uterus and agonist in the bone while having a neutral to antagonist effect in the breast.
• Its indication is for moderate to severe vulval and vaginal atrophy in post-menopausal women who are not candidates for local vaginal oestrogen.
• NICE says consider ospemifene as an oral treatment option for troublesome genitourinary menopause symptoms, if locally applied treatments are impractical, for example, because of disability.
• It does not appear to have any negative effects on the endometrium or be associated with an increased risk of thromboembolism.
• The commonest side effect is hot flushes, which are usually transient.
• Ospemifene should not be used in women with known or suspected breast cancer because the drug has not been adequately studied in this group.
• Specialist initiation may be required.

4. LASER TREATMENTS

• Although some studies are promising, the long-term efficacy and safety of laser treatments are lacking and there is potential for harm, for example in the form of scarring.
• NICE says do not offer vaginal laser treatment for troublesome genitourinary menopause symptoms unless as part of a randomised controlled trial.

5. GENERAL ADVICE

Perfumes, powders, soaps, deodorants, panty liners, spermicides and many brands of lubricants often contain irritant compounds and women should be advised to avoid these.