Vulvovaginal Atrophy, Genital Menopause Syndrome: Therapy

General measures

Conventional non-surgical therapy methods

  • Conventional non-surgical therapeutic procedures are available for
    • The overall problem of vulvovaginal atrophy, genitourinary menopause syndrome (vulva, vagina, bladder, urethra).
      • As vaginal fractionated laser therapy (vulvovaginal laser therapy).
        • It is an innovative, minimally invasive, non-surgical and non-hormonal procedure for the treatment of vulvovaginal dysfunctions, mostly recurrent, difficult to treat, esp. concerning sexuality and diseases in the intimate area. Predominantly women in premenopausal/menopausal or other estrogen deficiency situations suffer from it. Mild forms of urinary incontinence (bladder weakness), urge symptoms, nocturia (nocturnal urination), chronic recurrent cystitis (recurrent bladder infections), and descensus complaints can also improve. Particularly noteworthy are the excellent results in the treatment of lichen sclerosus, usually eliminating the need for cortisone therapy.Impressive is the minimal rate of side effects and the absence of complications with this method, as well as the possibility of use after chemotherapy or radiation therapy. However, evaluation by controlled studies is still lacking. For details see chapter: “Vulvovaginal laser therapy“, “Laser therapy for bladder problems in women“, “Laser therapy for lichen sclerosus“.
  • As non-hormonal local therapy measures in the form of medical devices:
    • Lubricants Their effectiveness is short and limited only to sexual intercourse. They are used when the vagina is not moist enough for “normal intercourse” or for special sexual practices (e.g., anal intercourse/anal sex, sex toys). Depending on the need (contraception; no restriction of sperm motility (sperm mobility); long sexual intercourse; use in water or with water (bathtub, shower), the choice of product should be made.
      • Water-based lubricants: they usually contain glycerin as a water reservoir.
        • Are condom friendly
        • Can be combined with sex toys made of latex or silicone
        • Are easily washable
        • Are not suitable for sex in the bathtub
        • Could promote candida infections or bladder infections in case of predisposition
      • Oil-based lubricants (mostly mineral oils e.g. kerosene oil or petrolatum or vegetable oils: olive oil, palm oil: they are suitable
        • For long-lasting sex sessions, in the water (swimming pool, bathtub, shower).
        • Difficult to remove (cave: vaginal douches).
        • Not suitable for condoms, diaphragms, sex toys (cave: toxic plasticizers or other toxins that can be absorbed).
        • Make stains on laundry and clothing
      • Silicone-based lubricants (dimeticones is the name for base silicone oils. They are also often referred to as dimethylpolysiloxanes or polydimethylsiloxanes) are.
        • Suitable for long sex sessions
        • Suitable for condoms
        • Unsuitable for silicone-based sex toys (cave: absorption of toxic substances).
        • Difficult to remove
        • Suitable for anal sex / anal sex with condom

      Best tolerated are water-based lubricants. The long-term effects of silicone are so far only insuffizient known (eg silicone in breast implants). Lubricants contain not only water, glycerin, oils or silicone but usually also additives, e.g. synthetic fragrances, preservatives, dyes and many others. Preservatives include parabens e.g. methylparaben, propylparaben, butylparaben, ethylparaben. Parabens are associated with breast tissue diseases (mammary carcinoma/breast cancer). Parabens have negative effects on sperm count and sperm quality through a weak estrogen-like effect. Sodium benzoate, a preservative in many lubricants, is considered carcinogenic (cancer-causing), toxic to cells and mutagenic (causing mutations/genetic changes).

    • Homemade lubricants
      • Coconut oil: contains antifungal caprylic acid. It can be used very well as a natural lubricant. It contains oil and is not suitable for condoms and sex toys. It has a soothing and cooling effect and is applied by many women after the shower on the labia and inner mucous membranes.
      • Aloe gel: it has a moisturizing, wound healing, regenerating, antipruritic and slightly antifungal effect.
      • Kiwi plant: a water-based lubricant made from the sap of the kiwi plant. It contains only a very small amount of glycerin, so it is not prone to mycosis (fungal infections). It can be used with condoms, diaphragms, sex toys without any problems. It does not leave stains.
    • Moisturizers:
    • Moisturizers are water-retaining and water-releasing formulations (hydrogels) with or without additives. They cause a moistening of the dry vagina. with a duration of action of up to 24 hours. They contain water-binding substances such as hyaluronic acid, propylene glycol, hydroxylethyl cellulose with or without additives. The main focus of use is the discomfort caused by vaginal dryness and not sexuality, as is the case with lubricants. However, they can of course also be used for intercourse during the preclimacteric and climacteric periods, as is very common. Whether you can be applied with condom is dependent on the formulation and must be clarified on the basis of the package insert.
    • Emollients (emollients): emollients serve as a care product (as well as on the rest of the skin) with a high moisture content and refatting lipids (duration of action about 24-48 hours). They are water-in-oil or oil-in-water emulsions. They contain lipids, water and, in some cases, water-binding substances such as urea, glycerin or dexpanthenol, etc. These increase water binding and form their own lipid layers that reduce water loss. Like the moisturizers, the focus of use is the discomfort resulting from vaginal dryness and not, as with lubricants, the desires of sexuality.
  • In specific problem areas of bladder function.
    • Urinary incontinence (bladder weakness):
    • Cystitis (bladder infection):
      • Postmenopausal patients (12 months after the last menstrual period (menopause)): Local-vaginal prophylactic estrogen therapy to prevent recurrent (recurring) infections.

Regular checkups

  • Regular medical check-ups are indicated in cases of cystitis, urinary incontinence

Nutritional medicine

Physical therapy (including physiotherapy)

  • Physical therapeutic measures are indicated for stress incontinence (see d. Pelvic floor exercises),

Psychotherapy

  • Psychotherapeutic measures are indicated in cases of stress incontinence (with psychosomatic changes), dyspareunia (with psychological conflicts)
  • Detailed information on psychosomatics (including stress management) is available from us.

Complementary treatment methods

  • Complementary treatment measures are indicated for stress incontinence, urge incontinence (biofeedback training, electrical stimulation, both in combination),