Materiały źródłowe

• #1 Genitourinary Syndrome of Menopause – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK559297/

  Estrogen plays a crucial role in maintaining the normal anatomy and physiology of the urogenital system. Estrogen receptors are present in the vagina, vulva, urethra, and bladder trigone, where they respond to estrogen stimulation by maintaining normal blood flow, tissue thickness, rugosity, elasticity, and moisture of epithelial surfaces. […] When estrogen levels decline, this process is disrupted, resulting in an atrophic vaginal epithelium with reduced secretions and a less acidic environment characterized by a pH greater than 5. These physiologic changes increase the risk of vaginal and urinary tract infections. […] Traditionally, estrogen has been recognized as the primary hormone responsible for the health and function of the vagina. However, increasing evidence suggests that androgens also play a crucial role in maintaining urogenital tissue health. The vagina contains androgen receptors that, when stimulated, help reduce inflammation and maintain vaginal contractility. After menopause, dehydroepiandrosterone (DHEA), a weak androgen primarily secreted by the adrenal glands, becomes the prominent sex steroid in the body. Within the vagina, DHEA is converted into both estrogens and androgens. This understanding has led to a newer approach to GSM treatment, including local androgen therapy with DHEA.

• #2 Vaginal dryness Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/vaginal-dryness

  Vaginal dryness is present when the tissues of the vagina are not well-lubricated and healthy. […] Atrophic vaginitis is caused by a decrease in estrogen. […] Estrogen keeps the tissues of the vagina lubricated and healthy. Normally, the lining of the vagina makes a clear, lubricating fluid. This fluid makes sexual intercourse more comfortable. It also helps decrease vaginal dryness. […] If estrogen levels drop off, the tissues of the vagina shrink and become thinner. This causes dryness and inflammation. […] Estrogen levels normally drop after menopause. […] Some women develop this problem right after childbirth or while breastfeeding. Estrogen levels are lower at these times. […] The vagina can also become further irritated from soaps, laundry detergents, lotions, perfumes, or douches. Certain medicines, smoking, tampons, and condoms may also cause or worsen vaginal dryness.

• #3 Vaginal dryness: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000892.htm

  Vaginal dryness is present when the tissues of the vagina are not well-lubricated and healthy. […] Atrophic vaginitis is caused by a decrease in estrogen. […] Estrogen keeps the tissues of the vagina lubricated and healthy. Normally, the lining of the vagina makes a clear, lubricating fluid. This fluid makes sexual intercourse more comfortable. It also helps decrease vaginal dryness. […] If estrogen levels drop off, the tissues of the vagina shrink and become thinner. This causes dryness and inflammation. […] Estrogen levels normally drop after menopause. […] The vagina can also become further irritated from soaps, laundry detergents, lotions, perfumes, or douches. Certain medicines, smoking, tampons, and condoms may also cause or worsen vaginal dryness. […] Prescription estrogen can work well to treat atrophic vaginitis. It is available as a cream, tablet, suppository, or ring. All of these are placed directly into the vagina. These medicines deliver estrogen directly to the vaginal area. Only a little estrogen is absorbed into the bloodstream.

• #4 Vaginal dryness

  https://www.mayoclinic.org/symptoms/vaginal-dryness/basics/causes/sym-20151520

  Reduced estrogen levels are the main cause of vaginal dryness. Estrogen is a hormone that helps keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. […] Other causes of vaginal dryness include certain medical conditions or hygiene practices. […] Estrogen levels can fall for a number of reasons: Breast-feeding, Childbirth, Cigarette smoking, Effects on your ovaries from cancer therapy, Immune disorders, Menopause, Perimenopause (the transition time before menopause), Oophorectomy (ovary removal surgery), Use of anti-estrogen medication. […] Other causes of vaginal dryness include: Douching, Sjogren’s syndrome (a condition that can cause dry eyes and a dry mouth), Use of allergy and cold medications.

• #5 What is the mechanism that causes a loss of estrogen and vaginal dryness during breastfeeding? – FemTouch for Improved Vaginal Health

  https://femtouch.eu/for-physicians/faq/what-is-the-mechanism-that-causes-a-loss-of-estrogen-and-vaginal-dryness-during-breastfeeding/

  The vagina consists of three layers: the vaginal epithelium, the lamina propria and the muscularis. All three layers have estrogen receptors. Estrogen is a major regulator of growth and function of vascular and nonvascular smooth muscle in the subepithelial layers of the vagina, the lamina propria and the muscularis. During menopause, due to substantial reduction in estrogen, a reduction in the thickness of the epithelium (from approximately eight to ten cell layers, to three to four) occurs. Estrogen deficiency influences the vaginal tissues, and causes the loss of collagen, loss of the ability to retain water and a thinning of the epithelial surface. Thinned tissue is more susceptible to irritation, and the vaginal surface becomes friable, with petechiae, ulcerations, and increased bleeding occurring after only minimal trauma.

• #6 Atrophic Vaginitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564341/

  Atrophic vaginitis is an inflammatory process that occurs in clients experiencing vaginal atrophy. Vaginal atrophy develops secondary to a lack of estrogen due to menopause. […] Atrophic vaginal changes are caused by thinning vaginal epithelium, decreased vaginal rugae and elasticity, and decreased vaginal secretions. Atrophic vaginitis is a symptomatic inflammatory process involving the thinned vaginal epithelium affecting some pre-menopausal and up to 50% of post-menopausal women. […] The hypoestrogenic state results in the fusion of collagen fibers and fragmentation of elastin fibers in vulvovaginal tissue and decreased squamous cells, resulting in decreased mucosal elasticity and decreased rugae, and narrowing of the vagina. […] The consequence of elevated vaginal pH is a shift in normal flora, Lactobacilli spp., and more susceptible to other pathogens such as Gardnerella, Prevoltella, Atopobium, and Streptococcus.

• #7 Atrophic Vaginitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK564341/

  The hypoestrogenic state results in the loss of dermal collagen, elastin fibers, and blood vessels in the lamina propria. These changes result in decreased elasticity and vascularity. Decreased vascularity, in response to low estrogen levels, results in thin friable vaginal mucosa and decreased secretions.

• #8 Vaginal Health in Menopausal Women

  https://www.mdpi.com/1648-9144/55/10/615

  The condition of hypoestrogenism related to menopause has a strong negative impact on vaginal and urinary health, often leading to a condition called genitourinary syndrome (GSM), a term introduced by the International Society for the Study of Women’s Sexual Health and the North American Menopause Society in 2014. GSM is associated with genital signs and symptoms such as dryness, burning, irritation, and sexual symptoms such as discomfort or pain, and impaired sexual function. […] The drop in circulating hormone levels, especially estrogens, represents the main trigger determining vulvovaginal atrophy. The vaginal epithelia of post-menopausal women display flattened epithelial surfaces with features of keratinization and the absence of papillae. Multiple layers of parabasal cells with higher nucleus to cytoplasm ratio and few intermediate and superficial cells are present in which glycogen stores are reduced. This leads to a decrease in the number of Lactobacilli resulting in an increase in vaginal pH.

• #9 Vaginal Health in Menopausal Women

  https://www.mdpi.com/1648-9144/55/10/615

  Hypo estrogenic vaginal states typically also include changes in the connective tissue composition with decreased type I/III collagen ratio, which leads to reduced tissue strength. Thinning of the vaginal epithelium increases susceptibility to trauma, resulting in bleeding, petechiae, and ulceration with any type of pressure including sexual activity or a simple gynecological maneuver. […] Due to these histological changes, clinical signs at the vaginal level include anything from dryness and insufficient hydration, redness, loss of elasticity, petechiae, ulceration, inflammation, atypical secretions, to fibrosis and vaginal obliteration. The most frequent signs at a vulvar level include reduction in tissue thickness, labia agglutination, loss of pubic hair, and scratching lesions due to itching.

• #10 Atrophic vaginitis – Wikipedia

  https://en.wikipedia.org/wiki/Atrophic_vaginitis

  Atrophic vaginitis is inflammation of the vagina as a result of tissue thinning due to low estrogen levels. Symptoms may include pain during penetrative sex, vaginal itchiness or dryness, and an urge to urinate or burning with urination. It generally does not resolve without ongoing treatment. Complications may include urinary tract infections. Atrophic vaginitis as well as vulvovaginal atrophy, bladder and urethral dysfunctions are a group of conditions that constitute genitourinary syndrome of menopause (GSM). Diagnosis is typically based on symptoms. […] The decrease in estrogen typically occurs following menopause. Other causes may include breastfeeding or using specific medications. Risk factors include smoking. […] Atrophic vaginitis may be caused by tissue thinning, loss of elasticity, and loss of vaginal fluids from low estrogen levels. Normally, estrogen helps the vagina shed old cells, which are then converted into lactic acid by good bacteria. This keeps the vagina’s pH acidic and healthy. When estrogen levels drop, this process slows down, leading to thinner vaginal tissue, less moisture, and a less acidic environment. As a result, there’s a higher risk of getting vaginal and urinary tract infections. Normal menopause and treatments such as chemotherapy or medications may result in loss of estrogen.

• #11 Vaginitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/257141-overview

  A complex and intricate balance of microorganisms maintains the normal vaginal flora. […] Atrophic vaginitis is associated with hypoestrogenism, and symptoms include dyspareunia, dryness, pruritus, and abnormal bleeding. […] Disturbance of the normal vaginal pH can alter the vaginal flora, leading to overgrowth of pathogens. […] Loss of vaginal lactobacilli appears to be the primary factor in the changes leading to bacterial vaginosis. Recurrences of vaginitis are associated with a failure to establish a healthy vaginal microflora dominated by lactobacilli.

• #12 Prasterone (Intrarosa) for Dyspareunia | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0115/p117.html

  Prasterone (Intrarosa) is an intravaginal product used to treat moderate to severe dyspareunia due to vulvar and vaginal atrophy caused by menopause. The mechanism of action of intravaginal prasterone is not known, but it may involve local metabolism to estrogens and androgens. […] Effectiveness has been evaluated in two clinical trials of 716 women with vaginal dryness and moderate to severe dyspareunia who reported avoiding or refraining from sexual activity because of pain (a score of 2 or 3 on a scale of 0 to 3, in which 3 is the worst pain). Using the prasterone 6.5-mg vaginal insert each evening will improve dyspareunia symptoms by 0.36 to 0.40 severity points more than an oil-based placebo at 12 weeks. […] Individual symptoms such as vaginal dryness and vulvovaginal irritation or itching are similar in the prasterone and placebo groups.

• #13 Genitourinary Syndrome of Menopause: AUA/FUFU/AUGS Guideline (2025) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause

  Pathologic conditions affecting genitourinary tissues are due to estrogen deficiency and possibly a decline in androgens as well. Both androgens and estrogens are critical physiologic modulators for development and maintenance of genital tissue structure and function. Androgens are necessary precursors for biosynthesis of estrogens. In the ovaries, adrenal gland, and peripheral tissues, DHEA can be converted to testosterone, which in turn can be converted to the more potent androgen 5-dihydrotestosterone by the action of 5-reductase, or to estradiol by aromatase. In postmenopausal women, circulating DHEA is an important precursor for the local synthesis of testosterone and estradiol in extragonadal tissues. Given that the genitourinary organs are heavily influenced by sex steroids, the absence of sufficient levels of these hormones may cause the clinical signs and symptoms of GSM. However, it is also important to educate patients that documentation of hormone levels is neither necessary nor helpful for the treatment of this condition.

• #14 What is the mechanism that causes a loss of estrogen and vaginal dryness during breastfeeding? – FemTouch for Improved Vaginal Health

  https://femtouch.eu/for-physicians/faq/what-is-the-mechanism-that-causes-a-loss-of-estrogen-and-vaginal-dryness-during-breastfeeding/

  During breastfeeding, women have high levels of prolactin, which exert an antagonistic action on estrogen production. For these reasons, hypoestrogenemia can occur throughout lactation. Decreased estrogen levels can cause urogenital atrophy, including epithelial thinning, decreased elasticity, and diminished vaginal blood flow. Symptomatic hypoestrogenic vulvovaginal changes are often referred to as atrophic vaginitis, and are typically present as vaginal dryness, itching, burning, irritation, and dyspareunia. Hypoestrogenemia may also cause urinary symptoms such as dysuria, urgency, and frequency.

• #15 3 reasons that are likely to cause vaginal dryness | HealthShots

  https://www.healthshots.com/intimate-health/feminine-hygiene/3-reasons-that-are-likely-to-cause-vaginal-dryness/

  A drop in estrogen levels is the chief cause of vaginal dryness. […] One of the most common causes of vaginal dryness is a decrease in estrogen levels. […] It is this decline in estrogen levels that causes the vagina to thin out, and lose its coating. […] Hormonal deficiency (low estrogen levels) can happen post-delivery, during breastfeeding. […] Cancer treatments including chemotherapy, any other sort of radiation or hormonal therapy can cause vaginal dryness. […] Vaginal dryness can be a hormonal side effect of some birth control methods such as hormonal birth control pills that contain the hormones estrogen or progesterone. […] Some kinds of drugs also cause vaginal dryness. […] Vaginal dryness is mostly because of low estrogen content in your body and it can be corrected by simple measures.

• #16 Vaginal Dryness – Dr. Murat Emanetoglu

  https://emanetoglu.com/en/vaginal-dryness/

  Decreased estrogen levels are the main cause of vaginal dryness. The hormone estrogen provides the vagina with wetness, elasticity and an acidic environment. This is how it defends itself against infections. When estrogen levels drop, this natural defense mechanism decreases as the vagina becomes thinner, less elastic and more sensitive. […] Conditions that reduce estrogen levels other than menopause include; childbirth, breastfeeding, cancer treatments affecting the ovaries, removal of the ovaries, immune system disorders, smoking.

• #17 Medications That Cause Vaginal Dryness

  https://www.verywellhealth.com/medications-that-cause-vaginal-dryness-3522671

  Vaginal tissues have a thin layer of protective, lubricating fluid and are highly susceptible to hormones such as estrogen and testosterone, which are responsible for blood flow to the vagina. […] Even slight fluctuations in hormone levels (for instance, as a result of taking a new medication) may affect blood flow, ultimately leading to dryness. […] Hormonal birth control pills can cause fluctuations in hormones and an imbalance of your estrogen/progesterone ratio that may lead to vaginal dryness in some people. […] Specifically, hormonal birth control can cause an increase in sex hormone binding globulin (SHBG), a protein created in the liver that’s responsible for binding up excess estrogen and testosterone, taking it out of the bloodstream. […] As with birth control pills, hormonal changes from birth control shots, such as Depo-Provera (medroxyprogesterone acetate), can suppress female hormones to mimic menopausal levels, resulting in reduced vaginal fluids and dryness.

• #18 Medications That Cause Vaginal Dryness

  https://www.verywellhealth.com/medications-that-cause-vaginal-dryness-3522671

  Vaginal dryness may occur with sedative drugs used for insomnia, such as Halcion (triazolam), Xanax (alprazolam), and other benzodiazepine medications used to treat anxiety but that also cause sexual dysfunction. […] Both prescription and over-the-counter (OTC) cold and allergy medications, such as Vistaril (hydroxyzine), have been found to cause vaginal dryness in some people. […] That’s because antihistamines and decongestants narrow blood vessels to lower moisture levels and reduce mucus throughout the body, including the vagina. […] Antibiotics can indirectly cause vaginal dryness. […] However, antibiotics can alter the delicate balance of bacteria found in the vagina. This may lead to a yeast infection, which can cause vaginal dryness. […] Both calcium channel blockers and beta blockers have been tied to vaginal dryness in some people.

• #19 Medications That Cause Vaginal Dryness

  https://www.verywellhealth.com/medications-that-cause-vaginal-dryness-3522671

  Beta-blockers may affect blood flow to the sexual organs, resulting in reduced vaginal lubrication. […] Tamoxifen and Evista, both estrogen modulators used in cancer treatment, function by blocking estrogen receptors in vaginal tissue, causing lower levels of lubrication. […] Chemotherapy (as well as radiation) may also result in dryness as they may directly decrease estrogen production. […] Drugs like Synarel (nafarelin) or Lupron (leuprolide), used to treat endometriosis, also disrupt estrogen production and can lead to vaginal dryness until you stop taking them.

• #20 Pathogenesis of Vaginal Dryness in Primary Sjögren’s Syndrome: A Histopathological Case-control Study – ACR Meeting Abstracts

  https://acrabstracts.org/abstract/pathogenesis-of-vaginal-dryness-in-primary-sjogrens-syndrome-a-histopathological-case-control-study/

  Pathogenesis of Vaginal Dryness in Primary Sjgrens Syndrome: A Histopathological Case-control Study […] Women with primary Sjgrens syndrome (pSS) often experience vaginal dryness, but the pathogenesis of this symptom is unknown. […] In the current analysis, we quantitatively studied changes in lymphocyte subsets, endothelial cells and soluble immune markers in the vagina and endocervix of women with pSS, compared to age-matched controls, which may explain vaginal dryness. […] Our findings indicate that in addition to chronic inflammation, vascular disturbances in the vaginal mucosa are likely to contribute to vaginal dryness in women with pSS.

• #21 Determinants of vaginal dryness in patients with primary Sjögren’s syndrome: a symptom with a multifactorial pathogenesis – Student Theses UMCG

  https://umcg.studenttheses.ub.rug.nl/2925/

  The majority of women with primary Sjgrens syndrome (pSS) suffer from vaginal dryness. Even so, the pathogenesis of vaginal dryness in pSS remains unclear. […] This study shows that vaginal dryness in pSS likely has a multifactorial pathogenesis. Vaginal dryness and oral and ocular dryness might have a similar pathophysiology. Peripheral neuropathy likely plays a significant role in the pathogenesis of vaginal dryness in pSS. This study could not show a direct relationship between vascular dysfunction and vaginal dryness in women with pSS.

• #22 Sjögren’s disease – Wikipedia

  https://en.wikipedia.org/wiki/Sj%C3%B6gren%27s_disease

  The pathogenetic mechanisms of Sjgren’s disease have not been fully elucidated, resulting in the lack of pathophysiology knowledge of the management of this autoimmune exocrinopathy. […] In the presence of a susceptible genetic background, both environmental and hormonal factors are thought capable of triggering the infiltration of lymphocytes, specifically CD4+ T cells, B cells, and plasma cells, causing glandular dysfunction in the salivary and lacrimal glands. […] Sjgren’s disease is associated with increased levels in cerebrospinal fluid (CSF) of IL-1RA, an interleukin 1 antagonist. This suggests that the disease begins with increased activity in the interleukin 1 system, followed by an autoregulatory upregulation of IL-1RA to reduce the successful binding of interleukin 1 to its receptors.

• #23 Sjögren’s disease – Wikipedia

  https://en.wikipedia.org/wiki/Sj%C3%B6gren%27s_disease

  However, Sjgren’s disease is characterized by decreased levels of IL-1ra in saliva, which could be responsible for mouth inflammation and dryness. […] Dysregulation of apoptosis (programmed cell death) is believed to play a role in the pathogenesis of a variety of autoimmune diseases, though its role in Sjgren’s disease is controversial. […] Both the Fas and Fas ligand proteins are overexpressed in primary Sjgren’s patients, while expression of BCL-1, which is known to downregulate apoptosis, was found significantly reduced in acinar and ductal epithelial cells of Sjgren’s patients compared to healthy people. […] Environmental factors, such as glandular viral infection, could prompt epithelial cells to activate the HLA-independent innate immune system through toll-like receptors. […] Epithelial cells in Sjgren’s disease lesions are active participants in the induction and perpetuation of the inflammatory process.

• #24 Dryness From Birth Control: Causes & How To Fix

  https://www.naturalcycles.com/cyclematters/how-to-fix-dryness-from-birth-control

  Hormonal birth control can cause vaginal dryness as well as dryness and dehydration in the rest of the body for some. […] One of the most common causes of vaginal dryness is hormonal fluctuations, particularly decreases in levels of the estrogen hormone. […] Most hormonal birth control methods work by altering levels of sex hormones in your body. […] While more research is needed to understand the exact mechanism behind why taking hormonal birth control can cause dryness in the body, there are a few leading theories: Estrogen: The estrogen hormone plays a vital role in maintaining the body’s overall hydration, and particularly vaginal lubrication. When estrogen levels drop, secretory glands in the body tend to produce less moisture leading to dryness not only in the vaginal area, but also in the skin and eyes.

• #25 Dryness From Birth Control: Causes & How To Fix

  https://www.naturalcycles.com/cyclematters/how-to-fix-dryness-from-birth-control

  Hormonal birth control also lowers levels of the hormone testosterone in your body. Vaginal dryness is a symptom of low testosterone, although it’s important to note that there are currently no conclusive guidelines for what is considered “low” testosterone levels in women. […] However, hormonal changes tend to be the leading cause of dryness (particularly vaginal). […] Aside from dryness, hormonal contraception can be the root cause of a host of other side effects including headaches, nausea, breast tenderness, and low libido.

• #26 Vaginal Dryness

  https://www.mybabydoc.com/vaginal-dryness/

  Vaginal dryness occurs mostly due to a hormonal imbalance in the female reproductive system as well as in the tissues and membranes of the vagina. This symptom is mostly associated with menopause. Additional causes of vaginal dryness are childbirth, breastfeeding, stress, birth control pills, medications, and other less common gynecological problems. […] Among the side effects of taking contraceptive or birth control pills, the most common is vaginal dryness. The vagina may lack the normal amount of natural lubrication. Although this is a normal side effect, itching or burning sensations, and difficulty having sex, can make life uncomfortable. […] Pills actually have less estrogen than your own body would produce during an average periodic cycle. It does not allow your body to produce the normal level of hormones. Therefore, birth control pills may simulate menopausal effects by disturbing the natural hormonal level.

• #27 Vaginal Dryness

  https://www.mybabydoc.com/vaginal-dryness/

  The contraceptive pill is made from progestin or a combination of progestin and estrogen. It affects vaginal moisture towards dryness by many ways. First, most pills keep the estrogen level at almost the same low amount throughout the month in contrast the body’s natural ovulation cycle. A higher level of estrogen is important to maintain the normal mucus production in the vagina. Second, while avoiding ovulation, the pill reduces the cyclical production of testosterone for libido. Decreased libido is the direct cause of the body’s decreased ability to respond sexual desire. Having less sexual desire leads to less lubrication in the vaginal area. Third, pills having a low-dose of estrogen may not provide sufficient estrogen to maintain lubrication in the vaginal area. And finally, the estrogen in the pill causes an increase in a hormone (SHBG) that actually removes testosterone out in the circulation, leading to decreased libido and less vaginal lubrication.

• #28 Vaginitis: Etiology and Role of Oxidative Stress, Inflammation and Antioxidants Therapy

  https://clinmedjournals.org/articles/rmi/reproductive-medicine-international-rmi-4-014.php?jid=rmi

  Vaginitis is an inflammation process which can be caused by multiple factors and conditions. […] Identification of underlying mechanisms and signaling pathways related to vaginitis gives us valuable information regarding the way for developing a better clinical approach and disease treatment. […] Oxidative stress (OS) and antioxidants depletion is likely a main reason for vaginitis development and pathology. Recent evidences have indicated that mucosa vagina samples of patients with vaginitis is associated with antioxidants depletion such as catalase (CAT) and glutathione (GSH), overproduction of reactive oxygen species (ROS), DNA fragmentation, and increased level of apoptosis biomarkers. Therefore, OS plays an important role in the development and pathogenesis of vaginitis. […] Recent studies have shown that reactive oxygen species (ROS) and oxidative stress (OS) caused by antioxidant depletion are a main underlying mechanism for vaginitis.

• #29 Vaginitis: Etiology and Role of Oxidative Stress, Inflammation and Antioxidants Therapy

  https://clinmedjournals.org/articles/rmi/reproductive-medicine-international-rmi-4-014.php?jid=rmi

  Therefore, oxidative damage seems to be a major risk factor for vaginitis development. […] In the current review, the etiology, different types of vaginitis, symptoms and diagnosis, current treatments, role of oxidative stress and inflammation, as well as antioxidant therapy in patients with vaginosis were considered. […] Oxidative stress is an imbalance between the production of ROS and the ability of body cells to neutralize their harmful effects through antioxidant defense systems. […] Recent studies have indicated that oxidative stress and inflammation may be a main reason for vaginitis development. […] Therefore, oxidative stress played an important role in vaginitis and antioxidant therapy seems to be helpful for the treatment of vaginitis. […] Although multiple factors are involved in the etiology of vaginitis, oxidative stress and apoptosis is one of main reason for the development and pathogenesis of vaginitis. An increasing number of evidence suggests that OS induced by ROS is likely a main mechanism of vaginitis development and pathogenesis which is associated with antioxidants depletion, DNA fragmentation, lipid and protein oxidation, inflammation, accumulation of leukocytes at the site of damaged tissues, as well as cells apoptosis and tissue damage. Therefore, the discovery and development of potent antioxidants is one of the most interesting and promising approaches for treatment of patients with vaginitis.

• #30 Vaginitis: Etiology and Role of Oxidative Stress, Inflammation and Antioxidants Therapy

  https://clinmedjournals.org/articles/rmi/reproductive-medicine-international-rmi-4-014.php

  Vaginitis is an inflammation process which can be caused by multiple factors and conditions. […] Identification of underlying mechanisms and signaling pathways related to vaginitis gives us valuable information regarding the way for developing a better clinical approach and disease treatment. […] Oxidative stress (OS) and antioxidants depletion is likely a main reason for vaginitis development and pathology. […] Therefore, OS plays an important role in the development and pathogenesis of vaginitis. […] Recent studies have shown that reactive oxygen species (ROS) and oxidative stress (OS) caused by antioxidant depletion are a main underlying mechanism for vaginitis. […] Data suggest that antioxidant therapy may induce antioxidant response to the oxidative stress and cause vaginitis improvement, while antioxidants depletion can be associated with ROS overproduction, oxidative stress and consequently vaginitis.

• #31 Vaginitis: Etiology and Role of Oxidative Stress, Inflammation and Antioxidants Therapy

  https://clinmedjournals.org/articles/rmi/reproductive-medicine-international-rmi-4-014.php

  In the current review, the etiology, different types of vaginitis, symptoms and diagnosis, current treatments, role of oxidative stress and inflammation, as well as antioxidant therapy in patients with vaginosis were considered. […] Recent studies have indicated that oxidative stress and inflammation may be a main reason for vaginitis development. […] Therefore, oxidative stress played an important role in vaginitis and antioxidant therapy seems to be helpful for the treatment of vaginitis. […] Although multiple factors are involved in the etiology of vaginitis, oxidative stress and apoptosis is one of main reason for the development and pathogenesis of vaginitis. […] An increasing number of evidence suggests that OS induced by ROS is likely a main mechanism of vaginitis development and pathogenesis which is associated with antioxidants depletion, DNA fragmentation, lipid and protein oxidation, inflammation, accumulation of leukocytes at the site of damaged tissues, as well as cells apoptosis and tissue damage. […] Therefore, the discovery and development of potent antioxidants is one of the most interesting and promising approaches for treatment of patients with vaginitis.

• #32 Vaginal dryness: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000892.htm

  The use of topical vaginal estrogen may also reduce your chances of developing a urinary tract infection. That is particularly true if you have a history of recurrent urinary tract infections. […] Vaginal dryness can: Make you more likely to get yeast or bacterial infections of the vagina. […] Cause pain with sexual intercourse, which may affect your relationship with your partner or spouse.

• #33 Vaginal Atrophy: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/15500-vaginal-atrophy

  Vaginal atrophy can affect your quality of life and your relationship with your partner(s). There are physical and emotional side effects of GSM. Physical symptoms like pain, burning, itching and leaking pee can disrupt all areas of your life. Emotional side effects are just as complicated as the physical side effects. […] Estrogen therapy and dehydroepiandrosterone (DHEA) are the only hormone therapies for vaginal atrophy. […] Topical vaginal estrogen treats symptoms of vaginal atrophy without increasing levels of estrogen levels in your bloodstream. […] Vaginal atrophy can’t be cured, but you don’t have to live with the discomfort. With proper diagnosis and treatment, the symptoms can be managed. […] Yes, it can. That’s why prompt treatment is important. The sooner you get treatment, the less likely it is that your vaginal atrophy will worsen. For example, the longer you go without estrogen, the dryer your vagina will become. Without treatment, your vaginal atrophy may get worse. Occasionally, atrophy can become so severe that it can significantly narrow your vaginal opening. This may make it harder to treat the atrophy if treatment is started too late.

• #34 Diagnosis and Treatment of Atrophic Vaginitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0515/p3090.html

  A long-term decrease in estrogen stimulation is generally required before symptoms of atrophic vaginitis arise. A decrease in vaginal lubrication is an early hallmark of hormone insufficiency. Genital symptoms include dryness, burning, dyspareunia, loss of vaginal secretions, leukorrhea, vulvar pruritus, feeling of pressure, itching and yellow malodorous discharge. Urinary symptoms of urethral discomfort, frequency, hematuria, urinary tract infection, dysuria and stress incontinence may be later symptoms of vaginal atrophy. […] Because the lack of circulating, natural estrogens is the primary cause of atrophic vaginitis, hormone replacement therapy is the most logical choice of treatment and has proved to be effective in the restoration of anatomy and the resolution of symptoms. Estrogen replacement restores normal pH levels and thickens and revascularizes the epithelium. Adequate estrogen replacement therapy increases the number of superficial cells. Estrogen therapy may alleviate existing symptoms or even prevent development of urogenital symptoms if initiated at the time of menopause.

• #35 'Vaginal Dryness’ Can Be Fatal. No, Really.

  https://www.medscape.com/viewarticle/996829

  I’m here to tell you that vaginal dryness is killing women. I mean it. It’s actually killing women. […] When women come to our offices and complain of a little vaginal dryness or they don’t even come to our office to complain of it because the doctor can’t be bothered with a little vaginal dryness what they don’t understand is that this „little vaginal dryness” is really something called genitourinary syndrome of menopause (GSM). […] It turns out that all of the genital and urinary symptoms from menopause just get worse over time. The bladder, the urethra, and the vagina have lots of hormone receptors, including estrogen and testosterone. When the body no longer makes those hormones, the system doesn’t work very well, and genital and urinary symptoms occur that just get worse over time without treatment.

• #36 'Vaginal Dryness’ Can Be Fatal. No, Really.

  https://www.medscape.com/viewarticle/996829

  Some are sexual: a little vaginal dryness, pain with sex, and worsening orgasm. But there are also genital and urinary symptoms that get worse: itching, burning irritation, rawness, an awareness of their genitals that the patient has never had before. […] The thing that kills women is recurrent urinary tract infections (UTIs). […] Did you know we’ve had safe and effective treatment options for GSM since the 1970s? Vaginal hormones have existed since the 1970s, but we’re using them only for pain with sex and not for GSM. […] In fact, data show that by using vaginal hormones, we can prevent UTIs by more than 50%. […] We can save lives using safe, effective, local, low-dose vaginal hormone strategies. […] We have to understand that UTIs kill people and having GSM is debilitating, often requiring pain medication because it can hurt to sit or to wear pads and our patients’ quality of life is severely affected. […] Vaginal estrogen or DHEA is basically like Flomax for women, but it prevents UTIs and actually works like sildenafil (Viagra) because it can help orgasm and reduce pain with sex.

• #37 Vaginal Health in Menopausal Women

  https://www.mdpi.com/1648-9144/55/10/615

  The REVIVE study suggested that VVA symptoms have a significant impact on the patients’ ability to achieve pleasurable relations (74%) and spontaneity (70%). Seventy-five percent of sexually active post-menopausal women with VVA were reported to have a significantly reduced sex drive as a direct consequence of the symptoms related to this condition.

• #38 Prasterone (Intrarosa) for Dyspareunia | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0115/p117.html

  A post hoc analysis of data from one of the original clinical trials found intravaginal prasterone to improve sexual desire and sexual arousal compared with placebo, regardless of whether the patients had dyspareunia as the most severe symptom at baseline. […] This study found statistically significant improvement (2.59 points greater than placebo on a 36-point scale) in sexual desire, arousal, orgasm, satisfaction, lubrication, and pain with sexual activity. […] Prasterone is similarly effective to nonprescription options for treating vaginal dryness and itching associated with menopause and may offer a small benefit in the treatment of dyspareunia.

• #39 Atrophic vaginitis: symptoms, diagnosis and treatment

  https://www.termedia.pl/Atrophic-vaginitis-symptoms-diagnosis-and-treatment,4,21669,1,1.html

  Atrophic vaginitis is a chronic condition and symptoms worsen with time since menopause. […] Local estrogen therapy of atrophic vaginitis is a simple and safe treatment leading to improvement of the quality of life. […] Early local therapy may prevent urogynecological complaints occurrence. […] Estriol administered in the ultra-low dose prevents a typical side effect of estrogen therapy such as endometrial proliferation. […] Numerous studies proved that the ultra-low dose of estriol (0.03 mg) combined with Lactobacilli administered vaginally relieved vaginal atrophy symptoms and re-established normal vaginal microflora with the same efficacy as 0.05 mg of estradiol.

• #40 Genitourinary syndrome of menopause

  https://www.racgp.org.au/afp/2017/july/genitourinary-syndrome-of-menopause

  Oestrogen vaginal preparations reduce symptoms and reverse the atrophic changes in pelvic tissues, and improve blood flow and the thickness of the epithelium in the vagina, bladder and urethra. There is minimal systemic absorption, with an initial peak, then almost no further absorption. Vaginal oestriol preparations of cream and pessaries provide a human oestrogen. Oestriol is the weakest oestrogen and has one-tenth of the potency of oestradiol. There is minimal absorption systemically and oestriol cannot be metabolised to oestradiol or oestrone. Low-dose vaginal oestradiol tablets are also very effective in relieving atrophic symptoms. The individual dose is 10 g, and studies have found that the annual absorption of oestradiol is only 1.14 mg. […] Systemic hormone therapy (ie MHT) will improve the vasomotor symptoms of menopause and may improve genitourinary symptoms; however, in some women, a vaginal oestrogen may also be needed. Individualising the vaginal oestrogen therapy, discussing which preparation the woman would prefer and instructing her in how to use it, will increase the womans adherence to therapy.

• #41 Genitourinary Syndrome of Menopause (GSM) – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/urogynecology/genitourinary-syndrome-menopause

  Vaginal estrogen is the most effective treatment for GSM. It improves the quality of the vaginal skin and tissues in and around the vagina. It thickens the skin of the vaginal canal and increases natural lubrication. It also restores the normal pH of the vagina. It has been shown to reduce the risk of UTI in many studies. […] Vaginal estrogen therapy (cream, tablet or ring) is considered the gold-standard of treatment.

• #42 Diagnosis and Treatment of Atrophic Vaginitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0515/p3090.html

  Transvaginal delivery of estrogen in the form of creams, pessaries or a hormone-releasing ring (Estring) has proved effective in relieving symptoms without causing significant proliferation of the vaginal epithelium. The genitourinary pH level is also lowered, leading to a decreased incidence of urinary tract infections.

• #43 Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer | ACOG

  https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2021/12/treatment-of-urogenital-symptoms-in-individuals-with-a-history-of-estrogen-dependent-breast-cancer

  If nonhormonal treatments have failed to adequately address symptoms, after discussion of risks and benefits, low-dose vaginal estrogen may be used in individuals with a history of breast cancer, including those taking tamoxifen. […] If vaginal estrogen is not an option, vaginal dehydroepiandrosterone (DHEA) or testosterone may help with dyspareunia and improve vaginal tissue health. […] Ospemifene, an orally administered selective estrogen receptor modulator, has been found to improve symptoms in a general population of menopausal individuals and may be considered as an option for individuals with a history of estrogen-dependent breast cancer. Although there is no indication that ospemifene is associated with increased risk of recurrence, long-term safety data are limited.

• #44 Osphena® Mechanism of Action video – Osphena HCP

  https://hcp.osphena.com/osphena-mechanism-of-action-video

  OSPHENA (ospemifene) is indicated for the treatment of moderate to severe vaginal dryness, a symptom of vulvar and vaginal atrophy, due to menopause. […] OSPHENA is an estrogen agonist/antagonist with tissue selective effects. In the endometrium, OSPHENA has estrogen agonistic effects. There is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens. […] An increased risk of endometrial cancer has been reported with the use of unopposed estrogen therapy in a woman with a uterus. The greatest risk appears to be associated with prolonged use and estrogen dose.

• #45 [itemid-118][section 4] aid-60 – Osphena HCP

  https://hcp.osphena.com/12-main-menu/safety/60-itemid-118-section-4-aid-60

  Once-daily Osphena is the first and only treatment for moderate to severe vaginal dryness and/or dyspareunia that is non-hormonal, comes in an oral tablet and acts locally to improve the condition of specific vaginal tissue.* Increases superficial cells, decreases parabasal cells, and reduces vaginal pH. […] OSPHENA is an estrogen agonist/antagonist with tissue selective effects. In the endometrium, OSPHENA has estrogen agonistic effects. There is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens. […] OSPHENA is indicated for the treatment of moderate to severe vaginal dryness, a symptom of vulvar and vaginal atrophy, due to menopause.

• #46 Treatment of Urogenital Symptoms in Individuals With a History of Estrogen-dependent Breast Cancer | ACOG

  https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2021/12/treatment-of-urogenital-symptoms-in-individuals-with-a-history-of-estrogen-dependent-breast-cancer

  Nonhormonal methods should be considered first-line treatment for urogenital symptoms in individuals with a history of estrogen-dependent breast cancer. […] Nonhormonal treatments that have been reported to be effective in treating vulvovaginal symptoms include silicone-, polycarbophil-, and water-based lubricants; hyaluronic acid; polyacrylic acid; and vitamin E and D vaginal suppositories. There are insufficient data to indicate that one approach is superior to others. […] Vaginal dryness and irritation, which often are contributing factors to dyspareunia, may be effectively treated with nonhormonal topical treatments. Several over-the-counter lubricants exist, and data demonstrate the effectiveness of vaginal moisturizers (eg, gels and creams) for the temporary relief of vaginal dryness, urogenital atrophy, and dyspareunia.

• #47 Genitourinary Syndrome of Menopause: AUA/FUFU/AUGS Guideline (2025) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause

  Clinicians should offer the option of local low-dose vaginal estrogen to patients with GSM to improve vulvovaginal discomfort/irritation, dryness, and/or dyspareunia. Local low-dose vaginal estrogen may be administered in the form of a cream, tablet, insert, or ring to improve symptoms of GSM. There are different rates of satisfaction and improvements in QoL across the various treatment modalities; therefore, the decision on the specific formulation should be made in the context of SDM, individualized for each patient, and based upon the patients personal preference. […] Clinicians should recommend the use of vaginal moisturizers and/or lubricants, either alone or in combination with other therapies, to improve vaginal dryness and/or dyspareunia in patients with GSM. Moisturizers (a gel product applied regularly and is intended to mimic the natural secretions in an estrogenized vagina independent of the timing of sexual activity) and lubricants (used at the time of sexual activity to provide short-term relief of discomfort during sexual activity and can be water, silicone, or oil based) have both been recommended to help alleviate several symptoms of GSM, though few clinical studies have been conducted on the long-term safety and efficacy of these products. Regular use of lubricants has been associated with increase in pleasure and ease of orgasm.

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• #50 Induced Dryness Stress on Human Vaginal Epithelium: The Efficacy of a New Vaginal Gel

  https://www.mdpi.com/2310-2861/7/4/157

  An experimental model of dryness on vaginal mucosa is proposed to assess the efficacy of a new vaginal gel (Respecta® Hydragel Ref 17031). The dryness model was induced on reconstituted human vaginal epithelium (HVE) by incubating the tissues in modified environmental conditions (R.H. < 50% and T = 40 °C) for 48 h. [...] Respecta® Hydragel demonstrated efficacy in regulating the water flux by inducing AQP3 expression thus determining a positive water balance within the vaginal epithelium. It induced a remodelling of the epithelium morphology with restored trophism compared to the dry HVE control. Furthermore, it demonstrated a significant increase of the expression of CD44, related to hyaluronic acid (HA) distribution in the extracellular matrix. [...] Vaginal dryness is a common symptom in women with vulvovaginal atrophy or genitourinary syndrome of menopause and has a substantial negative impact on their sexual and overall quality of life. Personal lubricants and moisturizers are effective treatment options in the management of vaginal dryness with a variety of causes and can be used as a first-line treatment.

• #51 Induced Dryness Stress on Human Vaginal Epithelium: The Efficacy of a New Vaginal Gel

  https://www.mdpi.com/2310-2861/7/4/157

  Respecta® Hydragel has demonstrated efficacy in regulating the water flux by inducing AQP3 expression thus determining a positive water balance within the vaginal epithelium. It induced a remodelling of the epithelium morphology with restored tropism compared to the dry HVE control. Furthermore, it demonstrated a significant increase of the expression of CD44, related to hyaluronic acid (HA) distribution in the extracellular matrix. It has the ability to act on the cellular matrix composition and its renewal compared to the dry HVE control. Through these mechanisms it induces a deep hydration and elasticity of the vaginal mucosa.

• #52 Tips for Dealing With Vaginal Dryness in Sjogren’s Syndrome | Sjogren’s Syndrome NewsEnvelope icon

  https://sjogrenssyndromenews.com/health-insights/tips-for-dealing-with-vaginal-dryness-in-sjogrens-syndrome/

  The vagina has a mechanism of automatically cleaning itself via natural secretions. Do not use perfumed soaps, gels, douches, and antiseptics to clean your vagina as these can disturb normal vaginal bacteria and affect pH levels, resulting in dryness. […] Vaginal moisturizers such as Replens and lubricants such as Astroglide are available over-the-counter and can be applied directly to the vagina to keep it moist and minimize painful intercourse. […] Your gynecologist can prescribe an estrogen topical cream (Estrace), tablet (Vagifem), or ring (Estring) to treat symptoms of vaginal dryness associated with Sjogren’s syndrome. If you’re a current or past breast cancer patient, consult your doctor before using topical estrogen therapies.

• #53 Genitourinary Syndrome of Menopause: AUA/FUFU/AUGS Guideline (2025) – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause

  Clinicians should counsel patients that the evidence does not support the use of alternative supplements in the treatment of GSM. Many botanicals and naturally occurring organic compounds have estrogenic and antiestrogenic effects mediated by direct receptor actions or indirect mechanisms. The effect of a given compound on the individual is heavily influenced by estrogen status and receptor concentration. […] Clinicians should counsel patients to avoid vulvovaginal irritants and/or cleansers which may exacerbate the signs and symptoms of GSM. Patients being treated for GSM should be counseled to avoid excessive cleansing with soap or harsh cleansers, and chemicals. Vulvovaginal irritants can worsen the symptoms of GSM including dryness and dyspareunia. Common vulvovaginal irritants include urine, sweat, feces, soaps, cleaners, douches, spermicides, pads, and liners.

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