The vagina: emerging evidence on the anti-inflammatory role of testosterone

The vagina: emerging evidence on the anti-inflammatory role of testosterone

Linda Vignozzi1,2– Orcid, Elisa Maseroli1 – Orcid, Ilaria Cellai2, Sandra Filippi3, Paolo Comeglio2, Sarah Cipriani2 – Orcid, Irene Scavello2 – Orcid, Giulia Rastrelli2 – Orcid, Margherita Frison2, Mario Maggi2 – Orcid

1 – SODc Andrology, Female Endocrinology and Gender Incongruence, Careggi University Hospital, Florence

2 – Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence

3 – Department of Neuroscience, Psychology, Pharmaceutical and Child Health Area, University of Florence

Corresponding author: Linda Vignozzi

linda.vignozzi@unifi.it


DOI: 10.53146/lriog1202122

Abstract

The female genitourinary tract is constantly exposed to infectious and inflammatory insults. Inflammation is an essential mechanism, usually able to restore tissue homeostasis; however, uncontrolled and self-maintaining inflammation can lead to dysfunctional processes, which may contribute to the onset of chronic conditions affecting the female genitourinary tract. These include the Genitourinary Syndrome of Menopause (GSM), characterized by vulvovaginal atrophy and symptoms of the lower urinary tract. The primary cause of GSM is a drop of estrogen levels at menopause; however, a decline in androgen level and chronic inflammation also play a pathogenic role. Androgen signaling generally suppress the activity of immune cells. In recent years, androgens have been described to play a key role in maintaining vaginal health, by positively regulating vascular and non-vascular smooth muscle and collagen growth and function, nerve density and function, and genital hemodynamics. Recent in vitro evidence also suggests an anti-inflammatory action of androgens within the vagina. In fact, it has been shown that hu- man vagina smooth muscle cells are able to be involved in the inflammatory response, behaving as resident nonprofessional antigen presenting cells and producing cytokines, chemokines and growth factors. Testosterone, ac- ting through its more active metabolite DHT (Dihydrotestosterone), seems to exert a relevant anti-inflammatory effect on vagina smooth muscle cells, blunting their ability to respond to inflammatory stimuli and to perpetuate inflammation. In particular, DHT counteracts the secretion of Interferon (IFNg), the most potent Th1 cytokine, which plays a key role in development of autoimmunity and chronic, self-perpetuating inflammatory diseases. These data suggest that androgens represent a potential therapeutic strategy for the GSM and other inflammatory conditions of the female genitourinary tract, to be further investigated in clinical studies.

Keywords: androgens; menopause; vagina; inflammation; infection.


Available in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283


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Vulvar and perivulvar infection of bacterial pathogenesis

Vulvar and perivulvar infection of bacterial pathogenesis

Paola Salzano – Orcid

Scientific coordinator of the “Vulva Forum” Naples

 

paola.salzano@gmail.com


DOI: 10.53146/lriog1202115

Abstract

Why are women vulnerable to bacterial infectious disease of the vulvar and perivulvar area? What kind of medical history and physical examination must be performed to arrive at a correct diagnosis? How to make a differential diagnosis between the various vulvar infectious skin diseases? Infectious diseases of the vulvar and perivulvar area have different characteristics and symptoms depending on their nature and etiological triggering factors. Abscesses, pus-containing skin sacs, are caused by bacteria of the Staphylococcus Aureus species. Folliculitis, a type of small skin abscess that affects the hair follicle, is often triggered by improper depilatory practices. Impetigo, a superficial skin infection usually caused by S. Aureus and minus S. Pyogenes, can arise as a complication of pre-existing dermatitis. Hidradenitis, characterized by painful nodules, abscesses, sinus tracts and scars, can occur due to genetic, hormonal, infectious and even immunological factors. Abscesses, folliculitis, impetigo and hidradenitis are all diseases of bacterial origin that can affect subjects at different stages of development, including women of childbearing age, with a peak incidence around the age of 20-30. For this reason and for their tendency to also arise in the vulvar and perivulvar area, they constitute a frontier study subject between dermatology and gynecology, offering significant food for thought on the dermatological skills that the gynecologist will have to acquire for the purposes of treatment. The aim of this work is therefore to offer an overview of these diseases from a purely gynecological point of view, focusing on diagnostic methods, anamnesis and therapeutic perspectives, with the auxiliary purpose of guiding the gynecologist in identifying and removing those predisposing factors that can trigger the chronicity of infectious vulvar diseases.

Keywords: abscess; folliculitis; impetigo; hidradenitis; vulvitis; infection.

Available in LRIOG Nr.1 – 2021

e-ISSN: 1824-0283


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