La vagina: ruolo terapeutico del prasterone

La vagina: ruolo terapeutico del prasterone

Linda Vignozzi1,2 – Orcid, Irene Scavello1 – Orcid, Elisa Maseroli1 – Orcid, Vincenzo Di Stasi– Orcid, Sarah Cipriani1,2 – Orcid

1 -Dipartimento di Scienze Biomediche Sperimentali e Cliniche “Mario Serio”, Università degli Studi di Firenze

2 – SODc Andrologia, Endocrinologia Femminile e Incongruenza di Genere, Azienda Ospedaliero-Universitaria Careggi, Firenze

Autore di riferimento: Linda Vignozzi

linda.vignozzi@unifi.it


DOI: 10.53146/lriog1202123

Abstract

Genitourinary menopause syndrome (GSM) is a chronic, progressive condition, which results from the effects of estrogenic and androgenic deficiency typical of menopausal age. It involves the genitourinary district and occurs with an extremely wide range of signs and symptoms. Dyspareunia, both superficial and deep, is among the main and most distressing symptoms of the GSM. Over the decades, different therapeutic approaches have been developed, aimed at improving the symptomatology and thus the quality of life of women, such as local estrogenic therapy, which until now has been considered the gold standard of GSM treatment. A new Prasterone formulation has recently been approved, which is biochemically and biologically identical to that of the endogenous human DHEA, an inactive steroid precursor that can be converted into estrogen and androgen into vaginal cells. The rationale of the use of prasterone is the theory of intracrinology, which is the proven ability of vaginal cells to convert an inactive compound into an active form. This molecule, absorbed locally, determines only a minimum increase in circulating hormonal values, which remains be- low the threshold of physiologic levels for menopausal women.

Keywords: prasterone; genitourinary syndrome; menopause; atrophy.


Presente in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283


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La vagina: evidenze emergenti sul ruolo anti-infiammatorio del testosterone

La vagina: evidenze emergenti sul ruolo anti-infiammatorio del 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 Andrologia, Endocrinologia Femminile e Incongruenza di Genere, Azienda Ospedaliero-Universitaria Careggi, Firenze

2 – Dipartimento di Scienze Biomediche Sperimentali e Cliniche “Mario Serio”, Università degli Studi di Firenze

3 – Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, Università degli Studi di Firenze

Autore di riferimento: 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.


Presente in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283


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Il pavimento pelvico: elementi comuni della valutazione fisioterapica e ginecologica

Il pavimento pelvico: elementi comuni della valutazione fisioterapica e ginecologica

Arianna Bortolami – Orcid

Fisioterapista

Consulente in Sessuologia

Dottore Magistrale
in Scienze delle Professioni Sanitarie della Riabilitazione

Docente a contratto Università degli Studi Milano-Bicocca

arianna.bortolami@gmail.com


DOI: 10.53146/lriog1202121

Abstract

Dysfunction of the pelvic floor muscles can cause urological, gynecological, anorectal, sexual and pain symptoms that can have a negative impact on a woman’s quality of life. Therefore, the evaluation of these muscles and the characteristics of the symptoms is fundamental for their management and treatment. Urological symptoms are related to both bladder filling, such as incontinence, frequency, urgency, nocturia, and emptying, such as urinary hesitation, intermittent, hypovalid, deviated mitt, straining, post voiding drip, sense of incomplete emptying. Anorectal symptoms are identified in anal incontinence and urgency, constipation and a sense of incomplete emptying. Alterations in the gynecological area refer to the prolapse of the pelvic organs. Sexual dysfunctions consist in the impossibility or difficulty in penetration and orgasm, in coital pain, and in the reduction of genital sensations of pleasure. Painlike symptoms refer to chronic/persistent pain in the pelvic area, including persistent vulvar pain. The common elements among professionals in the evaluation of the pelvic floor are identified in the medical history and physical examination. The first identifies symptoms and related risk factors. The latter include pregnancy, childbirth, menopause, syndromes involving persistent pelvic pain, systemic diseases involving connective tissue, skin and peripheral nervous system, oncological diseases, lifestyles that cause frequent increases in abdominal pressure or excessive contraction of the trunk and pelvis muscles, or prolonged sitting. The physical examination identifies the condition of the pelvic floor muscles, which may be excessively or poorly active. Anamnesis and physical examination then allow to plan the therapy, which can be identified in physiotherapy and rehabilitation, in psychological, pharmacological, surgical therapy.

Keywords: physical examination; manual palpation; muscle tone; muscle trophism; voluntary and involuntary motor activity; muscle pain.


Presente in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283


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La vagina, bersaglio oncologico: Vain e strategie terapeutiche

La vagina, bersaglio oncologico: Vain e strategie terapeutiche

Francesco Sopracordevole1 – Orcid , Nicolò Clemente1 – Orcid, Anna del Fabro1 – Orcid

1 – SOC di Ginecologia Oncologica – Centro di Riferimento Oncologico di Aviano – IRCCS

Autore di riferimento: Francesco Sopracordevole

fsopracordevole@cro.it


DOI: 10.53146/lriog1202120

Abstract

VaIN (Vaginal Intraepithelial Neoplasia) is a challenge disease for gynecologists: it is often undiagnosed, difficult to treat, with high rate of recurrence and, in some cases, it can progress to invasive vaginal cancer. Multiple treatments are often required, with a potential impairment of women’s quality of life. To get a proper diagnosis and adequate treatment, all the women with abnormal pap smear, should undergo an accurate colposcopic evaluation of vaginal walls. A colposcopy-guided biopsy of suspicious lesions is mandatory. The treatment of VaIN (especially the most complex cases) should be performed by expert colposcopists in referral centres.

Keywords: VaIN; vaginal intraepithelial neoplasia; pap smear; vaginal excision; vaginal surgery.


Presente in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283


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La vagina e il suo microbiota (residente e dinamico)

La vagina e il suo microbiota (residente e dinamico)

Francesco De Seta1,2 – Orcid, Gabriella Zito1 – Orcid, Giuseppe Ricci1,2, Simona Franzo2

1 – Istituto per la salute materna e infantile, IRCCS Burlo Garofolo, Trieste

2 -Dipartimento di Medicina, Chirurgia e Scienze della Salute, Università di Trieste

Autore di riferimento: Francesco De Seta

fradeseta@gmail.com


DOI: 10.53146/lriog1202119

Abstract

The vaginal microbiota and the immunologic milieu that derives are a dynamic and complex ensemble. A normal vaginal microbiota is mainly constituted by Lactobacillus sp.. This bacterium, thanks to the production of metabolites (lactic acid, hydrogen peroxide, bacteriocin) and stimulating the immune system toward an anti-inflammatory switch, can maintain the stability of vaginal microbiota and inhibit pathogen bacteria proliferation. Multiple factors affect vaginal microbiota composition. They can lead to high diversity and rise of anaerobic bacteria that enhance chronic inflammation, vaginal epithelial barrier damage, risk of STI transmission, infertility, preterm labor, PID. Research about this issue has intensified in the last decade, due to the development of molecular biology techniques that allow to isolate specific species of bacteria and analyse their specific functions. However, the understanding of the mechanisms through which the shifts in the microbiota can affect the health state and the immune system of the individual is still far. This constitutes a frontier for the development of prevention, diagnosis and therapeutic strategies.

Keywords: microbiome; bacteria, vagina; lactobacilli; dysbiosis.


Presente in LRIOG Nr.2 – 2021

e-ISSN: 1824-0283


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lriog-2021-2

LRIOG 2021-2

In questo numero:

Articoli originali

La vagina: quesiti clinici e bisogni terapeutici disattesi

Alessandra Grazziottin

PDF DOI:10.53146/lriog1202116 Abstract

La vagina come organo endocrino: implicazioni cliniche

Linda Vignozzi, Sarah Cipriani, Elisa Maseroli, Irene Scavello, Vincenza Di Stasi, Ilaria Cellai, Sandra Filippi, Paolo Comeglio

PDF DOI:10.53146/lriog1202117 Abstract

La vagina, organo sensuale ed erotico: le evidenze anatomofunzionali

Emmanuele A. Jannini, Fiorenza Pesce

PDF DOI:10.53146/lriog1202118 Abstract

La vagina e il suo microbiota (residente e dinamico)

Francesco De Seta, Gabriella Zito, Giuseppe Ricci, Simona Franz

PDF DOI:10.53146/lriog1202119 Abstract

La vagina, bersaglio oncologico: VAIN e strategie terapeutiche

Francesco Sopracordevole, Nicolò Clemente, Anna del Fabro

PDF DOI:10.53146/lriog1202120 Abstract

Il pavimento pelvico: elementi comuni della valutazione fisioterapica e ginecologica

Arianna Bortolami

PDF DOI:10.53146/lriog1202121 Abstract

La vagina: evidenze emergenti sul ruolo anti-infiammatorio del testosterone

Linda Vignozzi, Elisa Maseroli, Ilaria Cellai, Sandra Filippi, Paolo Comeglio, Sarah Cipriani, Irene Scavello, Giulia Rastrelli, Margherita Frison, Mario Maggi

PDF DOI:10.53146/lriog1202122 Abstract

La vagina: ruolo terapeutico del Prasterone

Linda Vignozzi, Irene Scavello, Elisa Maseroli, Vincenza di Stasi, Sarah Cipriani

PDF DOI:10.53146/lriog1202123 Abstract

La vagina: ruolo terapeutico dell’ Ospemifene

Novella Russo

PDF DOI:10.53146/lriog1202124 Abstract

La vagina: ruolo terapeutico degli estrogeni

Anna Maria Paoletti, Manuela Neri

PDF DOI:10.53146/lriog1202125 Abstract

Gonorrea, un’infezione minacciosa in ginecologia e ostetricia

Alessandra Graziottin, Elena Boero, Chiara Limongi

PDF DOI:10.53146/lriog1202126 Abstract

Dolore vulvo-vaginale, candidassi recidivante e rischio familiare per il diabete.
I fattori critici emersi dallo studio VuNet su 1183 casi – Parte II

Alessandra Graziottin, Dania Gambini, Elena Boero, Filippo Murina, ricercatori del Gruppo VuNet

PDF DOI:10.53146/lriog1202127 Abstract

Rivista trimestrale: Nr.2 – 2021

e – ISSN: 1824 – 0283

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