Continuing Medical Education: Vulvovaginal Atrophy: Current and Future Therapies (CME)

IntroductionVulvovaginal atrophy results from estrogen deficiency and affects a large number of postmenopausal women. Symptoms include vaginal dryness, itching, irritation, and dyspareunia.AimThe purpose of this review is to evaluate the efficacy, safety and acceptability of current treatment methods for vulvovaginal atrophy, as well as highlight evolving new treatment methods.MethodWe conducted a review of the literature concerning treatment of vulvovaginal atrophy.ResultsAll currently available low-dose local estrogen formulations are effective and yield few side effects. Fears sparked by the Women's Health Initiative, as well as recommendations by the FDA, have generated interest in the development of new treatment methods. Lower doses of existing formulations have proven to be efficacious. The use of estrogen agonists/antagonists and intravaginal dehydroepiandrosterone (DHEA) have both been shown to positively affect vaginal atrophy symptoms without inducing endometrial proliferation.ConclusionPotential new treatment methods show promise to provide efficacy in treatment while avoiding unwanted side effects. Further research is needed to establish optimal treatment formulations. Ibe C, and Simon JA. Vulvovaginal atrophy: Current and future therapies.     

Continuing Medical Education: Urogenital Complaints and Female Sexual Dysfunction (Part 2) (CME)

IntroductionFemale sexual dysfunction (FSD) is common in women with urogenital disorders that occur as a result of pelvic floor muscle and fascial laxity.AimProvide a comprehensive review of FSD as it relates to common urogenital disorders including pelvic organ prolapse (POP) and stress urinary incontinence (SUI) and to discuss the impact of the surgical repair of these disorders on sexual function.MethodsSystematic search of the medical literature using a number of related terms including FSD, POP, SUI, surgical repair, graft augmentation, complications, and dyspareunia.Main Outcome MeasuresReview of the medical literature to identify the relation between FSD and common urogenital disorders in women and to describe appropriate treatment strategies to improve quality of life (QOL) and sexual function.ResultsFSD is common in women with POP and SUI. Treatment options for POP and SUI include behavioral, pharmacological, and surgical methods which can also affect sexual function.ConclusionsSexual dysfunction is a common, underestimated complaint in women with POP and SUI. Treatment should be tailored toward improving sexual function and QOL. Surgical correction is generally beneficial but occasionally can result in negative alterations in sexual function. Patient selection and methods used for surgical repair are important factors in determining anatomical and functional success. Wehbe SA, Kellogg S, and Whitmore K. Urogenital complaints and female sexual dysfunction (part 2).     

Peyronie's disease (CME)

IntroductionThe management of Peyronie's disease (PyD) presents several challenges to the clinician. Despite progress in the understanding of PyD on several fronts, it remains a physically and psychologically devastating condition for the affected patient and partner.AimThe purpose of this Continuing Medical Education article is to review contemporary knowledge of the epidemiology, pathophysiology, evaluation, and management of PyD, thus enabling best-practice management.MethodsAn English-language MEDLINE review was performed from 1990 to present-day for PyD.Main Outcome MeasureCurrent state of, and new developments in, PyD.ResultsRecent studies have established a new paradigm for the natural history and epidemiology of PyD. Prevalence approaches 5%, while less than 20% of men report spontaneous resolution of deformity. The psychological sequelae on both patient and partner are underrepresented in literature; data gleaned from select Internet websites have better established Peyronie's effects on psyche and relationships. For the majority of patients, evaluation, information, and reassurance is sufficient. Few medical treatment options are supported by data from well-designed placebo-controlled trials. For men unresponsive to nonoperative therapies, plication, grafting, or implantation of a penile prosthesis are surgical management options.ConclusionsPyD does not invariably progress to a complete loss of the ability for sexual intercourse. Should deformities preclude intercourse, well-established medical or surgical options may be considered; indeed, using one or more of the treatment approaches outlined can, in most cases, result in adequate restoration of sexual function. Bella AJ, Perelman MA, Brant WO, and Lue TF. Peyronie's disease.     

Continuing Medical Education: Urogenital Complaints and Female Sexual Dysfunction (Part 1) (CME)

IntroductionSexual dysfunction and dyspareunia are common complaints in women with urological disorders.AimTo provide a comprehensive review of sexual dysfunction related to common hypersensitive/hyperactive urogenital disorders including interstitial cystitis/painful bladder syndrome (IC/PBS), overactive bladder (OAB) with and without incontinence, and high-tone pelvic floor muscle dysfunction and the appropriate treatment strategies.MethodsA medical literature search using several related terms including sexual dysfunction, dyspareunia, IC/PBS, OAB, urinary incontinence pelvic floor dysfunction, and levator ani muscle spasm.Main Outcome MeasuresReview of the medical literature to identify relation between sexual dysfunction and common urological disorders in women and to describe appropriate treatment strategies to improve the women's quality of life.ResultsA thorough review of sexual dysfunction in urological disorders and their related treatments modalities including: behavioral, pharmacological, and nonpharmacological therapies.ConclusionsSexual dysfunction is a common, underestimated, and untreated complaint in women with urologic disorders. Identifying sexual complaints and treating the underlying etiologies can result in significant improvement in a woman's quality of life. This process requires a focused, multidisciplinary approach tailored to meet the needs of women with urogenital complaints. Wehbe SA, Whitmore K, and Kellogg-Spadt S. Urogenital complaints and female sexual dysfunction (part 1).