Vaginal Atrophy Research Articles

Efficacy of Polycarbophil Moisturizing Gel in Women with Genitourinary Syndrome of Menopause: A Randomized Control Trial

Efficacy of Polycarbophil Moisturizing Gel in Women with Genitourinary Syndrome of Menopause: A Randomized Control Trial

AKT answer relating to vaginal prolapse and atrophy

AKT answer relating to vaginal prolapse and atrophy

AKT question relating to vaginal prolapse and atrophy

AKT question relating to vaginal prolapse and atrophy

Pre- versus Post-Menopausal Onset of Overactive Bladder and the Response to Vaginal Estrogen Therapy: A Prospective Study

Background and Objectives: This study examined the utility of local estrogen therapy for improving urinary symptoms in women diagnosed with Overactive Bladder allied to the time of onset of urinary symptoms whether pre- or post-menopausal. Materials and Methods: Subject to informed consent, menopausal women diagnosed with Overactive Bladder (OAB) and Genitourinary Syndrome of Menopause (GSM) were enrolled at three urogynecological units. OAB symptoms were scored using the Global Pelvic Floor Symptoms Bother Questionnaire (GPFSBQ), with explicit attention to question number 3 that specifically addresses the presence or absence of urgency and the Patient Perception of Intensity of Urgency Scale (PPIUS). The Vaginal Health Index (VHI) was used to assess the vaginal mucosa trophism. Exclusion criteria included: Pelvic organ prolapse (POP) ≥ stage II, urinary tract infection or disease, diabetes, inflammatory diseases, use of diuretics, alcohol or drug addictions, neurological and/or psychiatric disorders, and other precluding conditions. Women were treated with local estrogens for 3 months and re-evaluated. Results: Forty-three post-menopausal women were enrolled. Of these, ten women developed OAB symptoms before menopause (Group I) and 33 developed symptoms after menopause (Group II). Following local estrogen therapy, based on the Global Pelvic Floor Symptoms Bother Questionnaire, improvement of OAB symptoms was reported by 20% of patients in Group I (p = 0.414) and 64% of patients in Group II, (p = 0.002). Based on the PPIUS scale, diminution in urinary urgency was experienced by 20% of patients in Group I (p = 0.68) and 66% of patients in Group II (p = 0.036). Improved VHI scores were graded statisticaly significant in both groups (Group I in 100% of women, p = 0.005 vs. 76% in Group II, p = 0.004). Conclusions: Our results indicate that local estrogen therapy is more effective in women who develop OAB after menopause.

Vaginal oxygen plus hyaluronic acid on genito-urinary symptoms of breast cancer survivors

Objectives This study aimed to evaluate the efficacy of vaginal oxygen and hyaluronic acid on genito-urinary symptoms of breast cancer survivors. Methods Patients were enrolled at the Menopause Outpatient Clinic of a university hospital. Breast cancer patients in a stable relationship, suffering from vaginal atrophy (VA) consequent to hypoestrogenism, were included. Natural oxygen was introduced into the vagina for 15 min, coupled in the last 5 min with a 2% solution of hyaluronic acid. Treatment was repeated five times, every 15 days. Results Out of the 40 breast cancer patients enrolled, 65% had no sexual intercourse due to pain. During treatment, the Vaginal Health Index Score gradually improved from 9.5 ± 2.2 to 16.8 ± 2.8 (p < 0.001), the visual analog scale score for dyspareunia decreased from 8.9 ± 1.3 to 3.4 ± 2.1 (p < 0.001) and the Female Sexual Function Index increased from 8.6 ± 6.3 to 15.2 ± 8.1 (p < 0.001). At the end of treatment, only 15% women (p = 0.001 vs. pretreatment) had no intercourse due to pain. Benefits remained 30 days after last treatment. Conclusion Vaginal oxygenation coupled with hyaluronic acid every 15 days improves VA, sexuality and urinary symptoms of breast cancer patients. Beside data confirmation, additional studies are needed to determine the best interval between treatments, the optimal length of treatment and the long-term duration of the benefits.

Epidemiological study of genitourinary syndrome of menopause in Japan (GENJA study).

This study aimed to investigate the prevalence of genitourinary syndrome of menopause (GSM) in Japan using the Japanese translation of the Vulvovaginal Symptoms Questionnaire (VSQ) with online survey. In addition, we examined the relationship between sexual activity and GSM symptoms. An online survey on GSM was conducted with 4,134 women aged 40 to 79 years, who were registered in an online survey company. Several questionnaires with Japanese translations of linguistic validity were used in this study. GSM was defined as a condition in women older than 40 years with vulvovaginal symptoms on the VSQ. The percentage of postmenopausal women 40 years and older was 69.6%. The percentage of women with sexual activity was 22%. The prevalence of GSM with vulvovaginal symptoms was 11.6%, and 31.7% in sexually active women. The prevalence of GSM was associated with age and was significantly lower in the 70s age group than in other age groups. Vulvar hurting and dryness were both age-related only in the sexual activity group, with a statistically significantly higher prevalence in the 70s group than in the 40s group. The prevalence of vulvar dryness during sexual activity was significantly lower in the 40s age group. An online epidemiological survey of GSM was conducted for the first time in Japan using the linguistically validated Japanese translation of the VSQ. The prevalence of GSM with genital or sexual symptoms was 11.6% in Japanese women 40 years and older, and 31.7% in sexually active women.

Effect of ospemifene on vaginal microbiome in postmenopausal women with vulvovaginal atrophy.

This study aimed (i) to compare the vaginal microbiome profiles of women suffering from vulvovaginal atrophy with that of healthy postmenopausal women and to (ii) assess the effect of ospemifene and systemic hormone treatment on the composition of the vaginal microbiome. Sixty-seven postmenopausal women attending the Gynecology Clinic of Azienda Ospedaliero-Universitaria of Bologna (Italy) were enrolled. Of them, 39 received a diagnosis of atrophy and 28 were considered healthy controls. In the group of atrophic women, 20 were prescribed ospemifene and 19 received hormone treatment. The vaginal health index was calculated, and a vaginal swab was collected for the assessment of vaginal maturation index and the analysis of vaginal microbiome through 16S rRNA gene sequencing. Clinical/microbiological analyses were repeated after 3 months of treatment. The vaginal microbiome of atrophic women was characterized by a significant reduction of Lactobacillus ( P = 0.002) and an increase of Streptococcus ( P = 0.008) and Sneathia ( P = 0.02). A positive correlation between vaginal health index/vaginal maturation index and Lactobacillus abundance was found ( P = 0.002 and P = 0.035, respectively). Both therapeutic approaches effectively improved vaginal indices. Systemic hormone treatment induced changes in minority bacterial groups of the vaginal microbiome, whereas ospemifene was able to eliminate specific bacterial taxa, such as Staphylococcus ( P = 0.04) and Clostridium ( P = 0.01). Both treatments induced a trend in the increase of bifidobacteria. The vaginal microbiome of atrophic women differs significantly from that of healthy postmenopausal women. Ospemifene may lead to a condition of vaginal health, likely characterized by the reduction of "potentially harmful" bacteria.

Evaluation of 28-day estradiol and progesterone vaginal rings in a phase 1 clinical pharmacokinetic study.

The aim of this work is to develop a combination of 17β-estradiol (E2) and progesterone (P4) in a single-dose intravaginal ring (IVR) for the treatment of vasomotor symptoms (VMS) and genitourinary syndrome of menopause while providing endometrial protection. The objective of this study was to evaluate DARE-HRT1, a 28-day IVR that continuously delivers E2 and P4, in a phase 1 clinical trial to assess its pharmacokinetics. This was an open-label, three-arm (group) study. Thirty-two (32) healthy postmenopausal women were recruited at two Australian sites. The average age was 57.2 years (47-69 y). The first arm received one ring for 28 days designed to release E2 at a rate of 80 μg/d and P4 at 4 mg/d (80/4 IVR); the second arm received a ring releasing E2 at 160 μg/d and P4 at 8 mg/d (160/8 IVR). The third arm received oral Estrofem (1 mg E2) and Prometrium (100 mg P4) both daily for 29 days. Blood samples were taken predose then intensively over the first day (day 1) and periodically thereafter over the remaining 27 days. After removal of the rings on the morning of day 29, intensive samples were collected. Similar procedures were conducted with women enrolled in the oral group. The plasma samples were analyzed for E2, estrone (E1), and P4 using validated bioanalytical methods. The baseline-adjusted steady-state plasma levels of E2 and P4 from 80/4 IVR were 20.4 ± 17.1 pg/mL and 1.32 ± 0.19 ng/mL (n = 10), respectively. The baseline-adjusted steady-state plasma levels of E2 and P4 from 160/8 IVR were 30.9 ± 8.7 pg/mL and 2.08 ± 0.50 ng/mL (n = 10), respectively. The baseline-adjusted average plasma concentrations of E2 and P4 at day 29 of the oral group were 35.4 ± 11.2 pg/mL and 0.79 ± 0.72 ng/mL (n = 11), respectively. The baseline-adjusted steady state of E1 from the 80/4 IVR and the 160/8 IVR were 22.1 ± 16.6 pg/mL (n = 10) and 25.2 ± 12.3 pg/mL (n = 10), respectively. The baseline-adjusted concentration of E1 in the oral arm was 209 ± 67.7 ng/mL (n = 11). The IVR were well tolerated, and no serious adverse events were reported. The 80/4 IVR and 160/8 IVR gave similar steady-state concentrations of E2 as seen with drug products approved by the US Food and Drug Administration for treatment of VMS and genitourinary symptoms of menopause. The E2 concentrations of this study support the potential of DARE-HRT1, a promising new option for hormone therapy for treatment of VMS and vaginal symptoms associated with menopause.

Efficacy of laser remodeling in the genitourinary syndrome of menopause: A review

The real-world treatment of genitourinary syndrome of menopause has several limitations: contraindications to topical estrogen therapy, which is currently recognized as the "gold standard" treatment for vulvovaginal atrophy (VVA), fear of the systemic effects of topical estrogens or/and carcinophobia, and poor compliance of patients to intravaginal agents. Therefore, there is an unmet need for alternative noninvasive or minimally invasive therapies, mostly non-hormonal. A PubMed, Cochrane Library, Science Direct, and ELibrary databases were searched for the keywords CO2-laser, Er:YAG-laser, vulvovaginal atrophy, genitourinary syndrome of menopause, treatment, postmenopausal age for 20122022. Remodeling microablative laser therapy using carbon dioxide (CO2) is a promising method for treating VVA, acting pathogenetically and symptomatically. CO2 laser relieves VVA symptoms and improves the condition of the vaginal mucosa by enhancing regeneration and restoring vaginal pH. However, evidence of the efficacy and long-term safety of the method, obtained in high-quality studies, is needed before the method can be introduced into widespread clinical practice.&#x0D; Aim. To analyze and summarize the evidence-based and experimental data on the efficacy and safety of laser therapy for VVA and genitourinary syndrome of menopause.

A systematic review of laser therapy for vulvar skin conditions

To the Editor: While laser devices have been utilized for a variety of vulvar skin conditions, much of the literature focuses on laser use in vulvovaginal atrophy or genitourinary syndrome of menopause.1Song S. Budden A. Short A. Nesbitt-Hawes E. Deans R. Abbott J. The evidence for laser treatments to the vulvo-vagina: making sure we do not repeat past mistakes.Aust N Z J Obstet Gynaecol. 2018; 58: 148-162Google Scholar,2Pitsouni E. Grigoriadis T. Falagas M.E. Salvatore S. Athanasiou S. Laser therapy for the genitourinary syndrome of menopause. A systematic review and meta-analysis.Maturitas. 2017; 103: 78-88Google Scholar Prior reviews have also shown limited evidence for clinical efficacy and safety of laser treatments in female gynecologic and urologic conditions.3Preti M. Vieira-Baptista P. Digesu G.A. et al.The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: an ICS/ISSVD best practice consensus document.Neurourol Urodyn. 2019; 38: 1009-1023Google Scholar Herein, we conducted a systematic review of laser devices for neoplastic and inflammatory vulvar skin conditions. A literature search was conducted using PubMed, Ovid, and CINAHL using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with search terms “vulvar” or “vulva” and “laser”. Inclusion criteria consisted of articles published in English after 1990. Studies on rejuvenation and genitourinary syndrome of menopause were excluded. We identified 90 articles consisting of 2072 vulvar cases, comprising 23 diagnoses, treated by laser as monotherapy or in combination with other therapies (Supplementary Table I, available via Mendeley at https://doi.org/10.17632/f9sgx9nt2t.2, Supplementary Fig 1, available via Mendeley at https://doi.org/10.17632/f9sgx9nt2t.2). Of these 2072 cases, 1615 (78%) were neoplastic and 160 (7.7%) were inflammatory conditions. The remaining 297 (14%) were cases of vulvodynia. The most common neoplastic condition was vulvar intraepithelial neoplasia (VIN) (660/1615, 41%). The most common inflammatory condition was lichen sclerosus (LS) (154/160, 96%). For both VIN and LS, CO2 laser was the most common laser utilized in 79% (520/660) and 66% (102/154) of cases, respectively. Of 10 unique lasers used for vulvar conditions, CO2 lasers were most common overall (1674/2072, 81%). CO2 laser was at least partially effective for the following diagnoses: VIN (n = 468), LS (n = 100), Bartholin gland cyst/abscess (n = 689), condyloma acuminata (n = 79), extramammary Paget disease (n = 34), squamous cell hyperplasia/carcinoma (n = 27), vulvar papillomatosis (n = 16), lymphangioma/lymphangiectasia (n = 9), Buschke Lowenstein tumor (n = 3), vulvar syringoma (n = 3), vulvar tumor unspecified (n = 2), inflammatory linear verrucous epidermal nevus (n = 2), bowenoid papulosis (n = 1), vulvar adenosis (n = 1), lymphedema (n = 1), papular acantholytic dyskeratosis (n = 1), epidermoid cyst (n = 1), trichoadenoma of Nikolowski (n = 1), and vulvar pigmented follicular cyst (n = 1). While neither neoplastic or inflammatory, we found CO2 laser was also reported to be partially effective for vulvodynia (n = 96), Thirty-five (38.9%) studies reported at least 1 side effect, the most common being mild or transient pain and discomfort. Conventional treatments for vulvar inflammatory and malignant conditions include surgical excision, photodynamic therapy, and laser ablation. This review specifically highlights the use of laser therapies for vulvar conditions, with the most evidence for CO2 laser for VIN and LS. The heterogeneity of the studies precludes us from providing a standard of care in laser type and laser settings. While most studies reported minimal short-term complications, there is a paucity of data on long-term outcomes. The majority of the studies did not specify Fitzpatrick skin type of patients, limiting our ability to comment on the safety of laser-based devices across a broader range of skin types. More robust studies are needed to ultimately establish guidelines for optimal recommendations for use of lasers in vulvar inflammatory and neoplastic skin conditions. None disclosed.

Treating co-existent genitourinary syndrome of menopause in patients with lichen sclerosus improves symptoms.

Treating co-existent genitourinary syndrome of menopause in patients with lichen sclerosus improves symptoms.

Emerging Use of Vaginal Laser to Treat Genitourinary Syndrome of Menopause for Breast Cancer Survivors: A Review.

Breast cancer treatment, such as chemotherapy and endocrine therapy, can cause earlier and more sudden menopausal symptoms. Genitourinary syndrome of menopause (GSM) is one of the most bothersome side effects of breast cancer treatment, resulting in sexual dysfunction and impaired quality of life. GSM includes genital, urinary, and sexual symptoms. However, alleviating symptoms of GSM for breast cancer survivors may be challenging due to ineffectiveness, contraindications, and low adherence to treatment. The most recent data show the feasibility and safety of vaginal laser to treat GSM for breast cancer survivors. This narrative review provides the aspects of GSM in breast cancer patients, putting the focus on the efficacy and safety of vaginal laser therapy.

Epithelial thinning in vaginal atrophy related to lowering of calcitonin gene-related protein, vascular endothelial growth factor, and nerve growth factor expressions in a menopausal rat model

Context: Vaginal atrophy has been observed as a common sexual problem in post-menopausal women. The targeted protein to counteract menopause problems related to vaginal epithelial thinning is currently a research problem that has not been fully investigated. Aims: To explore the possible mechanism underlying vaginal atrophy in rat models. Methods: Following three-week ovariectomy (OVX), Sprague-Dawley female rats were randomly divided into two groups and orally administered estradiol for two weeks in the treated group. In parallel with this, six rats with sham surgery were used as control. Marker-related vaginal atrophy, including calcitonin gene-related protein (CGRP), vascular endothelial growth factor (VEGF), and nerve growth factor (NGF) in the vaginal wall, were compared using immunohistochemistry. Results: OVX as a menopausal model significantly induced vaginal epithelial cell thinning and decreased the expression of CGRP, VEGF, and NGF compared with sham surgery animals (p&lt;0.05). Estrogen replacement in OVX rats reversed the vaginal atrophic by recovering the protein expression CGRP, VEGF, and NGF (p&lt;0.05). Conclusions: Thus, it may be concluded that a possible mechanism underlying the OVX-induced vaginal atrophy may be related to the downregulation expression of CGRP, VEGF, and NGF in vaginal tissue.

Современные возможности лечения вульвовагинальной атрофии: гормональные методы и лазерная модулирующая терапия

Vulvovaginal atrophy (VVA) is a common but underreported condition in real clinical practice caused by decreased estrogenization of the vaginal tissues. The prevalence of VVA in the postmenopausal phase is at least 50%, and according to some data, 80%. Not only patients, but also some physicians consider VVA as an inevitable part of the aging process, which delays the diagnosis and treatment of genitourinary syndrome of menopause (GSM). Treatment options for GSM are limited by contraindications to local hormone therapy, poor patient compliance, and hormonophobia. In this regard, the search for alternative non-invasive treatment methods is relevant. The search for literature for 2012–2022 was performed in PubMed, CochraneLibrary, Science Direct, and ELibrary databases using the following keywords: vulvovaginal atrophy, genitourinary syndrome of menopause, treatment, CO2-laser, postmenopausal age. Conclusion. Microablative fractional CO2-laser therapy for VVA can relieve symptoms and improve the condition of the vaginal mucosa by enhancing regeneration processes, but high-quality research is needed to study the efficacy and safety of this treatment method. Key words: vulvovaginal atrophy, genitourinary syndrome of menopause, perimenopause, postmenopause, therapy, laser therapy, CO2-laser

Локальная гормональная терапия генитоуринарного менопаузального синдрома

Aim: To justify the viability and safety of local hormonal therapy with oestrogens in genitourinary syndrome of menopause. Key points. The overall ageing of the population results in an increased number of women who have problems during menopause associated with gradual reduction and switching-off of ovarian function and cessation of oestrogen generation by ovaries. Local changes at the pelvic level (urethra, bladder, vagina) are described as genitourinary syndrome of menopause. The most effective therapies for the syndrome include local hormonal therapy with oestrogens, including oestriol which is of interest due to its specific targeted action and lack of proliferative effect on endometrium and mammary glands. The use of oestriol eliminates a number of problems caused by oestrogen insufficiency: it minimises or eliminates dyspareunea, dryness and itching in vagina and lower section of the urogenital tract, inappropriate urination, enuresis, and recurring vulvovaginitis and cystitis. Conclusion. It has been proven that the local use of oestriol is efficient and safe for the management of genitourinary syndrome of menopause. The selection of a specific medicinal product should be evidence-based and should take into account the route of administration and pharmacological properties, including preparation of the active ingredient, and excipients contributing to the overall efficiency and safety. Keywords: genitourinary syndrome, menopause, estriol, micronization.

Гинекологические аспекты сексуальной дисфункции в постменопаузальном периоде

Sexuality is defined as a physical, emotional, psychological, and social welfare state associated with sexual desires. The prevalence of sexual dysfunction among postmenopausal women is estimated to be 68% to 87%. The most significant causes of sexual disorders in this period are physiological changes of female body, psychological problems, lack of special knowledge, and male health status. Sexual function is linked to the complex neurotransmitter-hormone interaction both at the central and peripheral levels. The major cause of sexual dysfunction in postmenopausal women is genitourinary menopausal syndrome. Most commonly, gynecologist becomes a first contact physician dealing with female sexual disorders. Sexual dysfunction diagnosis in postmenopause includes the use of validated questionnaires, the assessment of the type and severity of menopausal disorders, the impact of somatic diseases and psychological issues, as well as a thorough physical examination. As sexual dysfunction in postmenopausal women is caused by multiple factors and has a complex pathogenesis, it is necessary to set up a multidisciplinary approach to problem solving. According to the biopsychosocial model, gynecologist has a wide range of therapeutic options for dealing with sexual disorders — pharmacotherapy (hormonal and non-hormonal agents), rational psychotherapy, and multimodal treatment methods. KEYWORDS: sexual dysfunction, postmenopause, sexual hormones, estrogens, androgens, genitourinary menopausal syndrome, biopsychosocial model of healthcare. FOR CITATION: Sandakova E.A., Zhukovskaya I.G. Gynecological aspects of sexual dysfunction in the postmenopausal women. Russian Journal of Woman and Child Health. 2023;6(1):26–30 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-26-30.

Transcutaneous Temperature Controlled Radiofrequency: Groundbreaking Technology - Female Stress Urinary Incontinence and Overactive Bladder Can Be Treated Noninvasively and with Vulvovaginal Rejuvenation?

It has long been difficult to treat vulvovaginal laxity, genitourinary syndrome of menopause, stress urine incontinence, overactive bladder (OAB), and other indications of sexual dysfunction because women traditionally find it difficult to discuss these difficulties with clinicians and because society generally accepts these diseases. Originating in esthetic medicine, noninvasive feminine rejuvenation that targets vaginal tissue with energy-based methods has recently become more popular. A more youthful-looking vulva, the restoration of vaginal elasticity and "tightness," a significant improvement in stress urinary incontinence, a reduction in symptoms of OAB, and a decrease in sexual dysfunction are all benefits of transcutaneous temperature-controlled radiofrequency (TTCRF) therapy at the vulvovaginal region. It is also becoming more popular as a mild-to-moderate stress urinary incontinence and OAB noninvasive therapy option. Women will likely always be appreciative of their gynecologist for managing stress urinary incontinence with TTCRF therapy without making an incision, it would appear.

Преждевременная недостаточность яичников: последствия для здоровья и стратегии заместительной гормональной терапии

Aim: analysis of modern views on the pathogenesis of complications and long-term consequences of sex hormone deficiency among patients with premature ovarian insufficiency (POI), as well as the possibilities and strategies of hormone replacement therapy (HRT) for their treatment and prevention. Key Points. The consequences of a sex hormones deficiency in women with POI are not only short-term clinical manifestations similar to menopause, but also long-term negative outcomes for general health and life. HRT has therapeutic and prophylactic potential for all clinical aspects of the disease. However, the currently developed standard therapeutic strategies do not always allow to completely stop the symptoms of POI and ensure reliable prevention of complications in the future. Conclusion. The choice of adequate doses and composition of HRT, along with an interdisciplinary approach to the treatment of this pathology, will make it possible to level the associated risks and ensure a high quality of life for patients. Keywords: premature ovarian insufficiency, hormone replacement therapy, cardiovascular diseases, osteoporosis, genitourinary menopausal syndrome.

Sintomas geniturinários e qualidade de vida de mulheres com câncer de mama em tratamento quimioterápico

ABSTRACT This study aimed to compare genitourinary symptoms and quality of life in women with breast cancer before and after chemotherapy treatment. This is a prospective and analytical study carried out with 60 women treated at a hospital in the state of Paraná. Sociodemographic data, menopausal status, climacteric symptoms, quality of life, and pelvic floor strength and resistance were collected. Descriptive statistics, t-tests, Shapiro-Wilk, Cochran, Factorial Analysis of Variance for Repeated Measures and Fishers least significance difference were used for data analysis. Participants suffered genitourinary alterations, such as reduced strength and resistance of the pelvic floor muscles, urinary incontinence and vulvovaginal atrophy, regardless of the evaluated factors (type of chemotherapy, parity, and menopausal status). Therefore, greater attention and discussion by multidisciplinary health teams is necessary, as these symptoms can be reduced and managed if recognized early.

Microablative fractional radiofrequency for sexual dysfunction and vaginal Trophism: A randomized clinical trial

ObjectivesTo evaluate Microablative Fractional Radiofrequency (MAFRF) as a possible option in treating vaginal atrophy. MethodsThis was a randomized, controlled clinical trial with postmenopausal women diagnosed with vaginal atrophy. The treatment consisted of three sessions of MAFRF, compared to vaginal estrogen administration and an untreated control group. Assessments occurred at baseline and 90 days. The primary endpoints were sexual function, evaluated by the Female Sexual Function Index (FSFI), and vaginal health, assessed by the Vaginal Health Index (VHI). Secondary outcomes included vaginal microbiota composition (Nugent score) and epithelial cell maturation (Maturation Value ‒ MV). ResultsOne hundred and twenty women (40 in each group) were included. Concerning the FSFI, both groups, MAFRF (median 4.8 [3.6‒6.0]) and vaginal estrogen (mean 4.7 ± 1.1), experienced improved sexual desire when compared to the control group (median 3.6 [2.4‒4.8]). Regarding the total score of VHI, the authors observed an improvement in the mean of the MAFRF (23.7 ± 2.0) and vaginal estrogen groups (23.5 ± 1.9) when compared to the control (14.8 ± 2.9). The Nugent score was reduced in the MAFRF and estrogen groups (p < 0.01) compared to the control group. Lastly, the MV was modified after treatment with MAFRF (p < 0.01) and vaginal estrogen (p < 0.001). No differences existed between the MAFRF and vaginal estrogen groups in the studied variables. No adverse effects were reported following the MAFRF protocol. ConclusionsRadiofrequency was comparable in efficacy to estrogen administration for treating vulvovaginal atrophy. It deserves consideration as a viable option in managing this condition.