Lester Joanne, Pahouja Gaurav, Andersen Barbara, Lustberg Maryam
Clinical Research Nurse Practitioner, Division of Surgical Oncology, The Ohio State University, Columbus, OH 43210, USA.
Department of Psychology, The Ohio State University, Columbus, OH 43210, USA.
J Pers Med. 2015 Mar 25;5(2):50-66. doi: 10.3390/jpm5020050.
Management of breast cancer includes systematic therapies including chemotherapy and endocrine therapy can lead to a variety of symptoms that can impair the quality of life of many breast cancer survivors. Atrophic vaginitis, caused by decreased levels of circulating estrogen to urinary and vaginal receptors, is commonly experienced by this group. Chemotherapy induced ovarian failure and endocrine therapies including aromatase inhibitors and selective estrogen receptor modulators can trigger the onset of atrophic vaginitis or exacerbate existing symptoms. Symptoms of atrophic vaginitis include vaginal dryness, dyspareunia, and irritation of genital skin, pruritus, burning, vaginal discharge, and soreness. The diagnosis of atrophic vaginitis is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Lifestyle modifications can be helpful but are usually insufficient to significantly improve symptoms. Non-hormonal vaginal therapies may provide additional relief by increasing vaginal moisture and fluid. Systemic estrogen therapy is contraindicated in breast cancer survivors. Continued investigations of various treatments for atrophic vaginitis are necessary. Local estrogen-based therapies, DHEA, testosterone, and pH-balanced gels continue to be evaluated in ongoing studies. Definitive results are needed pertaining to the safety of topical estrogens in breast cancer survivors.
乳腺癌的治疗包括化疗和内分泌治疗等系统疗法，这些疗法可能导致多种症状，进而损害许多乳腺癌幸存者的生活质量。该群体常出现由循环雌激素水平降低至泌尿和阴道受体而引起的萎缩性阴道炎。化疗导致的卵巢功能衰竭以及包括芳香化酶抑制剂和选择性雌激素受体调节剂在内的内分泌治疗，可能引发萎缩性阴道炎的发作或加重现有症状。萎缩性阴道炎的症状包括阴道干燥、性交困难、生殖器皮肤刺激、瘙痒、灼痛、阴道分泌物增多和疼痛。萎缩性阴道炎的诊断通过患者自述症状以及对外阴结构、阴道口和阴道黏膜的妇科检查来确认。生活方式的改变可能有所帮助，但通常不足以显著改善症状。非激素阴道治疗可通过增加阴道湿度和液体来提供额外缓解。乳腺癌幸存者禁用全身雌激素治疗。有必要继续研究萎缩性阴道炎的各种治疗方法。正在进行的研究中持续评估基于局部雌激素的疗法、脱氢表雄酮、睾酮和pH平衡凝胶。需要获得关于局部雌激素在乳腺癌幸存者中安全性的确切结果。
