Pitsouni Eleni, Grigoriadis Themos, Douskos Athanasios, Kyriakidou Margarita, Falagas Matthew E, Athanasiou Stavros
Urogynaecology Unit, 1st Department of Obstetrics and Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Greece.
Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
Eur J Obstet Gynecol Reprod Biol. 2018 Oct;229:45-56. doi: 10.1016/j.ejogrb.2018.08.008. Epub 2018 Aug 6.
Genitourinary syndrome of menopause (GSM) increases the probability of female sexual dysfunction (FSD). The aim of the current study is to systematically assess data regarding sexual function and use of vaginal therapies, alternative to vaginal estrogens (VE), in menopausal women with GSM. PubMed, Scopus and Cochrane Library were searched (May-September 2017) using combination keywords: "dyspareunia and vaginal therapy", "sexual function and vaginal therapy", "orgasm and vaginal therapy", "vaginal atrophy" and "genitourinary syndrome of menopause". Eligible studies were RCTs focusing on the use of vaginal therapies, alternative to VE, in menopausal women. These studies were written in English language and published in peer-reviewed journals with impact factor. Assessment of risk of bias was performed using the Cochrane Risk of Bias Tool. Outcomes involved dyspareunia, vaginal dryness, orgasm and all parameters of sexual function. Twenty-nine RCTs including 3689 menopausal women, were included. Vaginal therapies, alternative to VE included non-hormonal (vaginal laser, lubricants/moisturizers, phytoestrogens and lidocaine) and hormonal ones (Dehyadroapiandrosterone (DHEA), testosterone and oxytocin). Dyspareunia and/or vaginal dryness were assessed in 72% of the articles, while the FSD and orgasm in 45% and 28% of articles, respectively. Dyspareunia and vaginal dryness improved in all relevant studies. Sexuality scores of lubricants were inferior to estrogens [3 studies, n = 138, standardized mean difference (smd) -0.64, (95%CI -1.1, -0.2)]. Orgasm domain was the same for the DHEA 0.5% and placebo (2 studies, n = 663, smd 1.29 (95% -0.47, 3.05), I:90%). Sexual satisfaction and sexuality score were the same when testosterone was compared or added to estrogen therapy (2 studies, n = 99, smd 0.16 (95%CI-0.23,0.56), I:12% and 2 studies (n = 87), smd 0.20 (95%CI-0.23,0.62), I:0%, respectively. Available data are not adequate to provide counseling by the physicians in menopausal women regarding the efficacy of vaginal therapies as an alternative to estrogens, on all parameters of sexual function.
更年期泌尿生殖综合征（GSM）会增加女性性功能障碍（FSD）的概率。本研究的目的是系统评估有关患有GSM的绝经后女性性功能以及使用替代阴道雌激素（VE）的阴道疗法的数据。利用组合关键词检索了PubMed、Scopus和Cochrane图书馆（2017年5月至9月）：“性交困难与阴道疗法”、“性功能与阴道疗法”、“性高潮与阴道疗法”、“阴道萎缩”以及“更年期泌尿生殖综合征”。符合条件的研究为聚焦于绝经后女性使用替代VE的阴道疗法的随机对照试验（RCT）。这些研究以英文撰写，并发表在具有影响因子的同行评审期刊上。使用Cochrane偏倚风险工具进行偏倚风险评估。结果涉及性交困难、阴道干燥、性高潮以及性功能的所有参数。纳入了29项RCT，包括3689名绝经后女性。替代VE的阴道疗法包括非激素疗法（阴道激光、润滑剂/保湿剂、植物雌激素和利多卡因）和激素疗法（脱氢表雄酮（DHEA）、睾酮和催产素）。72%的文章评估了性交困难和/或阴道干燥，而分别有45%和28%的文章评估了FSD和性高潮。在所有相关研究中，性交困难和阴道干燥均有所改善。润滑剂的性功能评分低于雌激素[3项研究，n = 138，标准化均数差（smd）-0.64，（95%CI -1.1，-0.2）]。0.5%的DHEA和安慰剂的性高潮领域相同（2项研究，n = 663，smd 1.29（95% -0.47，3.05），I：90%）。当比较睾酮或在雌激素治疗中添加睾酮时，性满意度和性功能评分相同（2项研究，n = 99，smd 0.16（95%CI -0.23，0.56），I：12%；以及2项研究（n = 87），smd 0.20（95%CI -0.23，0.62），I：0%）。现有数据不足以让医生就替代雌激素的阴道疗法对性功能所有参数的疗效为绝经后女性提供咨询。
