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外阴凝胶
结论：外阴凝胶并非只有一种，它们是针对不同女性私密健康问题的“多功能武器库”。从治疗难缠的霉菌感染、缓解更年期干涩疼痛，到通过光照治疗皮肤病，现代凝胶技术已经发展出能够“感知体温变形”或“只杀坏菌不伤好菌”的智能形态。
目前的科学证据表明，外阴凝胶主要用于四大类用途：一是抗感染（特别是针对念珠菌/霉菌），二是止痛与修复（针对外阴痛和性交痛），三是更年期护理（针对萎缩和干涩），四是皮肤病治疗（如硬化性苔藓）。有些新型凝胶不含药物，仅靠物理屏障就能改善生活质量；而有些则结合了纳米技术或光动力疗法，效果优于传统药膏。
以下是基于科学文献的详细分类解读：
1. 对抗顽固瘙痒与感染：不仅是杀菌，更是“智能战场”
很多女性深受外阴阴道假丝酵母菌病（俗称霉菌性阴道炎）的困扰。传统的药膏容易流出，且容易把好细菌一起杀死。最新的凝胶技术解决了这些问题。
- 智能“温控”凝胶，喷进去变成胶：
科学家研发了一种新型的原位凝胶（In situ gel）。这种药物在室温下是液体，可以像喷雾一样轻松喷入深处，一旦接触到人体（31°C左右），它就会立刻变成粘稠的凝胶，“粘”在黏膜上不掉下来。
- 数据支持：含有硝酸咪康唑的这种智能凝胶，能持续释放药物长达24小时，释放量达到81.72%，比市面上的普通药膏效果更好 。另一种酮康唑凝胶片剂，只需要3天疗程（每天50mg），效果就能媲美传统大剂量药膏 。
- 只杀坏蛋的“纳米保镖”：
为了防止复发，科学家开发了一种含“纳米酶”的水凝胶（FeLab）。它就像一群微小的巡逻兵，利用一种特殊的化学反应（产生羟基自由基），专门杀死致病的白念珠菌，却不会伤害保护阴道的乳酸杆菌。
- 科学原理：这种凝胶不仅杀菌，还能调节酸碱度，帮助有益菌群（如卷曲乳杆菌）重新生长，从而减少复发 。
- 锌元素的“灭火”作用： 有时霉菌感染引起剧烈瘙痒，不是因为细菌多，而是因为身体的免疫反应太激烈。研究发现，霉菌在缺锌时会释放一种引发炎症的蛋白质。使用含锌的凝胶，可以“欺骗”霉菌，抑制其发炎基因的表达，从而防止炎症和疼痛 。
名词解释：原位凝胶（In situ gel） 想象一下胶水，在瓶子里是水状的，倒出来遇到空气才变干变粘。原位凝胶类似，它是遇到“人体温度”或“身体酸碱度”后，瞬间从液体变成半固体的果冻状，这样药物就能牢牢贴在生病的地方，不会流得到处都是。
2. 缓解疼痛与同房不适：不含药也能起效
很多女性会感到莫名的外阴疼痛（外阴痛）或同房疼痛，这严重影响生活。凝胶在这里扮演了润滑剂和修复剂的角色。
- 无药凝胶也能提升“性福”：
对于一种叫“诱发性前庭痛”（一碰就痛）的疾病，研究表明，即便是不含药物成分的化妆品级凝胶（主要起保湿、润滑、保护作用），也能显著改善女性的性功能评分。
- 数据支持：使用一种名为Meclon Lenex的保护性凝胶后，患者的灼烧感、红斑和性交痛等级都有统计学意义上的显著下降 。
- 更年期的“回春”凝胶：
绝经后女性常因雌激素下降导致外阴萎缩、干涩。使用极低剂量的雌三醇凝胶（0.005%浓度）涂抹在外阴前庭，可以有效缓解疼痛。
- 数据支持：在一项针对老年女性的研究中，使用这种凝胶12周后，81.4% 的患者同房疼痛被治愈或明显改善（评分降至1分及以下） 。
- 非激素类的止痒选择： 如果不希望使用激素，含维生素E和乳香酸（boswellic acids）的无水脂质凝胶也是很好的选择，它能有效缓解瘙痒、干燥和红斑，特别适合作为激素治疗的补充手段 。
3. 治疗难治性皮肤病：光照下的“魔法”
对于外阴硬化性苔藓（一种导致皮肤变白、变硬、剧痒的慢性病）或尖锐湿疣，普通药膏效果有限。医生会使用一种含有5-氨基乙酰丙酸（ALA）的特殊凝胶，配合红光照射，这叫做光动力疗法（PDT）。
- 治疗过程：先涂上这种凝胶，让病变细胞吸收几个小时，然后用特定波长的光照射，以此“引爆”病变细胞，而正常细胞不受影响。
- 数据支持：这种疗法对87.25% 的外阴硬化性苔藓患者有效，尤其在减少皮下出血和裂口方面效果显著（改善率约70-78%） 。对于尖锐湿疣，这种疗法的完全清除率可达66%，且愈合时间短，不易留疤 。
4. 警惕：凝胶不是万能的，错误的卫生习惯会致病
虽然凝胶很有用，但并不是所有涂抹在外阴的产品都是好的。错误的清洁和护理习惯反而会导致疾病。
- 过度清洁与脱毛的风险：
研究发现，过度的卫生习惯可能与外阴痛的发生有关。
- 数据支持：相比于不怎么穿紧身裤的女性，每周穿4次或以上紧身牛仔裤或裤子的女性，患外阴痛的几率是别人的2倍。
- 此外，经常从阴阜（耻骨部位）去除体毛（尤其是每周一次或更频繁）的女性，患外阴痛的几率也接近2倍 。
- 特别值得注意的是，患有外阴痛的女性，使用肥皂或凝胶清洁外阴的比例反而较低，这暗示了可能之前过度的刺激导致了疼痛，或者她们因为疼痛而不敢再乱用清洁产品 。
名词解释：外阴硬化性苔藓（Lichen Sclerosus） 这不是一种普通的皮疹，而是一种会让外阴皮肤变得像羊皮纸一样薄、白、皱缩的慢性病，非常痒，如果不治疗可能会导致结构改变甚至癌变。光动力疗法中的凝胶是作为一种“光敏剂”来辅助治疗的。
总结建议
如果您考虑使用外阴凝胶：
- 分清目的：是治霉菌（选含咪康唑、酮康唑等成分或益生菌的）、治干涩（选含雌三醇或维生素E的），还是治皮肤病（需医生操作的光动力凝胶）。
- 关注剂型：新型的“温敏凝胶”或“脂质体凝胶”通常比老式药膏更不容易流出来，药效更持久。
- 不要滥用清洁凝胶：日常清洁清水即可，过度使用洗液或频繁脱毛、穿紧身裤可能适得其反，引发疼痛。
References
1A probiotic nanozyme hydrogel regulates vaginal microenvironment for vaginitis therapy.PubMed
Gen Wei, Quanyi Liu, Xiaoyu Wang, et al.
Sci Adv. 2023 May 19;9(20):eadg0949. doi: 10.1126/sciadv.adg0949. Epub 2023 May 17.
Molecular therapeutics are limited for vaginitis because they damage normal cells and tissues of vagina, aggravating the imbalance of vaginal microbiota and increasing the recurrence. To tackle this limitation, through the combination of peroxidase-like rGO@FeS nanozymes [reduced graphene oxide (rGO)] with -produced lactic acid and HO, a responsive hyaluronic acid (HA) hydrogel rGO@FeS/@HA (FeLab) is developed. FeLab has simultaneous anti- and vaginal microbiota-modulating activities. In particular, the hydroxyl radical produced from rGO@FeS nanozymes and kills isolated from clinical specimens without affecting . In mice with vaginitis, FeLab has obvious anti- activity but hardly damages vaginal mucosa cells, which is beneficial to vaginal mucosa repair. Moreover, a higher proportion of (especially ) and a decrease in reshape a healthy vaginal microbiota to reduce the recurrence. These results provide a combined therapeutic of nanozymes and probiotics with translational promise for vaginitis therapy.
2Zinc prevents vaginal candidiasis by inhibiting expression of an inflammatory fungal protein.PubMed
Elena Roselletti, Eva Pericolini, Alexandre Nore, et al.
Sci Transl Med. 2023 Dec 6;15(725):eadi3363. doi: 10.1126/scitranslmed.adi3363.
causes an estimated half-billion cases of vulvovaginal candidiasis (VVC) every year. VVC is most commonly caused by , which, in this setting, triggers nonprotective neutrophil infiltration, aggressive local inflammation, and symptomatic disease. Despite its prevalence, little is known about the molecular mechanisms underpinning the immunopathology of this fungal infection. In this study, we describe the molecular determinant of VVC immunopathology and a potentially straightforward way to prevent disease. In response to zinc limitation, releases a trace mineral binding molecule called Pra1 (pH-regulated antigen). Here, we show that the gene is strongly up-regulated during vaginal infections and that its expression positively correlated with proinflammatory cytokine concentrations in women. Genetic deletion of prevented vaginal inflammation in mice, and application of a zinc solution down-regulated expression of the gene and also blocked immunopathology. We also show that treatment of women suffering from recurrent VVC with a zinc gel prevented reinfections. We have therefore identified a key mediator of symptomatic VVC, giving us an opportunity to develop a range of preventative measures for combatting this disease.
3Atomic Insights Into Self-Assembly of Zingibroside R1 and its Therapeutic Action Against Fungal Diseases.PubMed
Mengyun Peng, Qiwei Peng, Wei Li, et al.
Adv Mater. 2025 Jul;37(26):e2503283. doi: 10.1002/adma.202503283. Epub 2025 May 6.
Natural products are a crucial resource for drug discovery, but poor understanding of the molecular-scale mechanisms of their self-assembly into soluble, bioavailable hydrogels limits their applications and therapeutic potential. It is demonstrated that Zingibroside R1 (ZR1), derived from Panax notoginseng, undergoes spontaneous self-assemble into a hydrogel comprising helical nanofibrils with potent antifungal activity lacking in its monomeric state. Cryogenic electron microscopy (cryo-EM) revealed an intricate hydrogen-bonding network that facilitates ZR1 nanofibril formation, characterized by a hydrophobic core and hydrophilic exterior architecture, which underpin its binding activity with cell wall in the vulvovaginal candidiasis (VVC) pathogen, C. albicans. The hydrogen-bonding interface between ZR1 gel and glucan compromises membrane integrity, inhibiting C. albicans proliferation in vitro and in VVC model mice in vivo. ZR1 gel could also deliver probiotic Lactobacillus, synergistically inhibiting VVC and restoring the vaginal microenvironment. This study advances the mechanistic understanding of ZR1's structure-function relationships, offering valuable insights into the rational design and therapeutic optimization of natural product-based hydrogels.
4What's New in Cosmetic Dermatology.PubMed
Anthony V Benedetto
Dermatol Clin. 2019 Jan;37(1):117-128. doi: 10.1016/j.det.2018.08.002.
Topical silicone gel is more beneficial than petrolatum-based products as an all-purpose wound dressing for granulating and sutured wounds, regardless of cause. Vaginal laser rejuvenation is effective in relieving genitourinary syndrome of menopause, stress urinary incontinence, vaginal relaxation syndrome, and related vulvar disorders. New cosmetic indications in the upper face for onabotulinumtoxinA have been approved by the Food and Drug Administration, whereas off-label treatments in the lower face increase in popularity. Clinical trials of uncomplexed daxibotulinumtoxinA demonstrate safety and efficacy lasting more than 6 months.
5Stimuli-Responsive in situ Spray Gel of Miconazole Nitrate for Vaginal Candidiasis.PubMed
Yong Kai Hsin, Thaneswary Thangarajoo, Hira Choudhury, et al.
J Pharm Sci. 2023 Feb;112(2):562-572. doi: 10.1016/j.xphs.2022.09.002. Epub 2022 Sep 9.
Vaginal candidiasis is a common form of infection in women caused by Candida species. Due to several drawbacks of conventional treatments, the current research is attempted to formulate and optimize a miconazole nitrate-loaded in situ spray gel for vaginal candidiasis. The stimuli-responsive (pH and thermo-responsive) polymers selected for the in situ gel were chitosan and poloxamer 407, respectively, whereas hydroxypropyl methylcellulose (HPMC) was introduced in the formulation to further improve the mucoadhesive property. The dispersion of each polymer was carried out using the cold method, whereas the optimization of the formulation was achieved using Box-Behnken statistical design considering viscosity and gelation temperature as dependent variables. Present design achieved the optimized outcome with HPMC, poloxamer and chitosan at 0.52% (w/v), 18.68% (w/v) and 0.41% (w/v), respectively. Evaluation of drug-excipients compatibility was performed using differential scanning calorimetry, Fourier transform infrared spectroscopy, and thermogravimetric analysis where the results showed the absence of any chemical interaction between the polymers and drug component. The optimized formulation showed gelation temperature at 31°C allowing in situ phase transition in a vaginal environment; pH of 4.21 is suitable for use in the vaginal cavity, and appropriate viscosity (290 cP) at storage temperature (below 30°C) would allow spraying at ease, whereas strong mucoadhesive force (22.4±0.513 g) would prevent leaking of the formulation after application. The drug release profile showed sustained release up to 24 h with a cumulative drug release of 81.72%, which is significantly better than the marketed miconazole nitrate cream. In addition, an improved antifungal activity could be correlated to the sustained release of the drug from the formulation. Finally, the safety of the formulation was established while tested on HaCaT cell lines. Based on our findings, it could be concluded that the in situ hydrogel formulation using stimuli-responsive polymers could be a viable alternative to the conventional dosage form that can help to reduce the frequency of administration with ease of application to the site of infection, thus will provide better patient compliance.
6Formulation and Characterization of Sertaconazole Nitrate Mucoadhesive Liposomes for Vaginal Candidiasis.PubMed
Menna M Abdellatif, Islam A Khalil, Yara E Elakkad, et al.
Int J Nanomedicine. 2020 Jun 11;15:4079-4090. doi: 10.2147/IJN.S250960. eCollection 2020.
PURPOSE: The aim of this study is to develop efficient localized therapy of sertaconazole nitrate for the treatment of vaginal candidiasis. METHODS: Sertaconazole nitrate-loaded cationic liposomes were prepared by thin-film hydration method and coated with different concentrations of pectin (0.05%, 0.1% and 0.2%) to develop mucoadhesive liposomes. The formulated mucoadhesive vesicles were characterized in terms of morphology, entrapment efficiency, particle size, zeta value, mucoadhesive properties and drug release. The selected formula was incorporated into a gel base and further characterized by an ex vivo permeation study in comparison with conventional sertaconazole gel. Also, the in vivo study was performed to assess the efficacy of sertaconazole mucoadhesive liposomal gel in treating rats with vaginal candidiasis. RESULTS: The mucoadhesive liposomes were spherical. Coating liposomes with pectin results in increased entrapment efficiency and particle size compared with uncoated vesicles. On the contrary, zeta values were reduced upon coating liposomes with pectin indicating efficient coating of liposomes with pectin. Mucoadhesive liposomes showed a more prolonged and sustained drug release compared with uncoated liposomes. Ex vivo study results showed that mucoadhesive liposomal gel increased sertaconazole tissue retention and reduced drug tissue penetration. In the invivo study, the mucoadhesive liposomal gel showed a significant reduction in the microbial count with a subsequent reduction in inflammatory responses with the lowest histopathological change compared with conventional gel. CONCLUSION: The study confirmed the potentiality of employing mucoadhesive liposomes as a successful carrier for the vaginal delivery of antifungal drugs.
7New Topical Therapy for Provoked Vestibulodynia: Improvement of Psychological and Sexual Well-Being.PubMed
Francesco De Seta, Patrizia Ianniello, Stefania Carlucci, et al.
Int J Environ Res Public Health. 2023 Jan 20;20(3):1931. doi: 10.3390/ijerph20031931.
Vulvodynia is a vulvar discomfort that occurs in the absence of any specific, clinically identifiable disorder. Few therapies have shown to be effective for the treatment of vulvodynia. In our recently published study, we tested a drug-free gel in women affected by vulvar vestibulitis. It is a cosmetic gel which acts locally without any metabolic, pharmacological or immunological effect. In order to further promote the validity of this new product, in this manuscript we analyzed the results obtained from the administration of four questionnaires in the same two groups of women affected by PVD and treated with a placebo and the new product. The questionnaires used: Female Sexual Function Index Scoring (FSFI), Female Sexual Distress Scale (FSDS), Hospital Anxiety and Depression Scale (HADS), and health-related quality of life measured by SF-36 (SF-36). The results obtained by this current analysis showed that the new gel has also proven benefits on women's quality of life and sexual function, including improvements in arousal, desire, orgasm and satisfaction.
8Exploring Hygienic Behaviors and Vulvodynia.PubMed
Alexandra M Klann, Jessica Rosenberg, Tanran Wang, et al.
J Low Genit Tract Dis. 2019 Jul;23(3):220-225. doi: 10.1097/LGT.0000000000000477.
OBJECTIVES: Vulvodynia is common and characterized by vulvar discomfort and pain. However, few studies have assessed hygienic practices in relation to onset. We investigated whether hygienic behaviors were associated with the onset of vulvodynia. MATERIALS AND METHODS: We assessed a self-reported history of personal hygienic behaviors, including wearing tight-fitting clothing, vulva care and genital washing, pubic hair removal, douching, and powdering, a year before first reported onset of vulvar pain among 213 clinically confirmed cases and a similar time period among 221 general population controls. RESULTS: Compared with women who reported never wearing tight-fitting jeans or pants, women wearing tight-fitting jeans or pants 4 or more times per week had twice the odds of vulvodynia (95% CI = 1.14-3.95). Relative to controls, women with vulvodynia were substantially less likely to report use of soaps and gels to cleanse the vulva (95% CI = 0.17-0.63). Among women who chose to remove pubic hair, those who removed pubic hair from the mons pubis compared with bikini-area only hair removal, were 74% more likely to have vulvodynia (95% CI = 1.05-2.89). Finally, compared with women who reported bikini-area only hair removal less than monthly, those who removed hair from the mons pubis weekly or more were nearly 2 times more likely to be vulvodynia cases (95% CI = 0.83-3.49). CONCLUSIONS: Wearing tight-fitting jeans or pants and removing hair from the mons pubis area were associated with increased odds of vulvodynia. Research on how hygienic practices could influence vulvar pain in larger and more temporally addressed populations is warranted.
9Photodynamic therapy in the treatment of vulvar lichen sclerosus.PubMed
Agnieszka Maździarz, Beata Osuch, Magdalena Kowalska, et al.
Photodiagnosis Photodyn Ther. 2017 Sep;19:135-139. doi: 10.1016/j.pdpdt.2017.05.011. Epub 2017 May 17.
BACKGROUND: Vulvar lichen sclerosus is a chronic and incurable disease that causes various unpleasant symptoms and serious consequences. OBJECTIVE: The purpose of the study was to assess the effectiveness of photodynamic therapy in the treatment of vulvar lichen sclerosus. METHODS: Participants in the study included 102 female patients aged 19-85 suffer from vulvar lichen sclerosus. The patients underwent photodynamic therapy (PDT). In the course of PDT the 5% 5- aminolevulinic acid was used in gel form. The affected areas were irradiated with a halogenic lamp PhotoDyn 501 (590-760nm) during a 10-min radiation treatment. The treatment was repeated weekly for 10 weeks. RESULT: PDT has brought about a good therapeutic effect (complete or partial clinical remission), with 87.25% improvement rate in patients suffering from lichen sclerosus. The greatest vulvoscopic response was observed in the reduction of subepithelial ecchymoses and teleangiectasia (78.95%), and the reduction of erosions and fissures (70.97%). A partial remission of lichenification with hyperkeratosis was observed in 51.61% of cases. The least response was observed in the atrophic lesions reduction (improvement in 37.36% of cases). CONCLUSION: Our patients suffering from vulvar lichen sclerosus demonstrated positive responses to photodynamic therapy and the treatment was well tolerated. Photodynamic therapy used to treat lichen sclerosus yields excellent cosmetic results.
10Epstein-Barr virus and human papillomavirus infection in vulvar lichen sclerosus.PubMed
Susana Aidé, Fernanda Ribeiro Lattario, Gutemberg Almeida, et al.
J Low Genit Tract Dis. 2010 Oct;14(4):319-22. doi: 10.1097/LGT.0b013e3181d734f1.
OBJECTIVE: We investigated the presence of the Epstein-Barr virus (EBV) and human papillomavirus (HPV) in patients with vulvar lichen sclerosus (LS). MATERIALS AND METHODS: We investigated the presence of HPV and EBV from 34 vulvar biopsies of patients with LS who had had no previous treatment and from 17 normal vulvar brushings used as controls. We used polymerase chain reaction to amplify DNA sequences of these viruses. Human papillomavirus and EBV DNA detection was carried out using MY09/MY11 and TC67/TC69 consensus primers, respectively. The amplified polymerase chain reaction products were analyzed by 10% polyacrylamide gel. RESULTS: The mean age of the patients was 57 years old, with the majority postmenopausal. Human papillomavirus DNA was not found in the LS samples studied, but it was found in 23.2% (4/17) of the controls. However, EBV DNA was found in 26.5% (9/34) of the LS samples analyzed, and it was not found in the controls. CONCLUSIONS: Our results showed no relationship between HPV and LS. This result is in accordance with the literature. We have found 26.5% of EBV in our samples. This is a preliminary study, and the follow-up of these patients will elucidate whether EBV could play a role in cases of LS.
11New options for menopausal symptoms after 15 years of WHI Study.PubMed
Santiago Palacios, Pluvio J Coronado
Minerva Ginecol. 2017 Apr;69(2):160-170. doi: 10.23736/S0026-4784.16.04007-7. Epub 2016 Dec 14.
Menopausal symptoms include vasomotor symptoms (VMS), vulvar-vaginal atrophy, and loss of bone mass associated with an increased risk of fracture. Treatment of VMS consists of lifestyle changes, hormone treatment (estrogens with and without progestogens, tissue selective estrogens complex or conjugated estrogens and bazedoxifene [CE/BZA], progestogens, and tibolone), and nonhormonal treatments. Genitourinary symptoms due to vulvar-vaginal atrophy are treated with systemic and local hormones, moisturizer creams and gels, CE/BZA, and a selective estrogen receptor modulator (ospemifene). In addition to lifestyle changes, treatments for the risk of fragility fracture include calcium and vitamin D, hormone treatment, selective estrogen receptor modulators (raloxifene, BZA), bisphosphonates, strontium ranelate, denosumab, and teriparatide. This article reviews treatment options and provides treatment algorithms for women with menopausal symptoms.
12Efficacy of ketoconazole gel-flakes in treatment of vaginal candidiasis: Formulation, in vitro and clinical evaluation.PubMed
Noura H Abd Ellah, Jelan A Abdel-Aleem, Mariana N Abdo, et al.
Int J Pharm. 2019 Aug 15;567:118472. doi: 10.1016/j.ijpharm.2019.118472. Epub 2019 Jun 25.
Candida albicans, as the main causative fungus of vaginal candidiasis, is currently a global issue of concern due to its high prevalence, biofilm formation and emergence of resistance. Ketoconazole (KTZ), an antifungal drug, which has poor water-solubility and penetration capacity, is ineffective against deep-seated Candida infection. Considering these issues, this work aimed to develop a novel multifunctional carrier for KTZ via encapsulation of KTZ/β-cyclodextrin (β-CD) co-ground mixture into chitosan/gellan gum gel-flakes (threadlike and polygonal structures). Analytical studies revealed existence of electrostatic-derived complexes between negatively charged gellan gum and positively charged chitosan. Gel-flakes were then loaded in in situ gel of pluronic F-127 (PF-127). Based on gelation temperature (T), viscosity and release studies; selected formulation was further evaluated, showing significant in vitro anti-candida activity. Despite reduced dosage regimen (50 mg/daily/three days), KTZ flakes in situ gel was as effective as Gynoconazol vaginal cream® (80 mg terconazole/daily/three days) in improving patient complaints and Candida eradication. Multifunctionality of KTZ carrier was based on efficient spreading and coating of the vagina due to free-flowing properties during application, flakes entanglement within folded vaginal epithelia, sustained release and increased penetration capacity of KTZ to reach deep-seated infections. In conclusion, flakes in situ gel could be considered as a highly promising KTZ delivery option for treatment of vaginal candidiasis.
13Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial neoplasia using topically applied 5-aminolevulinic acid.PubMed
Mathias K Fehr, René Hornung, Andrea Degen, et al.
Lasers Surg Med. 2002;30(4):273-9. doi: 10.1002/lsm.10048.
BACKGROUND AND OBJECTIVES: To determine the feasibility of photodynamic therapy (PDT) of vulvar and vaginal condyloma and intraepithelial neoplasia (VIN, VAIN) and to compare PDT results with conventional treatments. STUDY DESIGN/MATERIALS AND METHODS: Thirty-eight patients with vulvar or vaginal intraepithelial neoplasia (VIN) grade II/III (n = 22) or condyloma (n = 16) had 10% 5-aminolevulinic acid (ALA)-gel applied topically. After 2-4 hours, 80-125 J/cm(2) laser light at a wavelength of 635 nm was applied. PDT was compared to conventional treatments for condyloma (CO(2) laser evaporation) and for VIN III (laser evaporation, surgical excision). RESULTS: The complete clearance rate for condyloma treated by PDT was 66% and the rate for IN was 57% (as determined by biopsy). Of the neoplasia patients, none with hyperkeratotic VIN (n = 4) responded, and only one of four with increased pigmentation cleared. No scarring occurred, and postoperative discomfort lasted 4.9 +/- 3.4 days. Reduced disease-free survival (DFS) was associated with multifocal VIN (P = 0.02, OR 2.17, 95% CI 1.15-4.08), but DFS did not vary with treatment mode. CONCLUSIONS: Although PDT is not equally efficacious for all subgroups, PDT for condyloma and intraepithelial neoplasia appears to be as effective as conventional treatments, but with shorter healing time and excellent cosmetic results.
14Provoked Vestibulodynia and Topical Treatment: A New Option.PubMed
Francesco De Seta, Guglielmo Stabile, Graziana Antoci, et al.
Healthcare (Basel). 2022 Apr 30;10(5):830. doi: 10.3390/healthcare10050830.
BACKGROUND: Provoked vestibulodynia is commonly associated with dyspareunia and affects 7% to 15% of women. This pathology has major implications on sexual function and quality of life, and several types of treatments are available for its management. However, a consensus has not been reached concerning the best treatment of vulvar pain. The aim of this study was to assess the efficacy and safety of a brand-new product, the vulvar emulgel Meclon Lenex, for the management of provoked vestibulodynia and non-infective vulvitis. METHODS: This was a monocentric, prospective, randomized, double-blind and placebo-controlled study. We enrolled 40 women with provoked vestibulodynia; 20 patients received Meclon Lenex, whereas the remaining received a placebo. Each woman was assessed subjectively (through questionnaires) and objectively by evaluating vaginal and vulvar symptoms (Friedrichs criteria and Marinoff dyspareunia grade). We evaluated efficacy, safety, compliance and tolerability of the brand-new product vulvar gel Meclon Lenex in provoked vestibulodynia. RESULTS: After administration of Meclon Lenex, we evaluated all parameters of the Friedrichs criteria (burning, dyspareunia, erythema, vulvar pain at the 5 o'clock position and 7 o'clock position), as well as the levels of Marinoff dyspareunia. The active treatment showed to be statistically significantly effective ( value ≤ 0.05) in reducing all symptoms of Friedrichs criteria, vulvar pain and Marinoff dyspareunia. CONCLUSION: This prospective study showed that Meclon Lenex vulvar emulgel revealed an excellent tolerability and compliance, demonstrating to be a safe and effective option in the treatment of provoked vestibulodynia and non-infective vulvitis.
15Coital pain in the elderly: could a low dose estriol gel thrill the vulvar vestibule?PubMed
Filippo Murina, Alessandra Graziottin, Raffaele Felice, et al.
Eur J Obstet Gynecol Reprod Biol. 2016 Dec;207:121-124. doi: 10.1016/j.ejogrb.2016.10.016. Epub 2016 Nov 2.
OBJECTIVE: The aim of this study was to evaluate the effectiveness of the application of 0.005% estriol gel to the vulvar vestibule in the management of postmenopausal dyspareunia. STUDY DESIGN: Postmenopausal women with dyspareunia were enrolled in this study. Patients were instructed to use a fingertip to apply 0.25g of vaginal gel containing 25μg of estriol to the vulvar vestibule daily for three weeks and then twice weekly for up to 12 weeks. RESULTS: Assessment of symptoms (dyspareunia and cotton swab test) and signs of vestibular atrophy were performed, and changes between baseline and weeks 3 and 12 were assessed. Adverse events were recorded. A total of 63 women were included. Of the 63, 59 (93.6%) completed the 12-week treatment period, and four dropped out for vestibular burning. Dyspareunia improved or was cured (score ≤1) by week 12 in 81.4% of patients. The patients also showed a statistically significant reduction in vestibular atrophy and cotton swab test at the end of treatment. CONCLUSIONS: Application of 0.005% estriol gel to the vulvar vestibule is effective in correcting menopausal coital pain. This suggests that reduction in sensory vestibular innervation sensitivity is likely to play a pivotal role in the relief of dyspareunia. One limitation of this study is the limited follow-up, but the therapy may be continued for as long as the patients are distressed by their symptoms without estrogen intervention.
16Features of pigmented vulval lesions on dermoscopy.PubMed
S Ronger-Savle, V Julien, G Duru, et al.
Br J Dermatol. 2011 Jan;164(1):54-61. doi: 10.1111/j.1365-2133.2010.10043.x. Epub 2010 Nov 12.
BACKGROUND: The dermoscopic criteria for benign and malignant lesions on the vulva are not well established due to the lack of large series of such lesions. Melanoma should always be included in the differential diagnosis of pigmented lesions on the vulva especially when they are wide, or of recent onset. Elsewhere on the skin dermoscopy plays an important role in the selection of suspicious pigmented lesions, as well as in the selection of the best site to perform the biopsy. OBJECTIVES: To analyse the dermoscopic patterns observed in pigmented lesions of the vulva. METHODS: We analysed a nonselected consecutive series of 68 histopathologically proven cases comprising five melanomas, 16 naevi, 20 lentigos, 12 benign vulval melanoses, 11 cases of postinflammatory pigmentation, three pigmented cases of usual vulval intraepithelial neoplasia (VIN) and one seborrhoeic keratosis seen at our institution. The dermoscope was covered by translucent disposable food wrap and/or antibacterial gel to prevent possible transmission of infections. Descriptive statistics were performed using multiple correspondence analysis. RESULTS: The parallel (37%), ring-like (9%), homogeneous (22%), globular-like (13%) and reticular-like (6%) patterns were observed on benign lesions (naevi, lentigo, vulval melanosis and postinflammatory pigmentation). The cerebriform pattern (6%) was observed only on VIN and seborrhoeic keratosis. The multicomponent pattern (6%) was associated with melanoma (60%). In cases of melanoma we also occasionally observed an irregular pattern, a whitish or blue-whitish veil, irregularly distributed dots and globules and atypical vascular pattern. Using multiple correspondence analysis, we designed a new algorithm for the early detection of vulval melanomas. CONCLUSIONS: Dermoscopy can play a role in the noninvasive classification of vulval melanosis. However, further studies of larger collaborative series are needed to validate our vulval melanoma diagnostic algorithm. VIN and seborrhoeic keratosis share the same dermoscopic features and biopsy should be considered for seborrhoeic-like keratosis. In case of doubt pathological examination of a biopsy remains mandatory.
17[Treatment of atrophic and irritative vulvovaginal symptoms with an anhydrous lipogel and its complementary effect with vaginal estrogenic therapy: new evidences].PubMed
L Del Pup
Minerva Ginecol. 2010 Aug;62(4):287-91.
It is sometimes difficult to treat vulvovaginal itching and dryness, which represent frustrating symptoms for both patients and doctors. In case that the etiological agent is Candida albicans, effective antimycotic therapies are available; however, itching is often caused by aspecific allergic-irritative factors, which are difficult to be defined. In these cases, patients are invited to limit local irritative factors; nevertheless, this advice is not always taken and sometimes it turns out to be insufficient. Besides behavioral suggestions, a therapeutic support would be useful; medical doctors habitually prescribe local symptomatic treatments which, however, do not target numerous causes of irritative vulvovaginal symptomatology, though they are formulated for vulvovaginal application. If there is estrogenic deficit, the best therapeutic approach is based on topical estrogenic therapy, which is sometimes ineffective on vulvar symptoms. Frequently, it is necessary to choose a complementary therapeutic tool for vaginal application in order to alleviate itching, burning, erythema, dryness. The aim of this study was to evaluate the efficacy of an innovative anhydrous lipogel containing vitamin E and boswellic acids. Results of this study, performed on 34-58-year-old patients, confirmed the efficacy of the lipogel on irritative vulvovaginal symptoms. In postmenopausal women, the lipogel is a useful synergistic complement to topical hormonal therapy.
18Impact of a lactobacilli-containing gel on vulvovaginal candidosis and the vaginal microbiome.PubMed
Eline F M Oerlemans, Gert Bellen, Ingmar Claes, et al.
Sci Rep. 2020 May 14;10(1):7976. doi: 10.1038/s41598-020-64705-x.
Vulvovaginal candidosis (VVC) is a common condition with severe symptoms and high recurrence rates. Probiotic lactobacilli are explored as alternatives to azole treatments. Although the vaginal microbiota is generally not depleted in lactobacilli during VVC, studies indicate that the functionality and antimicrobial activity of the lactobacilli is impaired. We selected three strains from the Lactobacillus genus complex (L. rhamnosus GG, L. pentosus KCA1 and L. plantarum WCFS1) based on in vitro evaluation and formulated them in a gel for vaginal application. This gel was evaluated in 20 patients suffering from acute VVC, who were followed for four weeks including a 10-day treatment period. The microbiome was assessed through 16S rRNA (bacteria) and internal transcribed spacer (ITS; fungi) amplicon sequencing, supplemented with quantitative PCR, culture and microscopy for Candida evaluation. 45% of women did not require rescue medication (3×200 mg fluconazole), implying an improvement of their symptoms. These women showed similar end concentrations of fungi as women treated with fluconazole. Moreover, fluconazole appeared to reduce numbers of endogenous lactobacilli. Our study points towards important aspects for future selection of lactobacilli for probiotic use in VVC and the need to investigate possible negative influences of azoles on the vaginal bacterial community.
19Nanolipid Gel of an Antimycotic Drug for Treating Vulvovaginal Candidiasis-Development and Evaluation.PubMed
Dnyanesh Takalkar, Namita Desai
AAPS PharmSciTech. 2018 Apr;19(3):1297-1307. doi: 10.1208/s12249-017-0918-7. Epub 2018 Jan 16.
This paper focuses on the development and evaluation of mucoadhesive vaginal gel of fluconazole using nanolipid carriers to enhance tissue deposition in treating vulvovaginal candidiasis. Treatment of vulvovaginal candidiasis includes antimycotic agents prescribed for 1 to 7 days or longer, in relapse either orally or topically. The delivery of fluconazole as nanolipid carriers in vaginal gel can be proposed as suitable alternative to the existing conventional formulations to improve the patient acceptability, compliance and localized drug action. The nanolipid carriers of fluconazole were prepared by phase inversion temperature technique and incorporated into Carbopol 974P as gelling polymer. GRAS excipients selected and optimized were Precirol ATO 5, oleic acid and Kolliphor RH 40 to produce nanolipid dispersions. Stable nanolipid dispersions were developed using sodium dodecyl sulfate as the charge inducer. The optimized nanolipid dispersion of fluconazole had particle size, polydispersity index and zeta potential value of 158.33 ± 2.55 nm, 0.278 ± 0.003 and - 27.33 ± 0.40 mV, respectively and the average entrapment of fluconazole in the lipid carriers was found to be 67.24 ± 0.87%. The optimized vaginal gel had satisfactory mucoadhesive strength and rheological properties to facilitate vaginal application. The fluconazole release from the gel was sustained showing 30.69 ± 1.02% drug deposition in the porcine vaginal mucosa at the end of 8 h with improved antifungal activity against Candida albicans during well diffusion studies. The optimized gel was non-irritant to the vaginal mucosa of female Wistar rats with no signs of erythema or edema.
20Development of a novel synergistic thermosensitive gel for vaginal candidiasis: an in vitro, in vivo evaluation.PubMed
Mohd Aamir Mirza, Sayeed Ahmad, Md Nasar Mallick, et al.
Colloids Surf B Biointerfaces. 2013 Mar 1;103:275-82. doi: 10.1016/j.colsurfb.2012.10.038. Epub 2012 Oct 30.
The singular aim of the proposed work is the development of a synergistic thermosensitive gel for vaginal application in subjects prone to recurrent vaginal candidiasis and other microbial infections. The dual loading of Itraconazole and tea tree oil in a single formulation seems promising as it would elaborate the microbial coverage. Despite being low solubility of Itraconazole in tea tree oil, a homogeneous, transparent and stable solution of both was created by co-solvency using chloroform. Complete removal of chloroform was authenticated by GC-MS and the oil solution was used in the development of nanoemulsion which was further translated into a gel bearing thermosensitive properties. In vitro analyses (MTT assay, viscosity measurement, mucoadhesion, ex vivo permeation, etc.) and in vivo studies (bioadhesion, irritation potential and fungal clearance kinetics in rat model) of final formulation were carried out to establish its potential for further clinical evaluation.