Menopause Clinical Trial
Official title:
Effects of a New Vaginal Cream Containing Visnadine, Prenylflavonoids and Bovine Colostrum in Postmenopausal Sexually Active Women Affected by Vulvovaginal Atrophy: a Prospective Cohort Analysis
The effects of a new vaginal cream containing visnadine (0.30%), prenylflavonoids (0.10%) and
bovine colostrum (1%) will be evaluated in post-menopausal sexually active women affected by
vulvovaginal atrophy (VVA).
In a prospective cohort study, post-menopausal women affected by VVA will be enrolled. All
women will undergo vaginal health index score (VHIS) evaluation and will complete the female
sexual function index (FSFI) questionnaire at baseline evaluation (T0) and following 15 days
of vaginal cream treatment with one application per day (T1). All the side effects will be
recorded and an independent data safety and monitoring committee will evaluate the results of
the study.
Sexual health plays a key role during women's lives from puberty to post-menopausal period
and, for this reason, it has increasingly received public health, pharmaceutical, and medical
attention. According to the study of women's health across the nation (SWAN), more than 75%
of the middle-aged women reported that sex was moderately to extremely important; in
addition, the menopausal transition was characterized by increasing pain during sexual
intercourse and consequent decrease of sexual desire. Individual general health status,
diabetes mellitus, cardiovascular diseases, other genitourinary diseases,
psychiatric/psychological disorders, other chronic diseases and socio-demographic conditions
may all influence post-menopausal sexual health. Although aging could be considered an
independent risk factor for sexual dysfunction accumulating evidence suggests that
vulvovaginal atrophy (VVA) is strongly associated with female sexual dysfunction (FSD) among
sexually active postmenopausal women: in particular, VVA was found to be significantly
associated with a global indication of FSD and difficulties with sexual desire, arousal, and
orgasm. VVA often results from postmenopausal estrogen loss, which acts as a double-edged
sword: on the one hand, it plays a detrimental action on woman's desire and arousal; on the
other hand, it decreases the lubrication of the vagina before sexual activity and,
consequently, causes pain during intercourse, precludes satisfaction and further decreases
arousal.
Although several pharmacological approaches have been evaluated for the relief of VVA. Local
estrogens are considered a safe option for VVA, although many clinicians are hesitant to
prescribe them and many women reluctant to use them. In addition, non-hormonal treatments
such as moisturizers and precoital vaginal lubricants could be considered a safer
alternative, even in cancer patients. In this regard, visnadine, an active ingredient of the
fruit of Ammi visnaga, showed powerful vasodilatory activity, due to the inhibitory effects
on vascular smooth muscles mediated by Ca2+ entry through voltage-gated L-type Ca2+ channels.
In addition, visnadine improves both female sexual function index (FSFI) and color Doppler
sonography of clitoral blood flow. Furthermore, prenylflavonoids and phytoestrogens play a
potent role as estrogen receptor (ER)-alpha selective agonist, thus they may counteract the
effects of postmenopausal estrogen loss. Finally, a vaginal cream containing bovine colostrum
has been shown to be effective in relieving vaginal dryness and other VVA symptoms in
postmenopausal women, after 8 weeks of treatment. Based on this information, the
investigators aim to evaluate the effects of a new vaginal cream containing visnadine,
prenylflavonoids and bovine colostrum on vaginal health index score (VHIS) and FSFI in a
cohort of postmenopausal sexually active women affected by VVA.
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