Alterations in mucosal transudation in vulvovaginal atrophy: what mechanisms are involved?

The role of hyaluronic acid in influencing vaginal lubrication

Denis COUCHOUREL, PhD
Medical and Scientific Director of Vivacy Laboratories

INTRODUCTION

In 2014, the foundations for the definition of genitourinary menopausal syndrome were laid [18].

Essentially, any disturbance in the metabolism of sex hormones can induce a series of symptoms grouped together under the name of SGUM (Table I).
This syndrome can therefore occur at menopause [15], but also in younger patients, particularly women who have survived breast cancer.

Indeed, some of the treatments they undergo result in estrogen deficiency, leading to permanent or non-permanent amenorrhea [3, 20]. Patients undergoing chemotherapy or radiotherapy may also be affected.

MUMS therefore greatly affects patients' quality of life, and not just physically.

Women's sexual and intimate health, as well as their self-esteem, are also greatly affected, with deleterious consequences for their sleep and quality of daily life [14]. It is therefore a very significant problem on a population scale.
Vulvo-vaginal atrophy (VVA) is one of the main components of MGS [22]. The very structure of the tissues of the urogenital tract is directly dependent on sex hormones, particularly estrogen.

The symptomatology associated with VVA is also well characterized, and includes sensations of vaginal dryness, burning and irritation evoked by the SGUM scale [16].

It is therefore worth making a special point of this VVVA, as it implies an alteration in the synthesis and diffusion of the mucus that lubricates the vaginal walls and the introitus.

It's a very specific phenomenon, involving the transudation process we'll describe below, and largely dependent on the capacity of submucosal tissues to transport water to the surface.

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