{"id":2167,"date":"2020-11-04T17:59:56","date_gmt":"2020-11-04T16:59:56","guid":{"rendered":"http:\/\/www.looketmedecine.com\/?p=2167"},"modified":"2024-10-05T00:01:12","modified_gmt":"2024-10-04T22:01:12","slug":"vaginal-health-of-breast-cancer-survivors","status":"publish","type":"post","link":"https:\/\/looketmedecine.fr\/en\/vaginal-health-of-breast-cancer-survivors\/","title":{"rendered":"LM N\u00b01\/2020. Vaginal health of breast cancer survivors. Dana SAWAN,MD &amp; Barbara HERSANT,MD"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"2167\" class=\"elementor elementor-2167\" data-elementor-post-type=\"post\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-bc8bc83 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"bc8bc83\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d26d0bf\" data-id=\"d26d0bf\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-221f470 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"221f470\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9b189e1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9b189e1\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-664b7c2\" data-id=\"664b7c2\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d4202cc elementor-widget elementor-widget-text-editor\" data-id=\"d4202cc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h2 style=\"text-align: center;\"><span style=\"color: #d4b054;\"><em>Dana Sawan\u00a0 MD (gynecologist).\u00a0 <\/em><\/span><\/h2><h5 style=\"text-align: center;\"><em><strong><span style=\"color: #000000;\"><span style=\"font-weight: normal; color: #000000;\">Henri Mondor Breast Center, Henri Mondor University Hospitals, 51 Avenue Marechal de Lattre de Tassigny, 94010 Cr\u00e9teil, France. <span style=\"color: #0000ff;\">dana.s.sawan@gmail.com<\/span><\/span><\/span><\/strong><\/em><\/h5><h2 style=\"text-align: center;\"><span style=\"color: #0000ff;\"><em><span style=\"color: #d4b054;\">Barbara Hersant MD, PhD (plastic surgeon).<\/span> <\/em><\/span><\/h2><h5 style=\"text-align: center;\"><em><span style=\"font-weight: normal; color: #000000;\">Department of Maxillo-facial Surgery, Plastic and Reconstructive, Henri Mondor University Hospitals, 51 Avenue Marechal de Lattre de Tassigny, 94010 Cr\u00e9teil, France. <\/span><\/em><strong><span style=\"color: #000000;\"><em>barbara.hersant@gmail.com<\/em><\/span><\/strong><\/h5>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4d380ac elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4d380ac\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1c8db17\" data-id=\"1c8db17\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-263734d elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"263734d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c79f1a6 elementor-widget elementor-widget-gallery\" data-id=\"c79f1a6\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;gap&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:100,&quot;sizes&quot;:[]},&quot;lazyload&quot;:&quot;yes&quot;,&quot;gallery_layout&quot;:&quot;grid&quot;,&quot;columns&quot;:4,&quot;columns_tablet&quot;:2,&quot;columns_mobile&quot;:1,&quot;gap_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:10,&quot;sizes&quot;:[]},&quot;gap_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:10,&quot;sizes&quot;:[]},&quot;link_to&quot;:&quot;file&quot;,&quot;aspect_ratio&quot;:&quot;3:2&quot;,&quot;overlay_background&quot;:&quot;yes&quot;,&quot;content_hover_animation&quot;:&quot;fade-in&quot;}\" data-widget_type=\"gallery.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-gallery__container\">\n\t\t\t\t\t\t\t<a class=\"e-gallery-item elementor-gallery-item elementor-animated-content\" href=\"https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/Capture-de\u0301cran-2020-11-06-a\u0300-20.31.15.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"c79f1a6\" data-elementor-lightbox-title=\"Capture d\u2019e\u0301cran 2020-11-06 a\u0300 20.31.15\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MjMyNywidXJsIjoiaHR0cHM6XC9cL2xvb2tldG1lZGVjaW5lLmZyXC93cC1jb250ZW50XC91cGxvYWRzXC8yMDIwXC8xMVwvQ2FwdHVyZS1kZVx1MDMwMWNyYW4tMjAyMC0xMS0wNi1hXHUwMzAwLTIwLjMxLjE1LnBuZyIsInNsaWRlc2hvdyI6ImM3OWYxYTYifQ%3D%3D\">\n\t\t\t\t\t<div class=\"e-gallery-image elementor-gallery-item__image\" data-thumbnail=\"https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/Capture-de\u0301cran-2020-11-06-a\u0300-20.31.15.png\" data-width=\"155\" data-height=\"191\" aria-label=\"\" role=\"img\" ><\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-gallery-item__overlay\"><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t<a class=\"e-gallery-item elementor-gallery-item elementor-animated-content\" href=\"https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/10\/sujet_tabou1.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"c79f1a6\" data-elementor-lightbox-title=\"sujet_tabou1\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MTc4MywidXJsIjoiaHR0cHM6XC9cL2xvb2tldG1lZGVjaW5lLmZyXC93cC1jb250ZW50XC91cGxvYWRzXC8yMDIwXC8xMFwvc3VqZXRfdGFib3UxLnBuZyIsInNsaWRlc2hvdyI6ImM3OWYxYTYifQ%3D%3D\">\n\t\t\t\t\t<div class=\"e-gallery-image elementor-gallery-item__image\" data-thumbnail=\"https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/10\/sujet_tabou1-768x249.png\" data-width=\"768\" data-height=\"249\" aria-label=\"\" role=\"img\" ><\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-gallery-item__overlay\"><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t<a class=\"e-gallery-item elementor-gallery-item elementor-animated-content\" href=\"https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/Capture-de\u0301cran-2020-11-06-a\u0300-20.39.58.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"c79f1a6\" data-elementor-lightbox-title=\"Capture d\u2019e\u0301cran 2020-11-06 a\u0300 20.39.58\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MjMyOCwidXJsIjoiaHR0cHM6XC9cL2xvb2tldG1lZGVjaW5lLmZyXC93cC1jb250ZW50XC91cGxvYWRzXC8yMDIwXC8xMVwvQ2FwdHVyZS1kZVx1MDMwMWNyYW4tMjAyMC0xMS0wNi1hXHUwMzAwLTIwLjM5LjU4LnBuZyIsInNsaWRlc2hvdyI6ImM3OWYxYTYifQ%3D%3D\">\n\t\t\t\t\t<div class=\"e-gallery-image elementor-gallery-item__image\" data-thumbnail=\"https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/Capture-de\u0301cran-2020-11-06-a\u0300-20.39.58.png\" data-width=\"463\" data-height=\"306\" aria-label=\"\" role=\"img\" ><\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-gallery-item__overlay\"><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t<a class=\"e-gallery-item elementor-gallery-item elementor-animated-content\" href=\"https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/Capture-de\u0301cran-2020-11-17-a\u0300-18.05.38.png\" data-elementor-open-lightbox=\"yes\" data-elementor-lightbox-slideshow=\"c79f1a6\" data-elementor-lightbox-title=\"Pr Barbara HERSANT\" data-e-action-hash=\"#elementor-action%3Aaction%3Dlightbox%26settings%3DeyJpZCI6MjYyOCwidXJsIjoiaHR0cHM6XC9cL2xvb2tldG1lZGVjaW5lLmZyXC93cC1jb250ZW50XC91cGxvYWRzXC8yMDIwXC8xMVwvQ2FwdHVyZS1kZVx1MDMwMWNyYW4tMjAyMC0xMS0xNy1hXHUwMzAwLTE4LjA1LjM4LnBuZyIsInNsaWRlc2hvdyI6ImM3OWYxYTYifQ%3D%3D\">\n\t\t\t\t\t<div class=\"e-gallery-image elementor-gallery-item__image\" data-thumbnail=\"https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/Capture-de\u0301cran-2020-11-17-a\u0300-18.05.38.png\" data-width=\"621\" data-height=\"720\" aria-label=\"\" role=\"img\" ><\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-gallery-item__overlay\"><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-149cfef elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"149cfef\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5292a48\" data-id=\"5292a48\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3c55684 elementor-widget elementor-widget-video\" data-id=\"3c55684\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;video_type&quot;:&quot;hosted&quot;,&quot;controls&quot;:&quot;yes&quot;}\" data-widget_type=\"video.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"e-hosted-video elementor-wrapper elementor-open-inline\">\n\t\t\t\t\t<video class=\"elementor-video\" src=\"https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/MK363-vC-Waiting-room-video-DESIRIAL-EN.mp4\" controls=\"\" preload=\"metadata\" controlsList=\"nodownload\"><\/video>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a07aafe elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"a07aafe\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b82b519 elementor-widget elementor-widget-text-editor\" data-id=\"b82b519\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h2 style=\"text-align: center;\"><span style=\"color: #d4b054;\">Introduction<\/span><\/h2><h4><span style=\"color: #000000;\">Breast cancer is the most common cancer and the leading cause of cancer death in women.\u00a0<\/span><\/h4><h4><span style=\"color: #000000;\">The \u00be of breast cancers express estrogen receptors, including <strong>Estrogen Receptor alpha (ER\u03b1)<\/strong> (1- 4).\u00a0<\/span><\/h4><h4><span style=\"color: #000000;\">Tumours that do not express oestrogen receptors often express <strong>epidermal growth factor receptor (EGFR).\u00a0<\/strong><\/span><\/h4><h4><span style=\"color: #000000;\">The latter has been correlated with larger tumours and metastatic forms (5). <\/span><\/h4><h4><strong><span style=\"color: #000000;\">The hormone sensitivity and hormone dependence of breast cancers makes hormone therapy one of the main means of treating these cancers.\u00a0<\/span><\/strong><\/h4><h4><strong><span style=\"color: #000000;\">It consists of weaning them from the oestrogenic intake that maintains their growth, either by suppressing endogenous production (chemotherapy or irradiation of the ovaries), or by administering an anti-estrogenic substance systemically.<\/span><\/strong><\/h4><h4><span style=\"color: #000000;\">Advances in breast cancer detection technology now make it possible to detect tumours at an earlier stage than before and, as adjuvant chemotherapy is associated with ovarian failure (6) an increasing proportion of breast cancer survivors are becoming postmenopausal at an earlier age after cancer treatment (7). <\/span><\/h4><h4><span style=\"color: #000000;\">In addition, estrogen levels gradually decline as menopause approaches, leading to genital and urinary symptoms in affected women (8).<\/span><\/h4><h4><span style=\"color: #000000;\"><strong>Hormone replacement therapy (HS) is known to be effective and recommended in the control of menopausal symptoms such as hot flashes, sleep disorders, sexual dysfunction or vaginal atrophy and even the prevention of osteoporosis and cardiovascular disease (9,10).<\/strong><\/span><\/h4><h4><span style=\"color: #000000;\">In general, systemic estrogen therapy is recommended for women with general symptoms, while local estrogen therapy is recommended for those suffering from vulvo-vaginal atrophy (VVA) or genito-urinary menopausal syndrome (GUMS) (11). <\/span><\/h4><h4><span style=\"color: #000000;\">However, HS is risky in breast cancer survivors. <\/span><span style=\"color: #000000;\">Indeed, it has been shown that current and former HS users have a higher risk of developing breast cancer because estrogen plays a central role in the development of breast cancer (12). <\/span><\/h4><h4><strong><span style=\"color: #000000;\">Thus, women who have received primary treatment for early breast cancer may have a recurrence of the disease after HS (13). <\/span><\/strong><\/h4><h4><span style=\"color: #000000;\">Clinicians must therefore consider the goals of systemic endocrine therapy and the safety of this treatment modality in healthy women and those with a history of breast cancer (11). <\/span><\/h4><h4><span style=\"color: #000000;\">Given the safety concerns regarding the use of HS in women with a history of breast cancer, this document examines alternatives to estrogen replacement therapy that may help address specific survivorship issues such as GUMS in this group of women.<\/span><\/h4>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9a15fb9 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9a15fb9\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-8d474fd\" data-id=\"8d474fd\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6ab1acf elementor-widget elementor-widget-video\" data-id=\"6ab1acf\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;youtube_url&quot;:&quot;https:\\\/\\\/www.youtube.com\\\/watch?v=MFAbDA-zOQI&quot;,&quot;video_type&quot;:&quot;youtube&quot;,&quot;controls&quot;:&quot;yes&quot;}\" data-widget_type=\"video.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-wrapper elementor-open-inline\">\n\t\t\t<div class=\"elementor-video\"><\/div>\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-92b40b6 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"92b40b6\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-cdddb7a\" data-id=\"cdddb7a\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-357e35b elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"357e35b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0516ce8 elementor-widget elementor-widget-text-editor\" data-id=\"0516ce8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h2 style=\"text-align: center;\"><span style=\"color: #d4b054;\">Alternatives to Hormone Replacement Therapy<\/span><\/h2><h4><span style=\"color: #000000;\">Several alternatives to the use of hormone replacement therapy have been proposed to women who have already been diagnosed with breast cancer.<\/span><span style=\"color: #ff0000;\">\u00a0<\/span><\/h4><h2 style=\"text-align: center;\"><strong><span style=\"color: #000000;\">1. Medical means<\/span><\/strong><\/h2><h3 style=\"text-align: center;\"><strong><span style=\"color: #000000;\">1.1. Platelet-rich autologous plasma and hyaluronic acid (Cellular Matrix)<\/span><\/strong><\/h3><h4><span style=\"color: #000000;\">A multicentre, randomised, controlled, open-label study of 144 women found that hyaluronic acid vaginal gel was effective in improving vaginal dryness in post-menopausal women (14).<\/span><\/h4><h4><span style=\"color: #000000;\">A recent phase 2 clinical study suggested that intraperitoneal administration of a combination of autologous platelet-rich plasma and hyaluronic acid appeared to improve MUMS in women with a previous diagnosis of breast cancer (15).<\/span><\/h4><h4><span style=\"color: #000000;\">Researchers reported a significant increase in the volume of vaginal secretions after the start of treatment.<\/span><\/h4><h4><span style=\"color: #000000;\">The quality of sexual life of the participants was also significantly improved, as evidenced by a decrease in the female sexual distress score one, three and six months after treatment with platelet-rich autologous plasma and hyaluronic acid (15).<\/span><\/h4><h4><span style=\"color: #000000;\"><a href=\"https:\/\/www.youtube.com\/watch?v=MFAbDA-zOQI\" target=\"_blank\" rel=\"noopener noreferrer nofollow\"><span style=\"color: #0000ff;\"><strong><span style=\"color: #000000;\">Cellular Matrix INTIMACY<\/span><\/strong><\/span><\/a><\/span><\/h4><h4><span style=\"color: #000000;\">The patient&rsquo;s own platelet-rich plasma combined with hyaluronic acid for the regeneration of the skin and mucous membranes.<\/span><\/h4><h4><em><span style=\"color: #000000;\">TREATMENT OF GENITOURINARY MENOPAUSAL SYNDROME (GUMS):<\/span><\/em><\/h4><ol><li style=\"list-style-type: none;\"><ol><li><h4><span style=\"color: #000000;\">New vascularisation stimulated by the release of vascular endothelial growth factor (VEGF).<\/span><\/h4><\/li><li><h4>\u00a0Increase in elasticity thanks to a new synthesis of collagen and elastin.<\/h4><\/li><li><h4>Overall reduction in pain and discomfort.<\/h4><\/li><\/ol><\/li><\/ol><h4><em><span style=\"color: #000000;\">GUMS : Set of symptoms and signs associated with a decrease in oestrogen.<\/span><\/em><\/h4><ol><li style=\"list-style-type: none;\"><ol><li><h4><span style=\"color: #000000;\">Genital symptoms: &#8211; Dryness &#8211; Burning &#8211; Irritation.<\/span><\/h4><\/li><li><h4><span style=\"color: #000000;\">Sexual symptoms: &#8211; Lack of lubrication &#8211; Discomfort \/ pain &#8211; Impaired functioning.<\/span><\/h4><\/li><li><h4><span style=\"color: #000000;\">Urinary symptoms: &#8211; Emergency &#8211; Dysuria &#8211; Recurrent urinary infections.<\/span><\/h4><\/li><\/ol><\/li><\/ol><h4><span style=\"color: #0000ff;\"><a style=\"color: #0000ff;\" href=\"https:\/\/www.youtube.com\/watch?v=MFAbDA-zOQI\" target=\"_blank\" rel=\"noopener noreferrer nofollow\"><strong><span style=\"color: #000000;\">The cell matrix is also evaluated for sclerosing lichen, bartholinitis, caesarean section scars, episiotomy scars and stretch mark treatments.<\/span><\/strong><\/a><\/span><strong><span style=\"color: #000000;\">\u00a0<\/span><\/strong><\/h4><h3 style=\"text-align: center;\"><strong><span style=\"color: #000000;\">1.2. Vaginal laser therapy\u00a0<\/span><\/strong><\/h3><h4><span style=\"color: #000000;\"><strong><i>Laser therapy <\/i>has recently been proposed as a viable treatment for GUMS.\u00a0 The use of <\/strong><i><strong><span style=\"color: #000000;\">vaginal carbon dioxide lase<\/span><\/strong>r<\/i> for menopausal symptoms is somewhat new and very few studies have explored its effectiveness as recently as 12 weeks after therapy (16-18).\u00a0\u00a0<\/span><\/h4><ul><li style=\"list-style-type: none;\"><ul><li><h4><span style=\"color: #000000;\"><strong>A single-arm pilot study<\/strong> showed that the vaginal carbon dioxide laser improved VVA symptoms and sexual dysfunction (16).\u00a0 <i style=\"font-family: inherit; font-size: 1.25rem;\">\u00a0<\/i><\/span><\/h4><\/li><li><h4>In addition,<strong><span style=\"color: #000000;\"> a systematic review of 6 non-randomized studies <\/span><\/strong>suggested that the vaginal carbon dioxide laser may improve vaginal health in women diagnosed with breast cancer. (19)\u00a0<\/h4><\/li><\/ul><\/li><\/ul><h4><span style=\"color: #000000;\"><strong><i>The CO2 laser<\/i><\/strong> used to redraw the vaginal epithelium activates heat shock proteins which in turn activate growth factors that increase vascularization, collagen, extracellular matrix production and vaginal mucosal thickness (20).<\/span><\/h4><h4><span style=\"color: #000000;\"><strong><i>Recently, the VeLVET trial<\/i><\/strong> was conducted to compare the safety and efficacy of laser therapy with vaginal estrogen after six months of follow-up (21).\u00a0<\/span><\/h4><ul><li><h4>Investigators found that women in the laser-treated group and the vaginal estrogen group had comparable improvements in GUMS symptoms and sexual function at six months follow-up.<\/h4><\/li><li><h4>About 70-80% of women in both groups reported being satisfied or very satisfied with their treatment option. No serious adverse events were reported by the participants.<\/h4><\/li><\/ul><h4><span style=\"color: #000000;\"><strong><span style=\"color: #0000ff;\"><i><span style=\"color: #000000;\">The erbium YAG laser<\/span> <\/i><\/span><\/strong>was also satisfactorily tested in the GUMS, showing greater long-term efficacy than oestriol (22).<\/span><span style=\"color: #0000ff;\">\u00a0<\/span><\/h4><h3 style=\"text-align: center;\"><strong><span style=\"color: #000000;\">1.3. Intravaginal use of estrogen gels or creams\u00a0<\/span><\/strong><\/h3><ul><li><h4><span style=\"color: #000000;\">The use of estrogen gels and creams provides significant relief for patients suffering from GUMS. <\/span><span style=\"color: #000000;\">The main concern is the safety of this treatment, as the systemic passage of estrogen occurs through the vaginal mucosa. <strong>Several studies suggest the safety of this treatment (23,24).<\/strong> Indeed, systemic estrogen levels remain very low and the risk of cancer recurrence is not significantly high for estradiol doses of 0.25 mg and estradiol doses between 12.5 and 25 \u00b5g.<\/span><\/h4><\/li><li><h4><span style=\"color: #000000;\">Aspects that some patients are dissatisfied with are the \u00ab\u00a0messy\u00a0\u00bb nature of the administration, the unhygienic reusable applicator and the approximate dosage, as there is often no dosing device, which is problematic in our population (25). <\/span><\/h4><\/li><li><h4><span style=\"color: #000000;\">Administration is usually daily for the first two weeks and then bi-weekly for the maintenance period. <\/span><\/h4><ul><li><h4><span style=\"color: #000000;\"><strong>Intra-vaginal estradiol ova<\/strong> dosed at 4\u00b5g are also safely used in breast cancer survivors (25). <\/span><span style=\"color: #000000;\">They offer the advantage of accurate dosing and easier application. <\/span><\/h4><\/li><li><h4><span style=\"color: #000000;\">Similarly, there are <strong>vaginal rings that release estradiol <\/strong>at a sustained release rate of 7.5\u00b5g per day and can remain in place for up to 90 days (25). <\/span><\/h4><\/li><\/ul><\/li><li><h4><span style=\"color: #000000;\"><strong>This local hormone therapy s<\/strong>hould only be used when non-hormonal methods do not work, and if possible for a limited period of time. <\/span><span style=\"color: #000000;\">Long-term use can be made in patients on <strong>tamoxifen or <\/strong><span style=\"color: #0000ff;\"><strong><span style=\"color: #000000;\">raloxifene<\/span><\/strong> (<\/span>22,26,27). The latter block the possible oestrogenic effect in case of significant systemic passage. <\/span><\/h4><\/li><li><h4><span style=\"color: #000000;\">Hormone therapy should be avoided in any patient with unlabeled vaginal bleeding. <\/span><span style=\"color: #000000;\">Similarly, bleeding that appears under intravaginal hormone therapy should be investigated seriously (imaging, endometrial biopsy).<\/span>\u00a0<\/h4><\/li><\/ul><h3 style=\"text-align: center;\"><strong><span style=\"color: #000000;\">1.4. Specific oestrogen receptor modulators (SERMs)<\/span><\/strong><\/h3><h4><span style=\"color: #000000;\"><strong>These molecules are non-steroidal agent<\/strong>s that exert a plethora of estrogen agonist or antagonist effects on target organs.<\/span><\/h4><ol><li><h4><span style=\"color: #000000;\">&#8211; Only <strong><i>ospemifene <\/i><\/strong>is currently used in the management of GUMS (60 mg\/day), particularly in the treatment of moderate to severe dyspareunia. It improves the maturation of the vaginal mucosa and acidifies the pH (25).<\/span><\/h4><\/li><li><h4><span style=\"color: #000000;\">&#8211; <strong><i>Tamoxifen, <\/i><\/strong>on the other hand, has a variety of effects on the vagina and can cause dyspareunia, increased white discharge or vaginal dryness28.<\/span><\/h4><\/li><li><h4><span style=\"color: #000000;\">&#8211; <strong><i>Raloxifene<\/i> and <i>bazedoxifene<\/i> <\/strong>do not have a direct effect on the vagina.<\/span><\/h4><\/li><li><h4><span style=\"color: #000000;\">&#8211;<strong> However, when combined with equine estrogen<\/strong> (20\/0.45 mg per day), they have significantly improved the signs and symptoms of GUMS without causing endometrial hyperplasia (29).<\/span><\/h4><\/li><\/ol><h4 style=\"text-align: center;\"><strong><span style=\"color: #000000;\">1.5. Vaginal dehydroepiandrosterone (DHEA)\u00a0<\/span><\/strong><\/h4><h4><span style=\"color: #000000;\">DHEA is a pro-hormone in the biosynthesis of testosterone and estradiol. <\/span><\/h4><h4><span style=\"color: #000000;\">Tests have shown its effectiveness on the symptoms of SGUM (dyspareunia, vaginal maturation index, pH). <\/span><\/h4><h4><span style=\"color: #000000;\">DHEA exerts its vaginal effects through in situ conversion to testosterone and oestradiol. <\/span><\/h4><h4><span style=\"color: #000000;\">Serum levels are not elevated because these products are locally inactivated (30). <\/span><\/h4><h4><span style=\"color: #000000;\">It is therefore a safer alternative to local estrogen in breast cancer survivors. <\/span><\/h4><h4><span style=\"color: #000000;\">In addition, since aromatase does not exist in the endometrium, DHEA has no proliferative effect on the endometrium (31).<\/span><\/h4><h2 style=\"text-align: center;\"><span style=\"color: #d4b054;\">2. Non-medical means<\/span><\/h2><h3 style=\"text-align: center;\"><strong><span style=\"color: #000000;\">2.1 Education<\/span><\/strong><\/h3><h4><span style=\"color: #000000;\">Women need to be educated about the changes that occur as a result of the decrease in estrogen. <\/span><\/h4><h4><span style=\"color: #000000;\">Many patients are unaware of these changes and therefore cannot seek appropriate medical help. <\/span><\/h4><h4><span style=\"color: #000000;\">They need to know that the symptoms and signs of GUMS will not regress spontaneously and to be aware of the various treatment options available to them (25).<\/span><span style=\"color: #0000ff;\">\u00a0<\/span><\/h4><h3 style=\"text-align: center;\"><strong><span style=\"color: #000000;\">2.2 Vaginal lubricants and humidifiers<\/span><\/strong><\/h3><h4><span style=\"color: #000000;\">They offer an immediate solution to the problem of pain at the intromission which is the result of vaginal dryness. <\/span><\/h4><h4><span style=\"color: #000000;\">Lubricants are used at the time of intercourse while humidifiers are used remotely (32). <\/span><\/h4><h4><span style=\"color: #000000;\">There are water-based and silicone-based lubricants. <\/span><\/h4><h4><span style=\"color: #000000;\">The former do not stain and are better tolerated than the latter. <\/span><span style=\"color: #000000;\">However, the effectiveness of lubricants depends on their osmolarity. <\/span><\/h4><h4><span style=\"color: #000000;\">An osmolarity higher than 1200 mOsm\/kg is associated with irritation, contact dermatitis and cytotoxicity (32). <\/span><\/h4><h4><span style=\"color: #000000;\">Humidifiers increase moisture in the vaginal mucosa by adhering to it, mimicking vaginal secretions. <\/span><\/h4><h4><span style=\"color: #000000;\">They also contain additives that lower the pH and affect osmolarity (32).<\/span><\/h4><h3 style=\"text-align: center;\"><span style=\"color: #000000;\"><strong>2.3. Use of vibrators and vaginal dilators<\/strong><\/span><\/h3><h4><span style=\"color: #000000;\">They help maintain sexual function by stretching the vaginal and vulvar tissues. <\/span><\/h4><h4><span style=\"color: #000000;\">In fact, they stimulate these tissues and increase blood flow to them, whether or not the patient has a sexual partner (25). <\/span><\/h4><h4><span style=\"color: #000000;\">Women who have vaginismus can use these devices for conscious relaxation to facilitate the resumption of penetrative sexual activity (33).<\/span><\/h4><h3 style=\"text-align: center;\"><strong><span style=\"color: #000000;\">2.4. Pelvic floor re-education<\/span><\/strong><\/h3><h4><span style=\"color: #000000;\">Physiotherapy should ideally be guided by a professional specialising in pelvic pathology. <\/span><\/h4><h4><span style=\"color: #000000;\">It is indicated for women with pelvic muscle hypertonia caused by painful sexual activity secondary to GUMS (34).<\/span><\/h4><h3 style=\"text-align: center;\"><strong><span style=\"color: #000000;\">2.5 Topical Lidocaine<\/span><\/strong><\/h3><h4><span style=\"color: #000000;\">4% aqueous lidocaine applied in the vulval vestibule a few minutes before intercourse significantly reduces the pain of penetration. <\/span><\/h4><h4><span style=\"color: #000000;\">It can be used as an adjunct to other measures (lubricants, humidifiers, rehabilitation (35).<\/span><\/h4>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a9e71d8 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a9e71d8\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a83aef7\" data-id=\"a83aef7\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3f0023f elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"3f0023f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-90f637d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"90f637d\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-db2fc72\" data-id=\"db2fc72\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-167944a elementor-widget elementor-widget-text-editor\" data-id=\"167944a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h2 style=\"text-align: center;\"><span style=\"color: #d4b054;\">Conclusion<\/span><\/h2><h4><span style=\"color: #000000;\">Genitourinary menopausal syndrome is a consequence of breast cancer treatment that deprives the body of its estrogen supply. <\/span><\/h4><h4><span style=\"color: #000000;\">It poses a management problem because all modalities including estrogen must either be ruled out or carefully weighed on the risk\/benefit balance. <\/span><\/h4><h4><span style=\"color: #000000;\">However, there are many other options available that allow most patients to find the right formula for them<\/span><\/h4>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-84d71f5 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"84d71f5\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-88b489a\" data-id=\"88b489a\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-574c8f1 elementor-widget elementor-widget-text-editor\" data-id=\"574c8f1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<h2 style=\"text-align: center;\"><span style=\"color: #d4b054;\">References<\/span><\/h2><p><span style=\"color: #000000;\"><em>1. Najim O, Huizing M, Papadimitriou K, Trinh XB, Pauwels P, Goethals S, Zwaenepoel K, Peterson K, Weiler J, Altintas S, van Dam P and Tjama W. The prevalence of Estrogen Receptor 1 mutation in advanced breast cancer: The estrogen receptor 1 study (EROS 1). Cancer tratment and Research Communications. 2019 ;19, 100123.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>2. Robertson JFR, Bondarenko IM, Trishkina E, et al. Fulvestrant 500 mg versus anastrozole 1 mg for hormone receptor-positive advanced breast cancer (FALCON): an international phase 3, randomised, double-blind trial. Lancet Lond Engl. 2016;388(10063):2997-3005. doi:10.1016\/S0140-6736(16)32389-3.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>3. National Comprehensive Cancer Control Network. NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Ver. 2.2016. Fort Washington, PA; 2016. https:\/\/www.nccn.org\/store\/login\/login.aspx?ReturnURL=https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/breast.pdf. Accessed 31 March 2020.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>4. Spring LM, Gupta A, Reynolds KL, et al. Neoadjuvant Endocrine Therapy for Estrogen Receptor-Positive Breast Cancer: A Systematic Review and Meta-analysis. JAMA Oncol. 2016;2(11):1477-1486. doi:10.1001\/jamaoncol.2016.1897.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>5. Masuda H, Zhang D, Bartholomeusz C, Doihara H, Hortobagyi GN and Ueno NT. Role of epidermal growth factor receptor in breast cancer. Breast Cancer Res Treat. 2012. 136 :331-345.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>6. Bedoschi G, Navarro PA, Oktay K. Chemotherapy-induced ovarian lesions: mechanisms and clinical impact. Future Oncol. 2016;12(20):2333-2344. doi:10.2217\/fon-2016-0176.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>7. Passildas J, Collard O, Savoye A-M, et al. Impact of Chemotherapy-induced Menopause in Women of Childbearing Age With Non-metastatic Breast Cancer &#8211; Preliminary Results From the MENOCOR Study. Breast Cancer Clinic. 2019;19(1):e74-e84. doi:10.1016\/j.clbc.2018.10.003.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>8. Gersak K, Gersak ZM, Turcin A. Reproductive Aging: Perimenopause and Psychopathological Symptoms. Processes of the neurodegenerators of the sex hormone Dis. May 2018. doi:10.5772\/intechopen.74159.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>9. The advisory committee of the position statement on hormone therapy NAMS 2017. The North American Menopause Society&rsquo;s Hormone Therapy Position Statement 2017. Menopause N Y N. 2017;24(7):728-753. doi:10.1097\/GME.00000000000921.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>10. US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Hormone Therapy for the Primary Prevention of Chronic Conditions in Postmenopausal Women: Statement of Recommendation of the US Preventive Services Task Force. JAMA. 2017;318(22):2224-2233. doi:10.1001\/jama.2017.18261<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>11. American College of Obstetricians and Gynaecologists. Vaginal estrogen use in women with a history of estrogen-dependent breast cancer. Committee Opinion No. 659. Obstet Gynecol. 2016;127:e93-6.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>12. Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of hormonal treatment of menopause and breast cancer risk: meta-analysis of global epidemiological evidence by individual participants. The Lancet. 2019;394(10204):1159-1168. doi:10.1016\/S0140-6736(19)31709-X.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>13. Pan H, Gray R, Braybrooke J, et al. 20 Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years. N Engl J Med. 2017;377(19):1836-1846. doi:10.1056\/NEJMoa1701830.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>14. Chen J, Geng L, Song X, Li H, Giordan N, Liao Q. Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial. J Sex Med. 2013;10(6):1575-1584. doi:10.1111\/jsm.12125<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>15. Hersant B, SidAhmed-Mezi M, Belkacemi Y, et al. Efficacy of injecting platelet concentrate combined with hyaluronic acid for the treatment of vulvovaginal atrophy in<\/em><\/span><span style=\"color: #000000;\"><em> postmenopausal women with a history of breast cancer: a phase 2 pilot study. Menopause. 2018;25(10):1124-1130. doi:10.1097\/GME.0000000000001122.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>16. Pearson A, Booker A, Tio M, Marx G. Vaginal CO2 laser for the treatment of vulvovaginal atrophy in women with breast cancer: LAAVA pilot study. Breast Cancer Res Treat. 2019;178(1):135-140. doi:10.1007\/s10549-019-05384-9.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>17. Mothes AR, Runnebaum M, Runnebaum IB. Erbium laser ablative treatment: Two-phase YAG of vaginal symptoms related to atrophy in postmenopausal breast cancer survivors without hormonal treatment. J Cancer Res Clin Oncol. 2018;144(5):955-960. doi:10.1007\/s00432-018-2614-8<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>18. Pieralli A, Fallani MG, Becorpi A, et al. Fractional CO2 laser for vulvovaginal atrophy (VVA) dyspareunia relief in breast cancer survivors. Arch Gynecol Obstet. 2016;294(4):841-846. doi:10.1007\/s00404-016-4118-6.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>19. Knight C, Logan V, Fenlon D. A systematic review of laser therapy for vulvovaginal atrophy\/genitourinary syndrome of menopause in breast cancer survivors. ecancermedicalscience. 2019;13. doi:10.3332\/ecancer.2019.988.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>20. Stefano S, Stavros A, Massimo C. The use of pulsed CO2 lasers for the treatment of vulvovaginal atrophy. Curr Opin Obstet Gynecol. 2015;27(6):504-508.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>21. Paraiso MFR, Ferrando CA, Sokol ER, et al. A randomized clinical trial comparing vaginal laser therapy to vaginal estrogen therapy in women with genitourinary menopausal syndrome: The VeLVET trial. Menopause N Y N. 2020;27(1):50-56. doi:10.1097\/GME.0000000000001416<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>22. Gaspar A, Brandi H, Gomez V, Luque D. Efficacy of Erbium: YAG laser treatment compared to topical estriol treatment for symptoms of genitourinary syndrome of menopause. Lasers Surg Med. 2017;49(2):160-168.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>23. Dew JE, Wren BG &amp; Eden JA.A cohort study of topical vaginal estrogen therapy in women previously treated for breast cancer,Climacteric. 2003; 6:1, 45-52, DOI: 10.1080\/cmt.6.1.45.52<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>24. Biglia N, Peano E, Sgandurra P, Moggio G, Panuccio E, Migliardi M, Ravarino N, Ponzone R &amp; Sismondi P. Low-dose vaginal oestrogens or vaginal moisturizer in breast cancer survivors with urogenital atrophy : a preliminary study,Gynecological Endocrinology. 2010; 26:6, 404-412, DOI: 10.3109\/09513591003632258.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>25. Faubion SS, Sood R and Kapoor E. Genitourinary syndrome of menopause: management strategies for the clinician. Mayo Clin. Proc. 92 (2017), pp. 1842 -1849, 10.1016\/j.mayocp.2017.08.019.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>26. Le Ray I, Dell&rsquo;Aniello S, Bonnetain F, Azoulay L, Suissa S. Local estrogen therapy and risk of breast cancer recurrence among hormone-treated patients: a nested case-control study. Breast Cancer Res Treat. 2012; 135(2):603-609.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>27. O&rsquo;Meara ES, Rossing MA, Daling JR, Elmore JG, Barlow WE, Weiss NS. Hormone replacement therapy after a diagnosis of breast cancer in relation to recurrence and mortality. J Natl Cancer Inst. 2001; 93(10):754-762.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>28. Pinkerton JV, Stanczyk FZ. Clinical effects of selective estrogen receptor modulators on vulvar and vaginal atrophy. Menopause. 2014;21(3):309-319.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>29. Kagan R, Williams RS, Pan K, Mirkin S, Pickar JH. A randomized, placebo- and active-controlled trial of bazedoxifene\/conjugated estrogens for treatment of moderate to severe vulvar\/vaginal atrophy in postmenopausal women. Menopause. 2010;17(2): 281-289.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>30. Labrie F, Archer DF, Koltun W, et al; VVA Prasterone Research Group. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and <\/em><\/span><span style=\"color: #000000;\"><em>vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause. 2016;23(3):243-256.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>31. Portman DJ, Labrie F, Archer DF, et al; other participating members of VVA Prasterone Group. Lack of effect of intravaginal dehydroepiandrosterone (DHEA, prasterone) on the endometrium in postmenopausal women. Menopause. 2015; 22(12):1289-1295.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>32. Farrell, Elizabeth. Genitourinary syndrome of menopause [online]. Australian Family Physician, Vol. 46, No. 7, Jul 2017: 481-484. Availability: &lt;https:\/\/search.informit.com.au\/documentSummary;dn=919889601806011;res=IELIAC&gt; ISSN: 0300-8495.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>33. Zarski AC, Berking M, Fackiner C, Rosenau C, Ebert DD. Internet-based guided self-help for vaginal penetration difficulties: results of a randomized controlled pilot trial. J Sex Med. 2017;14(2):238-254.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>34. Faubion SS, Shuster LT, Bharucha AE. Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clin Proc. 2012;87(2):187-193.<\/em><\/span><\/p><p><span style=\"color: #000000;\"><em>35. Goetsch MF, Lim JY, Caughey AB. A practical solution for dyspareunia in breast cancer survivors: a randomized controlled trial. J Clin Oncol. 2015;33(30):3394-3400.<\/em><\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-bddc29f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"bddc29f\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-16b39e8\" data-id=\"16b39e8\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4532ed2 elementor-widget elementor-widget-image\" data-id=\"4532ed2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"775\" height=\"1024\" src=\"https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/Capture-de\u0301cran-2021-02-09-a\u0300-15.57.30-775x1024.png\" class=\"attachment-large size-large wp-image-4229\" alt=\"\" srcset=\"https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/Capture-de\u0301cran-2021-02-09-a\u0300-15.57.30-775x1024.png 775w, https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/Capture-de\u0301cran-2021-02-09-a\u0300-15.57.30-227x300.png 227w, https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/Capture-de\u0301cran-2021-02-09-a\u0300-15.57.30-768x1014.png 768w, https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/Capture-de\u0301cran-2021-02-09-a\u0300-15.57.30.png 892w\" sizes=\"(max-width: 775px) 100vw, 775px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-31772ea elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"31772ea\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0fcbf15 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0fcbf15\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-775fe96\" data-id=\"775fe96\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-97ef09d elementor-widget elementor-widget-image\" data-id=\"97ef09d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"120\" height=\"112\" src=\"https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/10\/LookMedecine_Monogramme.png\" class=\"attachment-large size-large wp-image-2567\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Dana Sawan\u00a0 MD (gynecologist).\u00a0 Henri Mondor Breast Center, Henri Mondor University Hospitals, 51 Avenue Marechal de Lattre de Tassigny, 94010 Cr\u00e9teil, France. dana.s.sawan@gmail.com Barbara Hersant MD, PhD (plastic surgeon). Department of Maxillo-facial Surgery, Plastic and Reconstructive, Henri Mondor University Hospitals, 51 Avenue Marechal de Lattre de Tassigny, 94010 Cr\u00e9teil, France. barbara.hersant@gmail.com https:\/\/looketmedecine.fr\/wp-content\/uploads\/2020\/11\/MK363-vC-Waiting-room-video-DESIRIAL-EN.mp4 Introduction Breast cancer [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":2628,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"auteur":[390,391],"mots-cles":[],"class_list":["post-2167","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nos-partenaires","auteur-barbara-hersant","auteur-dana-sawan"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>LM N\u00b01\/2020. Vaginal health of breast cancer survivors. 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