Treatment Challenges

The main challenge in managing post-menopausal vulvovaginal symptoms and treating most vaginal infections is the ability to adequately restore the physiological conditions of the vaginal mucosa and beneficial flora. This challenge often necessitates the use of prescription products or hormone replacement therapies (HRTs) that come with associated side effects and health risks.

POST-MENOPAUSAL VULVOVAGINAL SYMPTOMS

Treatment of post-menopausal vulvovaginal atrophy (VVA) typically falls into two categories: (1) over-the-counter (OTC) non-hormonal vaginal lubricants and moisturizers and (2) hormone replacement therapies (HRTs).

Existing non-hormonal, OTC vaginal lubricants and moisturizers comprise an undifferentiated market and are not considered a viable treatment option for symptoms of VVA by OBGYNs because:

They are not capable of restoring stasis to the anatomy and physiology;
They often contain ingredients that are not well-tolerated in the vaginal canal;
They are often not isotonic;
They are not long lasting; and
They are dramatically inferior to Hormone Replacement Therapies (HRTs) in terms of symptom relief and treatment of underlying pathology

While systemic HRT is no longer routinely recommended for the prevention of post-menopausal conditions because of the inherent risks and side effect profiles, locally administered, low-dose estrogen vaginal products are frequently prescribed for the prevention and treatment of VVA. Examples of these prescription, low-dose estrogen vaginal products are creams, tablets and rings. The success of low-dose estrogen is entirely dependent on absorption of the active estrogen species across the vaginal mucosal barrier.

VAGINAL INFECTIONS

Treatment of vaginal infections typically falls into two categories: (1) yeast infections and (2) bacterial vaginosis.

Most yeast infections are typically treated with either over-the-counter (OTC) anti-fungal creams or an oral anti-fungal. OTC anti-fungal creams often require multiple applications over 1 to 7 days and those applications are recommended to be performed prior to sleep to mitigate leakage from the vaginal canal. Oral anti-fungals have undesired, systemic side effects.

Bacterial vaginosis is typically treated with either oral metronidazole or metronidazole gel. Both oral metronidazole and metronidazole gels have undesired, systemic and vaginal side effects, respectively.