Portland: A new study found that estradiol cream applied to the vulvar vestibule in postmenopausal women along with pre-coital silicone lubricant can be a potential alternative to vaginal therapy for dyspareunia. The study results were published in the journal Menopause.
Sexual health is of paramount importance to women after menopause for their overall health and good quality of life. But due to lowered estrogen levels, women complain of multiple vulvovaginal symptoms. Vulvovaginal atrophy leading to dyspareunia is one of them. Research shows that vaginal estrogen may help relieve the symptoms. As there is uncertainty on the mode of application, researchers from Poland conducted a pilot randomized comparative trial to compare the efficacies of two strengths of estradiol cream applied to the vulvar vestibule and the use of silicone lubricant to reduce intercourse pain scores in postmenopausal women with moderate/severe dyspareunia.

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Nearly 50 women who participated in the trial were advised nightly applications of estradiol cream, 50 or 100 μg, for 12 weeks. Women were asked to have lubricated penetration twice weekly, with intercourse or performing a tampon test. A numerical Rating Scale from 0-10 was used to record pain. All the biopsychosocial outcomes, urinary symptoms, and measured serum estradiol levels and endometrial stripe thicknesses were assessed. Physical examinations were performed to determine tenderness levels of the vestibule, vagina, pelvic floor muscles, bladder, uterus, and adnexa. Two-sample t-test, Wilcoxon rank-sum test, or χ2/Fisher's exact test were used to make Comparisons.
Results:
About 47 women (94%), with a mean age of 59.7 years, finished the trial.
The baseline median intercourse pain score was 8/10 (interquartile range, 6, 8) as per the numerical rating scale.
There was no statistically significant difference between groups in the primary outcome, intercourse pain score, or any secondary outcome measure after 12 weeks.
For both groups together, there was a 50% decline in the median intercourse pain score after 4 weeks and 75% after 12 weeks (P < 0.001).
The vulvar vestibule which is the most tender anatomic area improved by 82% to 100% (P < 0.001) with therapy.
There was no statistically significant difference in serum estradiol levels or endometrial stripe thickness between groups.

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Thus, Estradiol cream along with pre-coital silicone lubricant on the vulvar vestibule proved to be a promising alternative to vaginal therapy for dyspareunia.
Further reading: Goetsch, Martha F. MD, MPH1; Garg, Bharti MBBS, MPH1; Lillemon, Jen MD2; Clark, Amanda L. MD, MCR, NCMP3. Treating where it hurts—a randomized comparative trial of vestibule estradiol for postmenopausal dyspareunia. Menopause ():10.1097/GME.0000000000002162, February 14, 2023. | DOI: 10.1097/GME.0000000000002162