Management of genitourinary syndrome of menopause in breast cancer survivors: An update

Table 1 Non-hormonal treatments (Classic moisturizers and lubricants and innovative preparations) in breast cancer survivors: Summary of studies and their outcomes

Ref.	Yr	n1	Design	Treatment	Conclusion
Loprinzi et al[119]	1997	45	A double-blind, crossover, randomized clinical trial	Vaginal lubricating preparation, (Replens®)	Both Replens and the placebo appear to substantially ameliorate vaginal dryness and dyspareunia in breast cancer survivors
Lee et al[129]	2011	44 vs 42	Randomised controlled trial, double blinded	pH balanced gel vs placebo for 12 wk	Vaginal pH balanced gel could relieve vaginal symptoms
Juraskova et al[137]	2013	25	Prospective, observational study	polycarbophil-based vaginal moisturizer + olive oil as a lubricant during intercourse	Significant improvements in dyspareunia, sexual function, and quality of life over time
Goetsch et al[130,131]	2014 2015	46	Double-blind rct	4% aqueous lidocaine vs saline	Significative and safe reduction in dyspareunia
Hickey et al[128]	2016		In a single-center, randomized, double-blind, ab/ba crossover design	Water- vs silicone-based lubricants	Total sexual discomfort was lower after use of silicone-based lubricant than water-based
Juliato et al[126]	2017	25 vs 25	Randomised trial	Polyacrylic acid vs lubricant	Polyacrylic acid was superior to lubricant
Marschalek et al[136]	2017	11 vs 11	Randomised controlled trial, double blinded pilot study	Vaginal lactobacillus capsules vs placebo	Lactobacillus improves microbiota in BCSs
Hersant et al[139]	2018	20	Prospective, comparative (before/after) pilot study	A-PRP and evaluated at 0,1,3 and 6 mo	A-PRP improves vaginal mucosa in 6 mo treatment according VHI criteria
Chatsiproios et al[125]	2019	128	Open, prospective, multicentre, observational study.	oil-in-water emulsion during 28 d	This treatment seems to improve VVA symptoms with a short treatment
Carter et al[122]	2021	101	Single-arm, prospective longitudinal trial	Hyaluronic acid (HLA) vaginal gel for 12 wk	HLA moisturization improved vulvovaginal health/sexual function of cancer survivors

¹Cases vs control/placebo/other treatment. BC: Breast Cancer, BCSs: Breast cancer survivors; A-PRP: Autologous platelet-rich plasma; VHI: Vaginal Health Index.