Hyaluronic acid in vulvar and vaginal administration: evidence from a literature systematic review

Abstract

Vulvovaginal pathology impairs the quality of life of both women in menopause and those who are not. Different therapies have been proposed, mainly related to estrogen therapy in postmenopausal women. However, some contraindications limit its use, and different moisturizers or lubricants have been tested. Hyaluronic acid is a promising and widely used vaginal medical treatment with a moisturizing action and appears to provide a solution. For this reason, we performed a systematic review of the literature. We searched for original articles without date restriction until 30 April 2020. We included all clinical trials which administered local hyaluronic acid in the vulva or vagina. Only English studies and those performed in humans were eligible. Seventeen original studies were included in the review (from randomized controlled trials to longitudinal studies). Hyaluronic acid was generally found to be effective in improving vulvovaginal symptoms (dyspareunia, itching, burning, dryness) and signs (bleeding, atrophy, vaginal pH). In conclusion, hyaluronic acid has the properties to be an efficient moisturizer for women suffering from vulvovaginal atrophy who have contraindications for estrogen therapy and for vulvovaginal signs and symptoms affecting sexual well-being. However, a well-designed randomized controlled trial is needed in order to clarify its efficacy and safety profile.

透明质酸在外阴和阴道给药中的作用：来自文献系统回顾的证据 摘要

外阴阴道病变影响绝经女性和非绝经女性的生活质量。目前提出的不同的治疗方法, 主要与绝经后女性的雌激素治疗有关。然而, 一些禁忌证限制了激素的使用。不同的保湿剂或润滑剂已通过试验。作为一种有前途的、广泛使用的阴道保湿药物, 透明质酸似乎提供了一种解决方案。为此, 我们对文献进行了系统的回顾。我们检索了截至2020年4月30日的原创文章。我们纳入了所有英语写作, 在女性外阴或阴道局部应用透明质酸的临床试验。有17项原始研究被纳入综述（从随机对照试验到纵向研究）。透明质酸能有效改善外阴阴道症状（性交困难、瘙痒、烧灼感、干燥）和体征（出血、萎缩、阴道酸碱度）。总之, 对于具有影响性健康的症状和体征, 同时有雌激素治疗禁忌证的外阴阴道萎缩女性, 透明质酸可以作为一种有效的保湿剂。但是, 其有效性和安全性有待一个精密设计的随机对照试验来阐明。

Keywords:

• Hyaluronic acid
• vulvovaginal atrophy
• menopause
• radiotherapy
• dyspareunia

Potential conflict of interest

All authors report no conflict of interest.

Source of funding

Nil.

Data availability statement

Quantitative data from RCTs are available upon request.