Higiene e cosmética vulvar

Higiene e cosmética vulvar
Vulvar care guidelines may likely play a significant role in managing many vulvar conditions. At our institution, we recommend VCGs for all of our vulvar patients, including those with identified conditions such as vulvar dermatoses and vulvovaginal atrophy. Vulvar care guidelines were developed chiefly to help eliminate common irritants to facilitate improvement of symptoms. Multiple studies have been conducted to show that there are important differences between vulvar tissue and other skin surfaces. Such characteristics as tissue structure itself, hydration status, occlusion, friction, and permeability make vulvar tissue more susceptible to inflammation as well as friction-related injury [3, 12Y16]. By following VCGs with regard to personal hygiene and product use, patients in whom contact dermatitis potentially plays the contributory role of symptom causation should be able to see improvement in their symptoms. Although VCGs are not enough to constitute the entire scope of treatment of various vulvar disorders, these guidelines can serve as an important adjunct to conventional treatment. Further studies evaluating this role are needed. Although time consuming and requiring patient motivation, VCGs should be included as the first-line treatment for women presenting with vulvar complaints. Thist tool is inexpensive, easy for patients to follow, and highly successful, at the same time imparting no tangible risks. In addition, it allows for the patients to become active participants in the treatment plan and gain a certain degree of autonomy in managing their symptoms. Further studies involving larger sample sizes and

vulva Função? reprodutiva excretora sexual erótica protectora
The vulvar structures cover the deeper structures of the female perineum (groin area). The labia maintain, by their apposition, the closure of the vaginal introitus (opening). The integument (skin) of the vulva has specialized nerve endings sensitive to touch. Mucus produced by the vestibular glands maintains the epithelial moisture in this region. What Does the Vulva Consist Of? "Vulva" refers collectively to several structures that make up the female sex organ. These include two layers of lip-like "labia," known as the "labia majora" and "labia minora;" the mons pubis, a "mound" of fatty tissue that bulges over the pubic bone, the clitoris, the urinary meatus, the vaginal orifice, and the hymen. Together, the structures make up a fleshy, door-like opening to the vagina and urinary tract. Various structures of the vulva each serve specific functions. Other related structures include the perineum, pudendal cleft, and vaginal glands. What is the Function of the Vulva? The vulva serves several functions, with each of its structures contributing to these purposes. The two sets of labia protect the opening to the vagina, serving as "double doors." Although the vagina is self-cleaning, the lips are necessary to keep unwanted debris from getting inside, much like the eyelids protect the eyes. The clitoris becomes stimulated and engorged during sexual intercourse, giving pleasure to the female. The opening to the urethra, which is located on the vulva, is key to urination, though the vulva is otherwise unrelated to the urination act Its appearance also serves as a potent sexual stimulant. The vulva has three main functions:1. It protects women's sexual organs and urinary opening from trauma and infection.2. It is vital for women's sexual response. The clitoris is the main organ of sexual arousal and orgasm response in most women. 3. The vulva and the perineum stretch to accommodate childbirth. The tissue swells up when aroused and gives pleasure when touched and is there to protect the entrance to the vaginal canal and the urethra. It's also stretches during childbirth so the baby safely can come out.

Fluidos vulvares Secreções em contacto com a vulva: Urina Suor
Ácidos alifáticos Menstruação Sebo Esmegma Secreções das glândulas de Skene e de Bartholin Secreção vaginal Lubrificação vaginal durante a excitação A mucosa da vulva está em contacto com inumeras secreções da vagina, urina, menstruação e suor, bem como com numerosas substâncias originárias de tecidos, toalhas de produtos de limpeza, espermicidas e medicamentos. Mas os orgaos sexuais tem sistemas de autolimpeza. A sua rica vascularização e a produção de muco que “lava os microorganismos deleterios” . A mucosa vaginal segrega e absorve fluidos muito mais do que a pele (é preciso cuidado com os produtos e tambem por isso aplicamos produtos quimicos por via vaginal) e é muito mais permeavel do que a pele. É preciso cuidado com as reacções alergicas e irritação em vulvas já sensiveis. Muitas mulheres aplicam produtos antipruriginosos, antifungicos que podem contribuir para aumentar a irritação. Fluids and odor There are a number of different secretions associated with the vulva, including urine, sweat, menses, skin oils (sebum), Bartholin's and Skene's gland secretions, and vaginal wall secretions. These secretions contain a mix of chemicals, including pyridine, squalene, urea, acetic acid, lactic acid, complex alcohols, glycols, ketones, and aldehydes. During sexual arousal, vaginal lubrication increases. Smegma Smegma is a white substance formed from a combination of dead cells, skin oils, moisture and naturally occurring bacteria, that forms in mammalian genitalia. In females it collects around the clitoris and labial folds. Aliphatic acids Approximately one third of women produce aliphatic acids. These acids are a pungent class of chemicals which other primate species produce as sexual-olfactory signals. While there is some debate, researchers often refer to them as human pheromones. These acids are produced by natural bacteria resident on the skin. The acid content varies with the menstrual cycle, rising from one day after menstruation, and peaking mid-cycle, just before ovulation. Já o aroma feminino característico concentra-se na região genital, por causa da sua lubrificação constante e do fato de o interior da vagina ser mais ácido, para proteger a mucosa. Além disso, existe grande concentração de glândulas sudoríparas na virilha e na vulva. O papel principal nessa história toda é justamente dessas glândulas produtoras do suor. Existem dois tipos: écrinas e apócrinas. As primeiras soltam um líquido que serve apenas para resfriar o corpo. Já as apócrinas liberam uma secreção leitosa, que é a verdadeira responsável pelos cheiros do corpo humano. “Essa secreção, que tem a função de manter a pele hidratada e contém gordura, é um alimento rico para as bactérias, que se aproveitam do calor e da umidade de certas regiões do corpo para proliferar, causando cheiros fortes”, afirma o dermatologista Luís Antônio Torezan, de São Paulo. O odor feminino também é atribuído aos chamados ácidos alifáticos, substâncias gordurosas presentes no suor e na secreção vaginal. Estudos comprovaram que esses ácidos são uma forte isca sexual entre os primatas. Um exemplo divertido é a famosa carta de Napoleão Bonaparte à sua amada Josephine, avisando que chegaria do campo de batalha em poucos dias e pedindo para ela parar de se banhar, para deixar bem concentrado seu aroma natural. Mas o mais incrível nesse setor da bioquímica erótica são os feromônios, hormônios que produzem aromas que não são percebidos conscientemente, mas que, no mundo animal, regulam a atração que leva ao acasalamento.

pH vaginal Variação do pH vaginal ao longo da vida da mulher pH
At birth, these tissues exhibit the effects of residual maternal estrogens. During puberty, the vulva and vagina mature under the influence of adrenal and gonadal steroid hormones. During the reproductive years, the vagina responds to ovarian steroid hormone cycling, and both tissues adapt to the needs of pregnancy and delivery. Following menopause, the vulva and vagina atrophy. A rise in the prevalence of incontinence among older women increases the risk of vulvar and perineal dermatitis. Vigilant care and proper hygiene in elderly people, especially those with incontinence, are needed to avoid dermatitis and skin deterioration which may be debilitating at this stage of life. O equilíbrio natural da sua zona íntima é sustentado por um balanceado, porém frágil, ecossistema. Uma zona vaginal saudável possui vastas colónias de bactérias (lactobacilos) produtoras de ácido láctico. O ácido láctico estabelece na zona íntima um ambiente ligeiramente ácido, com um pH entre 3,8 e 4,5. Ao longo da vida da mulher, devido ao ciclo menstrual, gravidez e menopausa, a flora vaginal sofre alterações. Estas alterações no equilíbrio interno são normais, mas podem, indiretamente, favorecer a colonização por agentes patogénicos. Devido a estes fatores, é necessário dar a devida atenção e cuidar desta área tão delicada do corpo. A higiene é um tema que ocupa grande parte da nossa rotina diária. Nas mulheres, deve haver uma atenção redobrada no que diz respeito à higiene íntima, pois a zona genital feminina é muito sensível e, com as alterações hormonais que surgem ao longo da vida, é necessária uma higiene e cuidados específicos. Além disso, em estados como a menopausa, a gravidez ou a menstruação, deve dar-se uma especial atenção à manutenção do pH vaginal, uma vez que as alterações hormonais alteram o pH, o que favorece o aparecimento de infeções. summary, the vulva and vagina undergo characteristic age- related changes over a lifetime. The picture that emerges from most studies of the vaginal microbiota described here is static because it is based on cross-sectional studies that assess the microbial constituents at discrete and infrequent time points. However, microbial communities in the human vagina likely undergo shifts in the representation and abundance of key species over time that are influenced by factors which may include age of the woman, hormonal fluctuations (e.g., stage of menstrual cycle, contraception), sexual activity (e.g., types of sexual activities such as oral or anal sex followed by vaginal sex, frequency of sex, number of sex partners, and the genitourinary tract microbiota of these partners), underlying health conditions (e.g., diabetes, urinary tract infection), use of medications (e.g., intravaginal and systemic antibiotics), intravaginal washing practices and hygiene. Future studies will benefit from the use of high throughput technologies that will facilitate measuring fluctuations in the human vaginal microbiota over time in longitudinal analyses with more frequent sampling. Current data suggest that these studies will reveal a highly dynamic human vaginal ecosystem in many women. Além disso, em estados como a menopausa, a gravidez ou a menstruação, deve dar-se uma especial atenção à manutenção do pH vaginal, uma vez que as alterações hormonais alteram o pH, o que favorece o aparecimento de infeções. Variação do pH vaginal ao longo da vida da mulher

Microbioma Vaginal Representação de 650 perfis de microbiomas vaginais
O equilíbrio natural da sua zona íntima é sustentado por um ecossistem frágil porém balanceado. Uma zona vaginal saudável possui vastas colónias de bactérias (lactobacilos) produtoras de ácido láctico. O ácido láctico estabelece na zona íntima um ambiente ligeiramente ácido, com um pH entre 3,8 e 4,5. Ao longo da vida da mulher, devido ao ciclo menstrual, gravidez e menopausa, a flora vaginal sofre alterações. Estas alterações no equilíbrio interno são normais, mas podem, indiretamente, favorecer a colonização por agentes patogénicos. O microbioma vaginal varia entre as raças tendo a raça negra e as hispanicas pH mais altos , provavelmente devido a habitos de higiene e tambem alteraçõe geneticas. A healthy vagina maintains a complex and interdependent community of bacteria (the vaginal microbiome) which support a natural defense to harmful pathogens that can lead to disease. Douching can disrupt this microbiome, by altering both the vaginal pH and changing the proportions and types of bacteria in the vagina. Regular douching has been associated in numerous studies with an increased risk of bacterial vaginosis, which occurs when the balance is upset and there is an overgrowth of certain microorganisms in the vagina.64 Other studies link douching to pelvic inflammatory disease, cervical cancer, low-birth weight, preterm birth, HIV transmission, sexually transmitted diseases, ectopic pregnancy, chronic yeast infections, and infertility.65 Studies have not identified Devido a estes fatores, é necessário dar a devida atenção e cuidar desta área tão delicada do corpo. The vaginal epithelium and microbiota undergo dramatic shifts that coincide with hormonal changes that occur throughout a woman’s life. As estrogen levels increase during puberty, glycogen is deposited in the stratified, squamous, non-keratinized vaginal epithelium [9] [10]. For many women, this physiological change coincides with and likely mediates a natural increase in the prevalence of species of lactobacilli, which then generally predominate during the reproductive years. The importance of species of the genus Lactobacillus has been appreciated for over a hundred years, dating back to Albert Döderlein’s late-19th-century discovery of long, thick gram-positive rods in the normal vaginal secretions of premenopausal women [11–13]. Lactobacillus species are able to ferment glycogen, thereby producing lactic acid, which is thought to establish the acidic vaginal environment (i.e. pH < 4.5) that has traditionally been considered a hallmark of vaginal health [14]. As estrogen levels gradually decline during menopause, the glycogen content in vaginal epithelial cells also declines, leading to a varying degree of depletion of lactobacilli [15–17]. Also during menopause, the vaginal epithelium thins and loses its elasticity, vaginal blood flow diminishes, and there is a marked decrease in vaginal secretions [18]. Thus, not surprisingly, the representation of lactobacilli in the vagina is diminished. Recent studies of the vaginal microbiome suggest that the traditional paradigm of vaginal health does not apply to all women. Several groups have reported that the average vaginal pH for African American and Hispanic women is higher than that of Caucasian women [19–21], and that in fact, a majority of women in these racial and ethnic groups have high vaginal pH (i.e., pH > 4.5) values, which is outside the range traditionally associated with health. Furthermore, recent studies using molecular techniques have found that Lactobacillus species do not predominate in the vaginal microbiome for a substantial proportion of healthy women of reproductive age [20] [22] [23]. In preliminary analyses of the vaginal microbiomes of a cadre of over 600 women, our results support these findings (Figure 1). Thus, a simple clustering of these microbiomes suggests the existence of multiple ‘vagitypes’, many of which are dominated by a single bacterial taxon. Mid-vaginal microbiome profiles using genus-level taxonomic classification A total of 650 microbiome profiles are represented. Each bar represents the genus-level microbiome profile for one mid-vaginal sample and each color represents a distinct genus. Mid-vaginal swab samples were obtained from participants enrolled in the Vaginal Human Microbiome Project at VCU. The V1–V3 hypervariable of the 16S rRNA gene was targeted, and on average, approximately 30,000 reads per sample were generated using the Roche 454 GS FLX Titanium platform Representação de 650 perfis de microbiomas vaginais Vaginal Human Microbiome Project A New Era of the Vaginal Microbiome: Advances using Next-Generation Sequencing Jennifer M. Fettweisa,b, Myrna G. Serranoa,b, Philippe H. Girerdc, Kimberly K. Jeffersona, and Gregory A. Bucka,b Chem Biodivers May ; 9(5): 965–976.

Higiene e cosmética vulvar
Lavagem Depilação Protecção e conforto Absorventes menstruais Emolientes Spray desodorizante Toalhetes actividade sexual Lubrificantes Piercings Cosmética A grande maioria dos produtos utilizados na mucosa genital são os produtos de higiene e control de odores Tips for vulvar care Use only warm water to wash the vulva. Dry thoroughly with a clean towel. (If the vulva is very irritated, you can try drying it with a blow dryer set on cool.) The vagina cleanses itself naturally in the form of normal, vaginal discharge. Avoid using douches unless prescribed by your physician. These products can upset the natural balance of organisms. Wear only white, 100 percent cotton underwear. Avoid wearing nylon, acetate, or other man made fibers. Avoid wearing thongs. Rinse underclothes carefully after washing. Or, double-rinse. Wash new underclothes before wearing. Use a mild soap (such as Woolite®) for washing underclothes. Do not use detergents (especially Tide) or fabric softeners (including dryer sheets.) Use soft toilet tissue (white only). Use tampons instead of sanitary napkins to control menstrual bleeding. (Do not use deodorant tampons.) Do not leave tampons in for a long period, due to toxic shock syndrome. Do not leave tampons in all night. Take Aveeno® sitz baths daily, if prescribed by your health care provider. Don't scratch. Avoid wearing nylon pantyhose or panty girdles. They trap heat and moisture, providing an ideal breeding environment for organisms. When nylons or leggings are required, wear cotton or nylons with a cotton panty. Avoid these feminine hygiene products, which can irritate the vulva: sanitary pads, feminine spray and deodorants, Vaseline®, oils, greases, bubble baths, bath oils, talc, or powder. Over-the-counter products for vaginal lubrication Vaginal moisturizers: Replens® (Warner Wellcome) - Using applicator, apply three times a week at bedtime to maintain normal vaginal moisture. Gyne-Moistrin® (Schering-Plough) For use during intercourse: Astroglide® (Astro-Lube, Inc.) Lubrin® Vaginal Suppository (Upsher-Smith Laboratories, Inc.) - Developed for postmenopausal women Condom-Mate® Vaginal Suppository (Upsher-Smith)— Developed for use with condoms; same as Lubrin®, but smaller. Today® Personal Lubricant (Made by manufacturers of the Today® Sponge) K-Y Jelly® (Johnson and Johnson) Petroleum-based lotions (such as Vaseline®) are not recommended. They may cause irritation and yeast infections and can weaken condoms to the point of breaking. References Self-Help Tips for Vulvar Skin Care. Accessed 5/1/2013. Vaginal Yeast Infections Fact Sheet. Accessed 5/1/2013. © Copyright The Cleveland Clinic Foundation. All rights reserved. Can't find the health information you’re looking for? Ask a Health Educator, Live! Know someone who could use this information?...send them this link. This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/30/2013. Index#4976

Higiene vulvar A higiene intima feminina define-se como as práticas de asseio da região ano-genital da mulher, para mantê-la livre de humidade e de resíduos. A grande preocupação das mulheres é que a falta de asseio da área genital possa promover o desenvolvimento de corrimentos, odores desagradáveis e infeções. Os produtos de higiene devem ter propriedades que contribuam para o bem-estar, conforto, segurança e saúde da mulher, prevenindo as infeções. É importante que as mulheres conheçam a sua própria anatomia. Para isso, devemos chamar a atenção para que, com um espelho, analisem com detalhe a região genital.

Higiene vulvar - produtos
acção de limpeza manter dermocompatibilidade com as mucosas, sem irritar nem secar, não alterar o manto lipídico (função de barreira), manter o pH ligeiramente ácido, ter ação refrescante e desodorizante, viscosidade adequada e capacidade espumante. efeito emoliente e de hidratação É importante escolher produtos com detergência suave, que formem pouca espuma e que por isso afetem menos a barreira cutânea. A capacidade de oclusão de produtos com acção oclusiva ajuda a prevenir a dermatite associada a incontinência efeito lubrificante proteção e facilitação das relações sexuais diminuindo a fricção Uma enorme quantidade de produtos são usados na area genital. A grande maioria são produtos de higiene e controlo de odores tais como geis de lavagem, toalhetes, sprays desodorantes A FDA regula os produtos classificando : Dispositivos médicos: tampões, pensos e lubrificantes (que não obriga a descrição dos ingredientes); não são obrigatórios testes em humanos com os lubrificantes Over the counter drugs: cremes anti-pruriginosos, duches medicados Produtos cosméticos: Sprays desodorizantes, geis de lavagem são produtos cosméticos e segundo a regulação não devem conter produtos venenosos ou substâncias deletérias

Higiene vulvar Tipo de produto Forma de apresentação Frequência diária
Preferencialmente, produtos apropriados para a higiene ano-genital que sejam hipoalergénicos e com pH ácido, variando entre 4,2 a 5,6 Forma de apresentação Preferencialmente, produtos de formulação liquida, pois os produtos sólidos, alem de serem mais abrasivos, geralmente apresentam pH muito alto (alcalino). Não usar o vulgar sabão. Frequência diária Uma a três vezes ao dia durante 2-3 minutos, dependente do clima, biótipo, atividade física e doenças associadas . 8 MOMENTOS EM QUE A HIGIENE ÍNTIMA DEVE SER REFORÇADA, DIARIAMENTE, COM UM PRODUTO ADEQUADO ›› Durante a menstruação ›› Durante a gravidez ›› No pós-parto, especialmente no puerpério, que é o período de 6-8 semanas após o parto ›› Na menopausa ›› Durante tratamentos ginecológicos e outros tratamentos médicos (por exemplo, a toma de antibióticos que afetam a nossa flora vaginal) ›› Se existe incontinência urinária ›› Após fazer desporto ou se existe excesso de suor ›› Antes e depois de ter tido relações sexuais

Higiene vulvar Conselhos de higiene monte púbico, pele da vulva,
Devemos ensinar que na região interna da vagina a introdução de produtos não está aconselhada, exceto sob prescrição médica, e que as zonas a lavar devem ser : monte púbico, pele da vulva, raiz das coxas, região perianal, interior dos grandes e dos pequenos lábios. A dermatite de contato pode surgir por contacto com papel perfumado ou de cor, lubrificantes, fluidos corporais, antisepticos, contraceptivos em gel, creme Topical antibiotics, anti-fungals, corticosteroids • Fragrances (feminine wash, bath products, etc) • Urine, feces • Plant compounds (calendula, tea tree oil, poison oak, poison ivy) • Menstrual pads, adult diapers • Detergents • Vehicle of topical medications (propylene glycol,preservatives) • Lidocaine, Benzocaine • Vagisil (benzocaine and resorcinol) • Wipes

Higiene vulvar Conselhos de higiene
a vulva, a região púbica, a região perianal e os sulcos crurais (raiz das coxas) deverão ser higienizados com agua corrente e com produtos de higiene, fazendo movimentos suaves que evitem trazer o conteúdo perianal para a região vulvar e que atinjam todas as dobras sem exceção. Incluir os sulcos interlabiais, região retro prepucial (clitóris). as áreas lavadas devem ser secas cuidadosamente com toalhas secas e limpas, que não agridam o epitélio da região. Nunca esfregar! sprays, perfumes, talcos, ou lenços humedecidos não devem ser utilizados A dermatite de contato pode surgir por contacto com papel perfumado ou de cor, lubrificantes, fluidos corporais, antisepticos, contraceptivos em gel, creme

Higiene vulvar – recomendações gerais
Banho e higiene Não se deve esfregar a pele vulvar com a toalha, mas sim secar Actividade sexual Após o ato sexual, lavar a área genital externa com agua e produto de higiene intima. Não se recomendam lavagens duches vaginais. Período perimenstrual, menstrual e puerpério recente Higiene deverá ser mais frequente, para aumentar a remoção mecânica dos resíduos e melhorar a ventilação genital, com consequente redução da humidade prolongada. Pós-menopausa Devido a menor espessura do epitélio, recomenda-se lavar, no máximo, duas vezes/dia Infância Deve ser feita a higiene diária com banho diário e após a defecação. Muitas mulheres (conforme as culturas, educação e hábitos sociais) acreditam ser uma medida normal e aceitável da higiene feminina especialmente na menstruação ou após as relações. Está totalmente contraindicado acarretando riscos de infecções, DIP, infertilidade , parto pre-termo

Higiene da vulva “irritada”
Aconselhar: papel higiénico macio, inodoro, cor branca banhos de assento mornos ou frios para aliviar a queimação e irritação. Evitar shampoo na área vulvar. Não usar banho de espuma, produtos de higiene feminina, cremes perfumados ou sabonetes. Lavagem da vulva com apenas água morna. Lavagem da vulva com água após a micção. Prevenir obstipação com dieta rica em fibras e pelo menos 8 copos de água diariamente. Pensos higiénicos sem perfume 100% algodão ou tampões ou copos menstruais Vestuário largo, interior de algodão; desnecessário durante o sono Use soft, white, unscented toilet paper. Use lukewarm or cool sitz baths to relieve burning and irritation. Avoid getting shampoo on the vulvar area. Do not use bubble bath, feminine hygiene products, or any perfumed creams or soaps. Wash the vulva with cool to lukewarm water only. Rinse the vulva with water after urination. Urinate before the bladder is full. Prevent constipation by adding fiber to your diet (if necessary, use a psyllium product such as Metamucil) and drinking at least 8 glasses of water daily. Use 100% cotton menstrual pads and tampons.

Produtos emolientes Base oleosa ou aquosa (aplicação mais fácil)
Possuem acção reparadora: lipidos e ceramida são incorporados pelo epitélio e restaurando a barreira lipidica “relaxam” o sistema imune e diminuem a inflamação Possuem componentes oclusivos: silicones (dimeticone), oleo mineral ou Petrolatum Componentes humectantes: sorbitol, ureia Possuem componentes hidratantes: estearato glicol, gliceril estearato A pele hidratada necessita menor potência dos fármacos There are two basic categories of moisturizer: humectants (which, like glycerin soap, absorb water from the air) and emollients. Emollients soften skin in part by delivering the goods directly. Unlike a humectant, emollients bring moisture to your skin via the composition of the product itself. Carrier oil, urea and man-made substances such as silicone oils and isopropyl myristate are all emollients that you might see on product labels. One moisturizer will often contain several different types of emollients (and possibly humectants as well). Emollients consist primarily of one of two things: oil or water. Oil-based emollients are greasier to the touch, are more easily seen on the face after application and stick around longer than water-based emollients. Water-based emollients are easier to apply and make less of a mess. Dry skin can be the result of a problem with your skin's barrier. When detected by the body, this problem can result in an immune system response that causes inflammation and redness. When you apply a moisturizer that contains an emollient, you are soothing and healing the external barrier layer, which in turn will tell the immune system to relax and the inflammatory response to cease. One of the main functions of an emollient is to trap moisture in the skin. However, if you don't properly apply an emollient, you may just wind up trapping moisture outside of the skin, leading to more problems with dryness. For this reason, it's important to apply an emollient cream when you already have some moisture on your face, hands or any other part of your body you are treating. A good time to apply an emollient is after bathing. Make sure you haven't completely dried off when you apply the emollient, thus trapping the external water beneath the artificial layer of oil you are applying. Otherwise, you'll be sealing in dry skin and preventing moisture from penetrating the emollient layer. Emollients not only help moisten your skin and trap moisture within, they also reduce the need to use more potent medications that may cause a negative reaction, especially when used over a long period of time. Your dermatologist will know which course of action is best to treat your dry skin, but proper use of an emollient cream is a safe treatment you can undertake right away, and one that usually delivers results.

hidratantes One of the main functions of an emollient is to trap moisture in the skin. However, if you don't properly apply an emollient, you may just wind up trapping moisture outside of the skin, leading to more problems with dryness. For this reason, it's important to apply an emollient cream when you already have some moisture on your face, hands or any other part of your body you are treating. A good time to apply an emollient is after bathing. Make sure you haven't completely dried off when you apply the emollient, thus trapping the external water beneath the artificial layer of oil you are applying. Otherwise, you'll be sealing in dry skin and preventing moisture from penetrating the emollient layer. Emollients not only help moisten your skin and trap moisture within, they also reduce the need to use more potent medications that may cause a negative reaction, especially when used over a long period of time. Your dermatologist will know which course of action is best to treat your dry skin, but proper use of an emollient cream is a safe treatment you can undertake right away, and one that usually delivers results.

lubrificantes Os lubrificantes são substâncias que colocadas entre duas superficies móveis ou uma fixa e outra móvel, formam uma película protetora que tem por função principal reduzir o atrito A lubrificação sexual é necessária de modo a permitir a penetração sem dor para ambos os parceiros. Qualidades a avaliar na selecção do lubrificante intimo: Viscosidade Consistência Duração de acção deslizamento humectante pegajosidade Conforto Compatibilidade com preservativos segurança A dor persistente pode levar a diminuição da excitação durante a actividade sexual por mecanismos cognitivos Nonhormonal Treatments Current over-the-counter treatments include nonhormonal vaginal moisturizers for VVA symptoms and lubricants for dyspareunia. Vaginal moisturizers, which are water based, are available as liquids, gels, or ovules inserted every few days. Vaginal moisturizers can be safely used long term, but they need to be used regularly for optimal effect. Vaginal lubricants are shorter acting than moisturizers and are applied at the time of sexual activity to reduce dyspareunia. They can be either water or silicone based, with the water-based products being the most widely available. They are applied to the vaginal opening and/or to the penis and often require repeated application during sexual activity. Silicone-based lubricants require application of only a very small amount and last longer; however, they can interfere with erectile function in male partners. The choice of lubricant may depend on individual preferences and product availability Under the 1976 FDA regulation 21 CFR , a lubricant is considered a “medical device” when “intended for medical purposes that is used to lubricate a body orifice to facilitate entry of a diagnostic or therapeutic device.” Personal lubricant products that claim to “moisturize” or “cleanse” have often been considered as a “cosmetic.” In 2003, the FDA announced a safety and efficacy review, and clarified how moisturizer/lubricant product claims to decrease pain, enhance sexual pleasure or contain spermicide would be categorized. Such product statements would be considered to be “drug” claims since they are related to easing discomfort or alleviating a condition (“mitigation or treatment of disease”). Furthermore, the FDA announcement stated they would not consider lubricants/moisturizers to be “cosmetic claims because they do not relate to ‘cleansing, beautifying, promoting attractiveness, or altering the appearance’” [27]. In response to the FDA review, some lubricant manufacturers and their representatives have opposed the FDA’s assertions, arguing that the “intended use” of lubricants is “cosmetic claims,” as their products aim to “cleanse” and not “treat disease.” Arguments included that the purpose of the lubricant products is not to alter body structure, and that the enhancement of sexual pleasure can broadly be interpreted as “beautifying” [28–30]. While this is not a comprehensive review of responses to the FDA, the arguments for “cosmetic” classification may, or may not, be influenced by a possibility that having lubricants classified as “drugs” by the FDA could add further regulatory burden upon lubricant manufacturers to test for safety. In 2008, the FDA stated that further guidance on lubricants and vaginal moisturizers is forthcoming [31], but this guidance does not yet appear to be final or readily accessible. In the meantime, the regulatory environment does not appear to always require lubricant manufacturers to rigorously confirm the vaginal and rectal safety of these products, especially if the product does not claim to be intended for sexual use. However, thanks to an emerging interest in the development of vaginal and rectal microbicides, new information is emerging. Preliminary data suggest that some water-based lubricants – depending on their formulation – may be less safe than previously believed. One clinical study reported greater rectal epithelial damage when exposed to hyperosmolar water-based gels [32]. Recent studies have also evaluated in vitro and ex vivo impacts of some water- and silicone-based lubricants, and found that some caused greater epithelial damage or irritation to cervical or rectal tissue than others [33–36]. Among these results, one study found that some hyperosmolar lubricants exposed to an in vitro epithelial model caused reduction of epithelial integrity, and four lubricants showed increased HIV replication in vitro [35]. Another recent study of some water-based lubricants found similar associations with epithelial damage in vitro, but with no increase in HIV replication [36]. These studies provide preliminary insights, but have not yet demonstrated definitive epidemiologic impacts on human populations. Evidence from behavioural data remains limited, as lubricant use has not often been assessed as HIV or STI risk factors in previous studies. One recent study, however, has found that rectal STI prevalence among lubricant-using men and women were significantly higher than non-lubricant users [37]. Combined with the recent laboratory evidence, this may be the cause for concern and more data are needed. Use of lubricants in Africa Both practices of dry sex and use of lubricants for the increase of pleasure, decrease of pain or replacement/removal of vaginal secretions have been documented in Africa; as has vaginal hygiene or washing practices – especially among sex workers [38]. General personal lubricant use, however, is rarely investigated in population-based surveys. It is only more recently that some studies have assessed lubricant usage, albeit among more key populations at risk such as MSM and FSW. A 2004 study of MSM in Nairobi reported that Vaseline® or petroleum jelly was used by 84% of respondents, baby oil or body lotion by 26% and water-based products by 41% [39]. Other MSM studies in Africa have also reported high levels of petroleum jelly use and sometimes other “condiments,” such as butter/margarine, yoghurt, shea butter, and cooking oils [40–42]. Information on lubricant use for heterosexual vaginal intercourse in Africa is less available, though limited evidence suggests that oil-based lubricants may often be used in heterosexual encounters. Separate studies of FSW in Nairobi, Kenya, have documented petroleum jelly use by 20–40% of participants [43,44]. Additionally, male sex workers in Mombasa reported using such lubricants as petroleum jelly, baby oil, lotions, vegetable oil, and coconut oil with both male and female sexual partners for both anal and vaginal sex (Population Council, unpublished data). Petroleum jellies may be a lubricant used for sex in many African countries, regardless of types of sexual intercourse or sexualities. These products, such as Vaseline®, are widely available and can be purchased everywhere from a city supermarket to remote rural kiosks. They are also relatively inexpensive compared to water-based pharmaceutical products such as KY Jelly®, which are usually only accessible in supermarkets and pharmacies. These factors may make petroleum jellies more attractive options in developing or poorer areas in Africa [45]. Current guidance for lubricant procurement and prevention programming in Africa Confidence in the condom-compatibility of water-based lubrication appears to be universal, and past guidance has strongly recommended their use [3,4]. However, the emerging evidence of possible correlations between use of water-based lubricants and HIV/STI transmission (especially rectal) has influenced some updated guidance. The PEPFAR guidance for combination prevention for MSM [46] recommends only procuring lubricants deemed safer by evidence presented at the Microbicides 2010 conference [36,37]. The PEPFAR guidance, however, does not specifically summarize which lubricant products are preferable. In 2011, the World Health Organization (WHO), in collaboration with United Nations Population Fund and Family Health International, published an advisory document which reconfirms that oil-based lubricants should be avoided, and provides more clarity on the procurement of safer water-based lubricants. A list of household products are listed as damaging to latex including: baby oil, burn ointment, dairy butter, palm or coconut oil, cooking oil, fish oil, mineral oil, suntan oil, haemorrhoid cream, petroleum jelly and body/hand lotions [47]. This WHO list, however, references a behavioural study in Jamaica [48] which actually does not specifically mention, or scientifically test the condom compatibility of most of these “condiments,” as is implied. Based on the evidence documenting epithelial or mucosal damage and/or irritation [32,34,35], the WHO advisory recommends a systematic review of lubricant safety, and provides interim recommendations for procurement agencies to avoid products with high osmolality and products containing polyquaternary compounds. Additional pH specifications for lubricants intended for vaginal or anal sex are provided [47]. The WHO document relists some commercial lubricants with their osmolality and pH from one of the recent studies [35], but – as with the PEPFAR guidance – stops short of declaring specific products as “safe” for procurement. Based on this guidance, it seems that programmers are currently expected to independently research the formulation or ingredients of lubricant products before procurement. Additionally, in Africa water-based lubricants remain costly, and prevention programmes also remain unable to advise on the safety and condom compatibility of some inexpensive “condiments” reportedly used by MSM and FSW in Africa – including butter, yoghurt and coconut oil. In response, some organizations, most notably the International Rectal Microbicides Advocates (IRMA), are monitoring these research developments, distributing summaries and fact sheets of lubricant safety, and advocating for greater research resources on lubricant safety and use both in Africa and worldwide [49]. CONCLUSIONS: The literature and evidence of lubricant condom compatibility and safety is not as thoroughly assessed and/or documented as commonly believed, and our knowledge is currently evolving and improving. This includes emerging awareness that Africans are using lubricants that may or may not be compatible with condoms, and that some Africans are engaging in anal sex, which requires more access to water-based lubricants. Additionally, further confirmation is needed on the safety and procurement criteria for some water- and silicone-based lubricants. Thus, the potential epidemiologic impact of lubricant use is under-assessed, and more attention must be given. First, the current global regulatory environment for lubricants may not always require rigorous safety testing and assessment, especially if a product is not marketed for sexual use. Whether lubricants or vaginal moisturizers should be classified as “drugs” or “cosmetics” and tested for safety accordingly is currently under debate, while Africans continue to use lubricants based on intuition, availability and affordability – sometimes with no knowledge of the current public health guidance. While the recent information on vaginal and rectal safety testing from microbicides research has been helpful, further guidance from the FDA and more research is needed to resolve outstanding safety concerns. This will help assure HIV prevention programmers and lubricant users that they are distributing or using lubricants which are safe, and do not put Africans at increased risk of HIV or STIs. Use lubricants to make vaginal penetration more comfortable. The list of lubricants below is not complete. It describes several commonly used lubricants. We do not officially recommend any one of these products, nor do we recommend any one product over other products. Some lubes have glycerin and some are ‘glycerin free.’ A few research studies have shown that glycerin lubricants increase the production of yeast and irritation in the vagina in some women. Propylene Glycol is another ingredient used in some lubricants that can cause irritation for some women. Remember most lubes impair sperm’s motility, so if trying to conceive, Pre-Seed is considered the best option. We do not list food-based oils because health care professionals caution against these. The oil can get into the urethra and contribute to urinary tract and bladder infections. Silicone lubricants last longer but often need to be cleaned off with soap and water. If you are prone to yeast infections, you may want to avoid silicone and stay with water-based lubes. Don’t mix silicone lubes with silicone sex toys, it can cause the silicone in sex toys to deteriorate. Following is a list of lubricants available at grocery stores, pharmacies and health food stores. You may also find them online.  ID Millenium – silicone based, non-glycerin, latex compatible  Slippery Stuff -water-based, water-soluble, non-glycerin, liquid or gel, latex compatible.  Sliquid Silver –silicone based, non-glycerin, paraben-free. Center for Sexual Health Lubricants and Related Items - 2 -  Pre-seed -will not affect sperm motility, water soluble  Astroglide - water-based, water-soluble, contains glycerin and propylene glycol, latex compatible  Astroglide Free -water-based, water-soluble, latex compatible, glycerin free contains propylene glycol  K-Y Jelly - water-based, water-soluble, contains glycerin and propylene glycol, latex compatible  Replens - Long lasting, inserted by applicator into the vagina. Can be used on a regular basis for vaginal moisturizing. Contains glycerin, water soluble.  Lubrin – Vaginal suppository, water soluble, latex compatible  Sylk- Made of Kiwi fruit vine and purified water. From New Zealand. Marketed through Whole Foods. Mimics natural secretions, contains glycerin  Surgilube - water soluble, contains propylene glycol, latex compatible  Vitamin E oil - Available in health food stores, natural, non-irritating qualities.  Saliva can be used for lubrication Hypoallergenic Lubricants- Organic and chemical free:  Pink- made with silicone, vitamin E and Aloe Vera, washes off easily. Available online at drugstore.com  Just Like Me- made by Pure Romance, pH balanced, safe for latex or polyurethane condoms  Good Clean Love  Sensual Organics Condoms: It is best to use non-lubricated condoms and apply your own water-based lube. Non-water based lubricants can break down the latex and make the condom unsafe. Following are different types of condoms:  Latex condoms – must be used with water based lubricant  Polyurethane  Non-latex polyisoprene: including Lifestyles SKYN condoms - higher sensitivity without latex- available online  Female Condoms, Nitrile FC2- available in latex-free material, available online

lubrificantes Tempo de acção mais curta que os emolientes
Usados no momento do acto sexual Existem diversos tipos de lubrificantes, destinados à prática do coito. Devem ser incolores, inodoros Os excipientes glicerina, glicerol, monolaurato, plietilenoglicol, e a presença de espermicidas podem ter toxicidade e aumentar a transmissão de ISTs A vaselina (base de Petroleum ) não está recomendada. Permanece dias na vagina, pode causar irritação e infecções fúngicas e enfraquece os preservativos aumentando as ISTs. O GINECOL INTIM é um gel fluido lubrificante não hormonal, formulado para ajudar a compensar a insuficiência das secreções vaginais naturais e possibilitar assim, uma melhor lubrificação. O GINECOL INTIM ULTRAGEL é um fluido incolor, inodoro, não gordo. A composição do GINECOL INTIM, é à base de água e com adição de humectantes, permite assegurar uma hidratação e lubrificação adequada da mucosa vaginal. Não contém agentes agressivos e restaura um nível de humidade adequado, protegendo a mucosa de escoriações e irritações durante o contacto íntimo. Não temos muitos estudos sobre o uso de lubrificantes nem temos formação para poder aconselhar corretamente. Existem questões por responder. Necessitar de lubrificante afecta a relação do casal? Usar lubrificante irá permitir a o coito sem vontade da mulher? Será que a necessitar de lubrificante leva a sensação de insuficiencia sexual? Nonhormonal Treatments Current over-the-counter treatments include nonhormonal vaginal moisturizers for VVA symptoms and lubricants for dyspareunia. Vaginal moisturizers, which are water based, are available as liquids, gels, or ovules inserted every few days. Vaginal moisturizers can be safely used long term, but they need to be used regularly for optimal effect. Vaginal lubricants are shorter acting than moisturizers and are applied at the time of sexual activity to reduce dyspareunia. They can be either water or silicone based, with the water-based products being the most widely available. They are applied to the vaginal opening and/or to the penis and often require repeated application during sexual activity. Silicone-based lubricants require application of only a very small amount and last longer; however, they can interfere with erectile function in male partners. The choice of lubricant may depend on individual preferences and product availability Under the 1976 FDA regulation 21 CFR , a lubricant is considered a “medical device” when “intended for medical purposes that is used to lubricate a body orifice to facilitate entry of a diagnostic or therapeutic device.” Personal lubricant products that claim to “moisturize” or “cleanse” have often been considered as a “cosmetic.” In 2003, the FDA announced a safety and efficacy review, and clarified how moisturizer/lubricant product claims to decrease pain, enhance sexual pleasure or contain spermicide would be categorized. Such product statements would be considered to be “drug” claims since they are related to easing discomfort or alleviating a condition (“mitigation or treatment of disease”). Furthermore, the FDA announcement stated they would not consider lubricants/moisturizers to be “cosmetic claims because they do not relate to ‘cleansing, beautifying, promoting attractiveness, or altering the appearance’” [27]. In response to the FDA review, some lubricant manufacturers and their representatives have opposed the FDA’s assertions, arguing that the “intended use” of lubricants is “cosmetic claims,” as their products aim to “cleanse” and not “treat disease.” Arguments included that the purpose of the lubricant products is not to alter body structure, and that the enhancement of sexual pleasure can broadly be interpreted as “beautifying” [28–30]. While this is not a comprehensive review of responses to the FDA, the arguments for “cosmetic” classification may, or may not, be influenced by a possibility that having lubricants classified as “drugs” by the FDA could add further regulatory burden upon lubricant manufacturers to test for safety. In 2008, the FDA stated that further guidance on lubricants and vaginal moisturizers is forthcoming [31], but this guidance does not yet appear to be final or readily accessible. In the meantime, the regulatory environment does not appear to always require lubricant manufacturers to rigorously confirm the vaginal and rectal safety of these products, especially if the product does not claim to be intended for sexual use. However, thanks to an emerging interest in the development of vaginal and rectal microbicides, new information is emerging. Preliminary data suggest that some water-based lubricants – depending on their formulation – may be less safe than previously believed. One clinical study reported greater rectal epithelial damage when exposed to hyperosmolar water-based gels [32]. Recent studies have also evaluated in vitro and ex vivo impacts of some water- and silicone-based lubricants, and found that some caused greater epithelial damage or irritation to cervical or rectal tissue than others [33–36]. Among these results, one study found that some hyperosmolar lubricants exposed to an in vitro epithelial model caused reduction of epithelial integrity, and four lubricants showed increased HIV replication in vitro [35]. Another recent study of some water-based lubricants found similar associations with epithelial damage in vitro, but with no increase in HIV replication [36]. These studies provide preliminary insights, but have not yet demonstrated definitive epidemiologic impacts on human populations. Evidence from behavioural data remains limited, as lubricant use has not often been assessed as HIV or STI risk factors in previous studies. One recent study, however, has found that rectal STI prevalence among lubricant-using men and women were significantly higher than non-lubricant users [37]. Combined with the recent laboratory evidence, this may be the cause for concern and more data are needed. Use of lubricants in Africa Both practices of dry sex and use of lubricants for the increase of pleasure, decrease of pain or replacement/removal of vaginal secretions have been documented in Africa; as has vaginal hygiene or washing practices – especially among sex workers [38]. General personal lubricant use, however, is rarely investigated in population-based surveys. It is only more recently that some studies have assessed lubricant usage, albeit among more key populations at risk such as MSM and FSW. A 2004 study of MSM in Nairobi reported that Vaseline® or petroleum jelly was used by 84% of respondents, baby oil or body lotion by 26% and water-based products by 41% [39]. Other MSM studies in Africa have also reported high levels of petroleum jelly use and sometimes other “condiments,” such as butter/margarine, yoghurt, shea butter, and cooking oils [40–42]. Information on lubricant use for heterosexual vaginal intercourse in Africa is less available, though limited evidence suggests that oil-based lubricants may often be used in heterosexual encounters. Separate studies of FSW in Nairobi, Kenya, have documented petroleum jelly use by 20–40% of participants [43,44]. Additionally, male sex workers in Mombasa reported using such lubricants as petroleum jelly, baby oil, lotions, vegetable oil, and coconut oil with both male and female sexual partners for both anal and vaginal sex (Population Council, unpublished data). Petroleum jellies may be a lubricant used for sex in many African countries, regardless of types of sexual intercourse or sexualities. These products, such as Vaseline®, are widely available and can be purchased everywhere from a city supermarket to remote rural kiosks. They are also relatively inexpensive compared to water-based pharmaceutical products such as KY Jelly®, which are usually only accessible in supermarkets and pharmacies. These factors may make petroleum jellies more attractive options in developing or poorer areas in Africa [45]. Current guidance for lubricant procurement and prevention programming in Africa Confidence in the condom-compatibility of water-based lubrication appears to be universal, and past guidance has strongly recommended their use [3,4]. However, the emerging evidence of possible correlations between use of water-based lubricants and HIV/STI transmission (especially rectal) has influenced some updated guidance. The PEPFAR guidance for combination prevention for MSM [46] recommends only procuring lubricants deemed safer by evidence presented at the Microbicides 2010 conference [36,37]. The PEPFAR guidance, however, does not specifically summarize which lubricant products are preferable. In 2011, the World Health Organization (WHO), in collaboration with United Nations Population Fund and Family Health International, published an advisory document which reconfirms that oil-based lubricants should be avoided, and provides more clarity on the procurement of safer water-based lubricants. A list of household products are listed as damaging to latex including: baby oil, burn ointment, dairy butter, palm or coconut oil, cooking oil, fish oil, mineral oil, suntan oil, haemorrhoid cream, petroleum jelly and body/hand lotions [47]. This WHO list, however, references a behavioural study in Jamaica [48] which actually does not specifically mention, or scientifically test the condom compatibility of most of these “condiments,” as is implied. Based on the evidence documenting epithelial or mucosal damage and/or irritation [32,34,35], the WHO advisory recommends a systematic review of lubricant safety, and provides interim recommendations for procurement agencies to avoid products with high osmolality and products containing polyquaternary compounds. Additional pH specifications for lubricants intended for vaginal or anal sex are provided [47]. The WHO document relists some commercial lubricants with their osmolality and pH from one of the recent studies [35], but – as with the PEPFAR guidance – stops short of declaring specific products as “safe” for procurement. Based on this guidance, it seems that programmers are currently expected to independently research the formulation or ingredients of lubricant products before procurement. Additionally, in Africa water-based lubricants remain costly, and prevention programmes also remain unable to advise on the safety and condom compatibility of some inexpensive “condiments” reportedly used by MSM and FSW in Africa – including butter, yoghurt and coconut oil. In response, some organizations, most notably the International Rectal Microbicides Advocates (IRMA), are monitoring these research developments, distributing summaries and fact sheets of lubricant safety, and advocating for greater research resources on lubricant safety and use both in Africa and worldwide [49]. CONCLUSIONS: The literature and evidence of lubricant condom compatibility and safety is not as thoroughly assessed and/or documented as commonly believed, and our knowledge is currently evolving and improving. This includes emerging awareness that Africans are using lubricants that may or may not be compatible with condoms, and that some Africans are engaging in anal sex, which requires more access to water-based lubricants. Additionally, further confirmation is needed on the safety and procurement criteria for some water- and silicone-based lubricants. Thus, the potential epidemiologic impact of lubricant use is under-assessed, and more attention must be given. First, the current global regulatory environment for lubricants may not always require rigorous safety testing and assessment, especially if a product is not marketed for sexual use. Whether lubricants or vaginal moisturizers should be classified as “drugs” or “cosmetics” and tested for safety accordingly is currently under debate, while Africans continue to use lubricants based on intuition, availability and affordability – sometimes with no knowledge of the current public health guidance. While the recent information on vaginal and rectal safety testing from microbicides research has been helpful, further guidance from the FDA and more research is needed to resolve outstanding safety concerns. This will help assure HIV prevention programmers and lubricant users that they are distributing or using lubricants which are safe, and do not put Africans at increased risk of HIV or STIs. Use lubricants to make vaginal penetration more comfortable. The list of lubricants below is not complete. It describes several commonly used lubricants. We do not officially recommend any one of these products, nor do we recommend any one product over other products. Some lubes have glycerin and some are ‘glycerin free.’ A few research studies have shown that glycerin lubricants increase the production of yeast and irritation in the vagina in some women. Propylene Glycol is another ingredient used in some lubricants that can cause irritation for some women. Remember most lubes impair sperm’s motility, so if trying to conceive, Pre-Seed is considered the best option. We do not list food-based oils because health care professionals caution against these. The oil can get into the urethra and contribute to urinary tract and bladder infections. Silicone lubricants last longer but often need to be cleaned off with soap and water. If you are prone to yeast infections, you may want to avoid silicone and stay with water-based lubes. Don’t mix silicone lubes with silicone sex toys, it can cause the silicone in sex toys to deteriorate. Following is a list of lubricants available at grocery stores, pharmacies and health food stores. You may also find them online.  ID Millenium – silicone based, non-glycerin, latex compatible  Slippery Stuff -water-based, water-soluble, non-glycerin, liquid or gel, latex compatible.  Sliquid Silver –silicone based, non-glycerin, paraben-free. Center for Sexual Health Lubricants and Related Items - 2 -  Pre-seed -will not affect sperm motility, water soluble  Astroglide - water-based, water-soluble, contains glycerin and propylene glycol, latex compatible  Astroglide Free -water-based, water-soluble, latex compatible, glycerin free contains propylene glycol  K-Y Jelly - water-based, water-soluble, contains glycerin and propylene glycol, latex compatible  Replens - Long lasting, inserted by applicator into the vagina. Can be used on a regular basis for vaginal moisturizing. Contains glycerin, water soluble.  Lubrin – Vaginal suppository, water soluble, latex compatible  Sylk- Made of Kiwi fruit vine and purified water. From New Zealand. Marketed through Whole Foods. Mimics natural secretions, contains glycerin  Surgilube - water soluble, contains propylene glycol, latex compatible  Vitamin E oil - Available in health food stores, natural, non-irritating qualities.  Saliva can be used for lubrication Hypoallergenic Lubricants- Organic and chemical free:  Pink- made with silicone, vitamin E and Aloe Vera, washes off easily. Available online at drugstore.com  Just Like Me- made by Pure Romance, pH balanced, safe for latex or polyurethane condoms  Good Clean Love  Sensual Organics Condoms: It is best to use non-lubricated condoms and apply your own water-based lube. Non-water based lubricants can break down the latex and make the condom unsafe. Following are different types of condoms:  Latex condoms – must be used with water based lubricant  Polyurethane  Non-latex polyisoprene: including Lifestyles SKYN condoms - higher sensitivity without latex- available online  Female Condoms, Nitrile FC2- available in latex-free material, available online

lubrificantes base de água:
contem tipicamente água deionizada, glicerina, propylene glycol e conservantes não tóxico. compatível com preservativo, rapidamente absorvidos Podem ser hiperosmolares (a glicerina retira agua das células causando lesão vaginal e rectal que pode levar a transmissão de IST) Devem ser hipoalergênicos: seleccionar aqueles livre de glicerina, parabenos e todos os irritantes conhecidos. base de óleo: NÃO compatível com preservativo, Normalmente fabricados com produtos naturais como óleos vegetais podem ser usados na vagina Quando existe uma necessidade de uma lubrificação de longa duração, o lubrificante à base de óleo dá um deslizamento prolongado base silicone: Elevada espessura, demasiado deslizantes e de remoção dificil exigem muito detergente (prejudicial à flora vaginal) Menor risco de infecção IST Moench TR, et al. Microbicide excipients can greatly increase susceptibility to genital herpes transmission in the mouse.BMC Infect. Dis., DOI: /1471 Craig W. Hendrix J Infect Dis DOI: 1086/511279 Petróleo. Fabricados a partir de gel de petróleo, óleo mineral ou petrolato, os lubrificantes a base de petróleo são o tipo mais usado de lubrificação.Tipos diferentes incluem produtos de Vaselina e óleos para uso infantil. Como os lubris a base de petróleo destroem o látex ao mínimo contato não devem ser usados nunca com preservativos, diafragmas e capas cervicais. Além disso mancham tecidos, são difíceis de lavar e irritam a vagina. Assim não são a melhor opção para uma mulher querendo curtir uma penetração vaginal mas são bons para masturbação masculina. * A base de óleo. Normalmente fabricados a partir de produtos naturais como óleos vegetais, óleos de nozes, manteiga, tendem a manchar os tecidos e também destroem o látex. Podem ser usados na vagina sem problema sendo ótimos para sexo anal, intercurso vaginal e masturbação feminina. * A base de água. Estes lubrificantes contem tipicamente água deionizada , glicerina, propylene glycol e conservantes não tóxicos. Com ou sem sabor a maioria tem um sabor ligeiramente adocicado. Não mancham tecidos, podem ser usados com látex e outros mecanismos de controle de natalidade tipo barreira e raramente causam irritação. Apesar de serem absorvidos rapidamente durante o sexo podem ser facilmente reavivados com um pouco de saliva ou um borrifo de água. Por sua versatilidade e efetividade são os mais recomendados por terapeutas sexuais e casais experientes. * A base de silicone. São similares aos com base em água com uma diferença fundamental:são totalmente a prova de água o que os torna ideais para uso em ambientes molhados. Eles também conservam as propriedades lubrificantes melhor e por mais tempo do que os a base de água e são altamente concentrados, assim um pouco vai longe! Mas cuidado: o silicone não destrói o látex, mas exige limpeza com muito sabão e isso pode ser prejudicial à flora bacteriana da vagina e podem estragar os brinquedos feitos em silicone, normalmente os mais caros. Assim ao usar um determinado tipo lembre-se das restrições de cada um delas. Experimente algum tipos com seu parceiro para conhecer as texturas, sabores e consistências. Se não encontrar logo um de seu agrado não se desespere existem inúmeras opções. O importante é usar um e sentir a enorme diferença! Não temos muitos estudos sobre o uso de lubrificantes nem temos formação para poder aconselhar corretamente. Existem questões por responder. Necessitar de lubrificante afecta a relação do casal? Usar lubrificante irá permitir a o coito sem vontade da mulher? Será que a necessitar de lubrificante leva a sensação de insuficiencia sexual? Já os lubrificantes à base de silicone apresentam riscos menores de infecção, mas não são indicados para qualquer pessoa devido à sua espessura. "Como não são absorvidos facilmente, eles deslizam demais. Um iniciante pode não se adaptar e acabar com um problema físico", alerta Paula. Também não devem ser usados com brinquedos do mesmo material, pois dissolvem a superfície. "Prefira sempre lubrificantes à base de água. Esses podem ser usados à vontade", garante Badiglian Nonhormonal Treatments Current over-the-counter treatments include nonhormonal vaginal moisturizers for VVA symptoms and lubricants for dyspareunia. Vaginal moisturizers, which are water based, are available as liquids, gels, or ovules inserted every few days. Vaginal moisturizers can be safely used long term, but they need to be used regularly for optimal effect. Vaginal lubricants are shorter acting than moisturizers and are applied at the time of sexual activity to reduce dyspareunia. They can be either water or silicone based, with the water-based products being the most widely available. They are applied to the vaginal opening and/or to the penis and often require repeated application during sexual activity. Silicone-based lubricants require application of only a very small amount and last longer; however, they can interfere with erectile function in male partners. The choice of lubricant may depend on individual preferences and product availability Under the 1976 FDA regulation 21 CFR , a lubricant is considered a “medical device” when “intended for medical purposes that is used to lubricate a body orifice to facilitate entry of a diagnostic or therapeutic device.” Personal lubricant products that claim to “moisturize” or “cleanse” have often been considered as a “cosmetic.” In 2003, the FDA announced a safety and efficacy review, and clarified how moisturizer/lubricant product claims to decrease pain, enhance sexual pleasure or contain spermicide would be categorized. Such product statements would be considered to be “drug” claims since they are related to easing discomfort or alleviating a condition (“mitigation or treatment of disease”). Furthermore, the FDA announcement stated they would not consider lubricants/moisturizers to be “cosmetic claims because they do not relate to ‘cleansing, beautifying, promoting attractiveness, or altering the appearance’” [27]. In response to the FDA review, some lubricant manufacturers and their representatives have opposed the FDA’s assertions, arguing that the “intended use” of lubricants is “cosmetic claims,” as their products aim to “cleanse” and not “treat disease.” Arguments included that the purpose of the lubricant products is not to alter body structure, and that the enhancement of sexual pleasure can broadly be interpreted as “beautifying” [28–30]. While this is not a comprehensive review of responses to the FDA, the arguments for “cosmetic” classification may, or may not, be influenced by a possibility that having lubricants classified as “drugs” by the FDA could add further regulatory burden upon lubricant manufacturers to test for safety. In 2008, the FDA stated that further guidance on lubricants and vaginal moisturizers is forthcoming [31], but this guidance does not yet appear to be final or readily accessible. In the meantime, the regulatory environment does not appear to always require lubricant manufacturers to rigorously confirm the vaginal and rectal safety of these products, especially if the product does not claim to be intended for sexual use. However, thanks to an emerging interest in the development of vaginal and rectal microbicides, new information is emerging. Preliminary data suggest that some water-based lubricants – depending on their formulation – may be less safe than previously believed. One clinical study reported greater rectal epithelial damage when exposed to hyperosmolar water-based gels [32]. Recent studies have also evaluated in vitro and ex vivo impacts of some water- and silicone-based lubricants, and found that some caused greater epithelial damage or irritation to cervical or rectal tissue than others [33–36]. Among these results, one study found that some hyperosmolar lubricants exposed to an in vitro epithelial model caused reduction of epithelial integrity, and four lubricants showed increased HIV replication in vitro [35]. Another recent study of some water-based lubricants found similar associations with epithelial damage in vitro, but with no increase in HIV replication [36]. These studies provide preliminary insights, but have not yet demonstrated definitive epidemiologic impacts on human populations. Evidence from behavioural data remains limited, as lubricant use has not often been assessed as HIV or STI risk factors in previous studies. One recent study, however, has found that rectal STI prevalence among lubricant-using men and women were significantly higher than non-lubricant users [37]. Combined with the recent laboratory evidence, this may be the cause for concern and more data are needed. Use of lubricants in Africa Both practices of dry sex and use of lubricants for the increase of pleasure, decrease of pain or replacement/removal of vaginal secretions have been documented in Africa; as has vaginal hygiene or washing practices – especially among sex workers [38]. General personal lubricant use, however, is rarely investigated in population-based surveys. It is only more recently that some studies have assessed lubricant usage, albeit among more key populations at risk such as MSM and FSW. A 2004 study of MSM in Nairobi reported that Vaseline® or petroleum jelly was used by 84% of respondents, baby oil or body lotion by 26% and water-based products by 41% [39]. Other MSM studies in Africa have also reported high levels of petroleum jelly use and sometimes other “condiments,” such as butter/margarine, yoghurt, shea butter, and cooking oils [40–42]. Information on lubricant use for heterosexual vaginal intercourse in Africa is less available, though limited evidence suggests that oil-based lubricants may often be used in heterosexual encounters. Separate studies of FSW in Nairobi, Kenya, have documented petroleum jelly use by 20–40% of participants [43,44]. Additionally, male sex workers in Mombasa reported using such lubricants as petroleum jelly, baby oil, lotions, vegetable oil, and coconut oil with both male and female sexual partners for both anal and vaginal sex (Population Council, unpublished data). Petroleum jellies may be a lubricant used for sex in many African countries, regardless of types of sexual intercourse or sexualities. These products, such as Vaseline®, are widely available and can be purchased everywhere from a city supermarket to remote rural kiosks. They are also relatively inexpensive compared to water-based pharmaceutical products such as KY Jelly®, which are usually only accessible in supermarkets and pharmacies. These factors may make petroleum jellies more attractive options in developing or poorer areas in Africa [45]. Current guidance for lubricant procurement and prevention programming in Africa Confidence in the condom-compatibility of water-based lubrication appears to be universal, and past guidance has strongly recommended their use [3,4]. However, the emerging evidence of possible correlations between use of water-based lubricants and HIV/STI transmission (especially rectal) has influenced some updated guidance. The PEPFAR guidance for combination prevention for MSM [46] recommends only procuring lubricants deemed safer by evidence presented at the Microbicides 2010 conference [36,37]. The PEPFAR guidance, however, does not specifically summarize which lubricant products are preferable. In 2011, the World Health Organization (WHO), in collaboration with United Nations Population Fund and Family Health International, published an advisory document which reconfirms that oil-based lubricants should be avoided, and provides more clarity on the procurement of safer water-based lubricants. A list of household products are listed as damaging to latex including: baby oil, burn ointment, dairy butter, palm or coconut oil, cooking oil, fish oil, mineral oil, suntan oil, haemorrhoid cream, petroleum jelly and body/hand lotions [47]. This WHO list, however, references a behavioural study in Jamaica [48] which actually does not specifically mention, or scientifically test the condom compatibility of most of these “condiments,” as is implied. Based on the evidence documenting epithelial or mucosal damage and/or irritation [32,34,35], the WHO advisory recommends a systematic review of lubricant safety, and provides interim recommendations for procurement agencies to avoid products with high osmolality and products containing polyquaternary compounds. Additional pH specifications for lubricants intended for vaginal or anal sex are provided [47]. The WHO document relists some commercial lubricants with their osmolality and pH from one of the recent studies [35], but – as with the PEPFAR guidance – stops short of declaring specific products as “safe” for procurement. Based on this guidance, it seems that programmers are currently expected to independently research the formulation or ingredients of lubricant products before procurement. Additionally, in Africa water-based lubricants remain costly, and prevention programmes also remain unable to advise on the safety and condom compatibility of some inexpensive “condiments” reportedly used by MSM and FSW in Africa – including butter, yoghurt and coconut oil. In response, some organizations, most notably the International Rectal Microbicides Advocates (IRMA), are monitoring these research developments, distributing summaries and fact sheets of lubricant safety, and advocating for greater research resources on lubricant safety and use both in Africa and worldwide [49]. CONCLUSIONS: The literature and evidence of lubricant condom compatibility and safety is not as thoroughly assessed and/or documented as commonly believed, and our knowledge is currently evolving and improving. This includes emerging awareness that Africans are using lubricants that may or may not be compatible with condoms, and that some Africans are engaging in anal sex, which requires more access to water-based lubricants. Additionally, further confirmation is needed on the safety and procurement criteria for some water- and silicone-based lubricants. Thus, the potential epidemiologic impact of lubricant use is under-assessed, and more attention must be given. First, the current global regulatory environment for lubricants may not always require rigorous safety testing and assessment, especially if a product is not marketed for sexual use. Whether lubricants or vaginal moisturizers should be classified as “drugs” or “cosmetics” and tested for safety accordingly is currently under debate, while Africans continue to use lubricants based on intuition, availability and affordability – sometimes with no knowledge of the current public health guidance. While the recent information on vaginal and rectal safety testing from microbicides research has been helpful, further guidance from the FDA and more research is needed to resolve outstanding safety concerns. This will help assure HIV prevention programmers and lubricant users that they are distributing or using lubricants which are safe, and do not put Africans at increased risk of HIV or STIs. Use lubricants to make vaginal penetration more comfortable. The list of lubricants below is not complete. It describes several commonly used lubricants. We do not officially recommend any one of these products, nor do we recommend any one product over other products. Some lubes have glycerin and some are ‘glycerin free.’ A few research studies have shown that glycerin lubricants increase the production of yeast and irritation in the vagina in some women. Propylene Glycol is another ingredient used in some lubricants that can cause irritation for some women. Remember most lubes impair sperm’s motility, so if trying to conceive, Pre-Seed is considered the best option. We do not list food-based oils because health care professionals caution against these. The oil can get into the urethra and contribute to urinary tract and bladder infections. Silicone lubricants last longer but often need to be cleaned off with soap and water. If you are prone to yeast infections, you may want to avoid silicone and stay with water-based lubes. Don’t mix silicone lubes with silicone sex toys, it can cause the silicone in sex toys to deteriorate. Following is a list of lubricants available at grocery stores, pharmacies and health food stores. You may also find them online.  Slippery Stuff -water-based, water-soluble, non-glycerin, liquid or gel, latex compatible.  ID Millenium – silicone based, non-glycerin, latex compatible  Sliquid Silver –silicone based, non-glycerin, paraben-free. Center for Sexual Health Lubricants and Related Items - 2 -  Pre-seed -will not affect sperm motility, water soluble  Astroglide - water-based, water-soluble, contains glycerin and propylene glycol, latex compatible  K-Y Jelly - water-based, water-soluble, contains glycerin and propylene glycol, latex compatible  Astroglide Free -water-based, water-soluble, latex compatible, glycerin free contains propylene glycol  Lubrin – Vaginal suppository, water soluble, latex compatible  Replens - Long lasting, inserted by applicator into the vagina. Can be used on a regular basis for vaginal moisturizing. Contains glycerin, water soluble.  Sylk- Made of Kiwi fruit vine and purified water. From New Zealand. Marketed through Whole Foods. Mimics natural secretions, contains glycerin  Vitamin E oil - Available in health food stores, natural, non-irritating qualities.  Surgilube - water soluble, contains propylene glycol, latex compatible  Saliva can be used for lubrication Hypoallergenic Lubricants- Organic and chemical free:  Pink- made with silicone, vitamin E and Aloe Vera, washes off easily. Available online at drugstore.com  Just Like Me- made by Pure Romance, pH balanced, safe for latex or polyurethane condoms  Sensual Organics  Good Clean Love It is best to use non-lubricated condoms and apply your own water-based lube. Non-water based lubricants can break down the latex and make the condom unsafe. Following are different types of condoms: Condoms:  Latex condoms – must be used with water based lubricant  Polyurethane  Female Condoms, Nitrile FC2- available in latex-free material, available online  Non-latex polyisoprene: including Lifestyles SKYN condoms - higher sensitivity without latex- available online

Lubrificantes Petróleo. Fabricados a partir de gel de petróleo, óleo mineral ou petrolato, os lubrificantes a base de petróleo são o tipo mais usado de lubrificação.Tipos diferentes incluem produtos de Vaselina e óleos para uso infantil. Como os lubris a base de petróleo destroem o látex ao mínimo contato não devem ser usados nunca com preservativos, diafragmas e capas cervicais. Além disso mancham tecidos, são difíceis de lavar e irritam a vagina. Assim não são a melhor opção para uma mulher querendo curtir uma penetração vaginal mas são bons para masturbação masculina. * A base de óleo. Normalmente fabricados a partir de produtos naturais como óleos vegetais, óleos de nozes, manteiga, tendem a manchar os tecidos e também destroem o látex. Podem ser usados na vagina sem problema sendo ótimos para sexo anal, intercurso vaginal e masturbação feminina. * A base de água. Estes lubrificantes contem tipicamente água deionizada , glicerina, propylene glycol e conservantes não tóxicos. Com ou sem sabor a maioria tem um sabor ligeiramente adocicado. Não mancham tecidos, podem ser usados com látex e outros mecanismos de controle de natalidade tipo barreira e raramente causam irritação. Apesar de serem absorvidos rapidamente durante o sexo podem ser facilmente reavivados com um pouco de saliva ou um borrifo de água. Por sua versatilidade e efetividade são os mais recomendados por terapeutas sexuais e casais experientes. * A base de silicone. São similares aos com base em água com uma diferença fundamental:são totalmente a prova de água o que os torna ideais para uso em ambientes molhados. Eles também conservam as propriedades lubrificantes melhor e por mais tempo do que os a base de água e são altamente concentrados, assim um pouco vai longe! Mas cuidado: o silicone não destrói o látex, mas exige limpeza com muito sabão e isso pode ser prejudicial à flora bacteriana da vagina e podem estragar os brinquedos feitos em silicone, normalmente os mais caros. Assim ao usar um determinado tipo lembre-se das restrições de cada um delas. Experimente algum tipos com seu parceiro para conhecer as texturas, sabores e consistências. Se não encontrar logo um de seu agrado não se desespere existem inúmeras opções. O importante é usar um e sentir a enorme diferença! The most common symptom is vaginal dryness, which can be reduced with instructions to use vaginal moisturizers or vaginal lubricants.92 Another consideration is the use of vaginal estrogen therapy (creams, tablets, estrogen- releasing ring), which have minimal systemic absorption and high patient satisfaction rates.93,94 Although studies are limited, these local therapy options have a high success rate (80%) and have been used safely in survivors of breast cancer.92,93 However, the use of local estrogen therapy may negate the benefit of aromatase inhibitors and should not be recommended in patients who undergo this therapy.95,96 Vaginal dryness may be accompanied by diminished sensation and pleasure and possibly dyspareunia withpartnered activity. For pervasive sexual difficulties, referral of patients to professionals with training in behavioral sex therapies IS ADVISED sexual difficulties may be doubly burdened if the difficulties Examples of commonly used lubricants, moisturizers, and vaginal estrogen products LubricantsWater-based: Astroglide, FemGlide, Just Like Me, K-Y Jelly, Pre-Seed, Slippery Stuff, Summer’s Eve, others Silicone-based: ID Millennium, Pink, Pjur, Pure Pleasure, others Oil-based (avoid): Mineral oil, Elegance Woman’s Lubricant, others Vaginal moisturizersFresh Start, K-Y Silk-E, Moist Again, Replens, K-Y Liquibeads, others Vaginal estrogen productsVagifem (vaginal tablet), Estrace (cream), Neo-Estrone (cream), Premarin (cream), Estring (low-dose vaginal ring) Lubricants and moisturizers Lubricants and moisturizers are effective in relieving pain during intercourse for many midlife women with mild to moderate vaginal dryness, so these products are a natural place to start. That’s particularly the case for women who are not candidates for vaginal estrogen therapy or are not comfortable using it. Vaginal estrogen products deliver estrogen directly to the vagina, with minimal absorption to the rest of the body, and restore thickness and flexibility to vaginal tissues. If you have more severe vaginal dryness and related pain, or if lubricants and moisturizers don’t work well for you, see your healthcare provider. There may be a more serious cause of your discomfort that should be diagnosed and treated. You and your healthcare provider can also discuss low-dose vaginal estrogen products. These prescription-only products deliver estrogen directly to the vagina, with minimal absorption to the rest of the body, and restore vaginal tissue thickness and flexibility. These actions may help prevent other sexual problems (such as worsening pain during sex, vaginismus, or diminished arousal or orgasm) that can result from chronically painful sex. Lubricants. Vaginal lubricants work by reducing the friction associated with thin, dry genital tissue. They come in liquid or gel form and are applied to the vagina and vulva (and, if desired, to a partner’s penis) right before sex. Lubricants are not absorbed into the skin, are immediate-acting, and provide temporary relief from vaginal dryness and related pain during sex. They are particularly appropriate for midlife women whose vaginal dryness is an issue only or primarily during sex. A wide variety of lubricants are commercially available, either as water-based, silicone-based, or oil-based products. Water-based lubricants have the advantage of being nonstaining. Oil-based lubricants (such as petroleum jelly and baby oil) should be avoided, as they can cause vaginal irritation and are associated with high rates of latex condom breakage that can lead to sexually transmitted infections. Polyurethane condoms do not break with oil-based lubricants. “Warming” lubricants: Mixed responses Most lubricants are intended to temporarily address vaginal dryness, but some “warming” or “zesty” lubricants are marketed to enhance sexual response and function. These products cause a warming sensation on the skin that’s triggered by ingredients such as capsaicin (a component of chili peppers) or menthol. One of the warming lubricants, Zestra, has been shown to enhance sexual response in research studies. While some women experience pleasurable warming sensations with these products, others report that they cause stinging or burning pain. Moisturizers. Like lubricants, vaginal moisturizers reduce the painful friction that sex can cause as a result of vaginal atrophy. Additionally, moisturizers, unlike lubricants, are absorbed into the skin and cling to the vaginal lining in a way that mimics natural secretions. Another difference is that moisturizers are applied regularly, not just before sex, and their effects are more long-term, lasting up to 3 or 4 days. Some moisturizers have an applicator to help place the product into the vagina. For both moisturizers and lubricants, you may need to experiment with several products to find the one that’s best for you. Because moisturizers maintain vaginal moisture and acidity, they are particularly appropriate for midlife women who are bothered by symptoms of vaginal dryness (such as irritation and burning) that are not limited to sexual activity. Some women who regularly use moisturizers still use a lubricant as needed before sex, for additional lubrication and comfort. For both moisturizers and lubricants, you may need to experiment with several products to find the one that’s best for you. Low-dose vaginal estrogen therapy. Estrogen products designed for vaginal application have been proven to restore vaginal blood flow and improve the thickness and stretchiness of vaginal tissue in peri- and postmenopausal women. These products act to reverse the thinning and dryness of vaginal tissues rather than just providing the temporary relief that lubricants and moisturizers do. For this reason, low-dose vaginal estrogen is appropriate in most cases for peri- and postmenopausal women who do not get sufficient relief from moisturizers or lubricants or whose symptoms of vaginal atrophy are interfering with their quality of life. Severe vaginal atrophy may respond more quickly to vaginal estrogen therapy than to hormone pills or patches. Women who need relief from other significant symptoms of menopause, such as hot flashes and night sweats, may want to consider higher-dose hormone therapy that raises estrogen levels throughout the body, as discussed on the next page of this program. However, for women without those other menopause symptoms, vaginal estrogen should be used since it is concentrated where it is needed and minimizes blood levels and possible side effects of estrogen on the rest of the body. Additionally, severe vaginal atrophy may respond more quickly to vaginal estrogen therapy than to hormone pills or patches that deliver estrogen throughout the body. Vaginal estrogen should be used at the lowest effective dose, again to limit any effects elsewhere in the body. If you’ve had breast cancer, be sure to mention this to your healthcare provider before using estrogen in any form so that you can properly weigh its benefits and risks. Low-dose vaginal estrogen is very effective against atrophy-related pain during sex, with up to 93% of women reporting significant improvement and 57% to 75% reporting that their sexual comfort is restored Improvements in vaginal moisture and health typically occur within a few weeks of starting therapy, although relief from severe vaginal atrophy can take several months. Vaginal estrogen is available in several forms, all of which require a prescription: Vaginal creams are applied in small amounts ( g) in the vagina 2 to 3 times a week. These products, known by the brand names Premarin, Estrace, and (in Canada) Neo-Estrone, should not be used as a lubricant before intercourse since the estrogen can be absorbed through a partner’s skin. The low-dose vaginal ring, Estring, is inserted into the vagina and worn for 3 months before being taken out and replaced; it does not need to be removed before sex. This low-dose estrogen ring is designed only to treat vaginal dryness and should not be confused with Femring, which is another vaginal ring that releases higher doses of estrogen for treating hot flashes and other symptoms of menopause. The vaginal tablet, Vagifem, is placed in the vagina twice a week using an applicator (recommended) or a finger. Many women find the estrogen tablet less messy than estrogen creams. All forms of vaginal estrogen are similarly effective, and most forms are associated with minimal side effects, although women’s individual responses may differ. The form chosen should be based on your individual preference, factoring in cost and insurance coverage, after discussion with your healthcare provider. If low-dose vaginal estrogen therapy is right for you, you may also use lubricants and moisturizers as needed. Sometimes, after estrogen therapy has restored the vaginal tissues to a more healthy state, it can be stopped and nonhormonal lubricants or moisturizers can be used alone. To maintain the benefit, however, it is important to continue regular vaginal sexual activity.

Pilosidade púbica ? funções
Protecção da delicada pele vulvar, e do vestíbulo Barreira mecânica contra irritantes e fricção do dia a dia Atracção sexual Concentração e emissão de odores (feromonas) Lubrificação da área sexual Diminuição da fricção e irritação da pele durante o coito Protecção contra infecções A função dos pelos púbicos Ninguém sabe ao certo a função dos pelos púbicos. Alguns dizem que os possuímos para atração física. Entretanto, médicos suspeitam que eles provavelmente existam para ajudar a concentrar e emitir os odores que o corpo exala - chamados ferormônios e secreções glandulares - que são poderosos afrodisíacos. São esses cheiros que as pessoas sentem quando ficam atraídas por alguém. Manter a depilação em dia é importante, mas tome alguns cuidados na hora de escolher a melhor forma de levar sua amiga ao cabeleireiro. Para quem tem pele sensível, até os métodos de depilação específicos para a área pubiana podem ser abrasivos. "Ingredientes ásperos como o hidróxido de cálcio - presente em loções removedoras - podem desencadear uma reação alérgica", alerta Jennifer. "O método mais seguro é sempre a lâmina", completa. Se você é daquelas que acreditam que depilar geral é mais higiênico, está enganada. Do ponto de vista médico, isso não favorece a saúde íntima. "Na verdade, os pelos formam uma proteção natural da vagina", diz Bauer. É claro que você não vai deixar de colocar aquele biquíni pequenininho ou a lingerie sexy que tem data marcada para ser estreada. Estar depilada é um prazer pessoal e pode fazer toda a diferença. Apenas evite abusar de sua pele Outra funções Pubic hair is normal and, like every other body part/appendage/function, serves a biological purpose. For example, when sweat evaporates it cools our body, eyebrows keep sweat out of our eyes, and orgasms make us want to have more sex so we perpetuate the species. We are a grand work of evolution and genetic code that doesn’t contribute to survival of the species gets dropped along the way. Pubic hair has stood the test of time. What pubic hair does is protect the delicate skin of the vulva and the vestibule (the opening of the vagina, just outside of the hymen). Pubic hair is a mechanical barrier to the irritants and friction in everyday life. It is the first line of physical defense, the labia being the second (I’ll save labial reduction for another post). There does seem to be a trend towards removing all pubic hair. Approximately 10% of women report being typically pubic hair-free and another 26% report removing all of their pubic hair some of the time. Removing pubic hair is purely a cosmetic act and, like all cosmetic procedure, carries both short and long-term risks. Lichen simplex chronicus, an eczema-like condition that can affect the vulva, is more common when women remove pubic hair. Irritation from products or razors also plays a role, but without hair the delicate vulvar skin is intimately exposed to a multitude of irritants (FYI, the symptoms of lichen simplex chronicus, chronic itching and irritation, are frequently misdiagnosed as chronic yeast infections). Other health consequences of shaving pubic hair include molluscum contagiosum, a common virus that may be spread by using a razor and infections from the trauma of shaving and waxing. I also see my fair share of inflamed and infected hair follicles as well as more serious infections. And finally there are potential cosmetic consequences. When the pubic hair is removed long-term (either laser hair removal or simply chronic waxing or shaving) the labia can thicken over time and take on a leathery appearance. This is called lichenification and is simply a normal response to chronic exposure to daily irritation. Keep in mind that many of the things we do for cosmetics have consequences. Over plucked eyebrows don’t always grow back and breast implants can scar and often need to be replaced. Hey, coloring your hair has risks. I color my hair (shocker, I know) and I understand there is a risk of scalp irritation and even allergy. For me, the benefit of not having grey hair outweighs those risks. Everyone views risks and benefits differently. In addition to risks I think it is important to really understand why you want to do something cosmetic. I pluck my eyebrows because I prefer a nice arch. I color my hair because I don’t want grey hair. However, I once chemically straightened my hair because my ex kept dropping hints I’d look better that way. Sigh. Straight hair was his beauty ideal. Of course, once done there were other faults. Hey, it was a great lesson that cosmetic enhancements should never be about someone else. My friend, the one who’s dating, went back to her her prospective partner about the risks and was still met with a skeptical look. “He was unconvinced. He seems really great, but I don’t think I’m into getting a Brazilian. What should I say?” she asked. My answer, which was probably more relationship advice than medical advice: “If the concept that you could be at higher risk for chronic skin irritation and other issues doesn’t sway him (because he should really care about your genital health, especially if you’re going to sleep with him), tell him that he should be so lucky to pick one of your pubic hairs out of his teeth and move on to someone who is more invested in you.” Jennifer Gunter is an Outras funções dos pelos pubianos podem incluir lubrificar a área genital durante a relação sexual, e deixar a movimentação mais confortável e mais suave para que a fricção não cause irritação. Esses pelos também podem evitar que bactérias entrem no corpo. In some cultures, including modern Western culture, women have shaved or otherwise depilated part or all of the vulva. When high-cut swimsuits became fashionable, women who wished to wear them would shave the sides of their pubic triangles, to avoid exhibiting pubic hair. Other women relish the beauty of seeing their vulva with hair, or completely hairless, and find one or the other more comfortable. Depilation of the vulva is a fairly recent phenomenon in the United States, Canada, and Western Europe, but has been prevalent, usually in the form of waxing, in many Eastern European and Middle Eastern cultures for centuries, usually due to the idea that it may be more hygienic, or originating in prostitution and pornography. Shaving may include all or nearly all of the hair. Some styles retain a small amount of hair on either side of the labia or a strip directly above and in line with the pudendal cleft. Many people object to pubic shaving, which can result in cuts to the vulva and clitoris, ingrown hairs, pseudofolliculitis barbae (razor bumps) and folliculitis.[7] Since the early days of Islam, Muslim women and men have followed a tradition to "pluck the armpit hairs and shave the pubic hairs". This is a preferred practice rather than an obligation, and could be carried out by shaving, waxing, cutting, clipping, or any other method. This is a regular practice that is considered in some more devout Muslim cultures as a form of worship, not a shameful practice, while in other less devout regions it is a practice for the purpose of good hygiene. (See Islamic hygienical jurisprudence.) The reasons behind removing this hair could also be applied to the hair on the scrotum and around the anus, because the purpose is to be completely clean and pure and keep away from anything that may cause dirt and impurities.[8]

The Origin-of-the-World
Gustave Courbet Courbet pintou nus femininos Regularmente, às vezes francamente libertino. Mas em A Origem do Mundo, teve comprimentos de ousadia e franqueza que deu sua pintura seu fascínio único. A descrição quase anatômica de órgãos sexuais femininos não é atenuado por qualquer dispositivo histórico ou literário. No entanto, graças ao grande virtuosismo de Courbet e do refinamento de seu esquema de cor âmbar, a pintura escapa estado pornográfico. A vulva aqui representada com pelos pubicos torna-se bastante erotica quase pornografica, coloquei aqui porque se trata de um exemplo da função erótica do pelo pubico Courbet regularly painted female nudes, sometimes in a frankly libertine vein. But in The Origin of the World he went to lengths of daring and frankness which gave his painting its peculiar fascination. The almost anatomical description of female sex organs is not attenuated by any historical or literary device. Yet thanks to Courbet's great virtuosity and the refinement of his amber colour scheme, the painting escapes pornographic status. This audacious, forthright new language had nonetheless not severed all links with tradition: the ample, sensual brushstrokes and the use of colour recall Venetian painting and Courbet himself claimed descent from Titian and Veronese, Correggio and the tradition of carnal, lyrical painting. The Origin of the World, now openly displayed, has taken its proper place in the history of modern painting. But it still raises the troubling question of voyeurism There does seem to be a trend towards removing all pubic hair. Approximately 10% of women report being typically pubic hair-free and another 26% report removing all of their pubic hair some of the time. Removing pubic hair is purely a cosmetic act and, like all cosmetic procedure, carries both short and long-term risks. Lichen simplex chronicus, an eczema-like condition that can affect the vulva, is more common when women remove pubic hair. Irritation from products or razors also plays a role, but without hair the delicate vulvar skin is intimately exposed to a multitude of irritants (FYI, the symptoms of lichen simplex chronicus, chronic itching and irritation, are frequently misdiagnosed as chronic yeast infections). Other health consequences of shaving pubic hair include molluscum contagiosum, a common virus that may be spread by using a razor and infections from the trauma of shaving and waxing. I also see my fair share of inflamed and infected hair follicles as well as more serious infections. And finally there are potential cosmetic consequences. When the pubic hair is removed long-term (either laser hair removal or simply chronic waxing or shaving) the labia can thicken over time and take on a leathery appearance. This is called lichenification and is simply a normal response to chronic exposure to daily irritation. Keep in mind that many of the things we do for cosmetics have consequences. Over plucked eyebrows don’t always grow back and breast implants can scar and often need to be replaced. Hey, coloring your hair has risks. I color my hair (shocker, I know) and I understand there is a risk of scalp irritation and even allergy. For me, the benefit of not having grey hair outweighs those risks. Everyone views risks and benefits differently. In addition to risks I think it is important to really understand why you want to do something cosmetic. I pluck my eyebrows because I prefer a nice arch. I color my hair because I don’t want grey hair. However, I once chemically straightened my hair because my ex kept dropping hints I’d look better that way. Sigh. Straight hair was his beauty ideal. Of course, once done there were other faults. Hey, it was a great lesson that cosmetic enhancements should never be about someone else. My friend, the one who’s dating, went back to her her prospective partner about the risks and was still met with a skeptical look. “He was unconvinced. He seems really great, but I don’t think I’m into getting a Brazilian. What should I say?” she asked. My answer, which was probably more relationship advice than medical advice: “If the concept that you could be at higher risk for chronic skin irritation and other issues doesn’t sway him (because he should really care about your genital health, especially if you’re going to sleep with him), tell him that he should be so lucky to pick one of your pubic hairs out of his teeth and move on to someone who is more invested in you.” Jennifer Gunter is an Outras funções dos pelos pubianos podem incluir lubrificar a área genital durante a relação sexual, e deixar a movimentação mais confortável e mais suave para que a fricção não cause irritação. Esses pelos também podem evitar que bactérias entrem no corpo. In some cultures, including modern Western culture, women have shaved or otherwise depilated part or all of the vulva. When high-cut swimsuits became fashionable, women who wished to wear them would shave the sides of their pubic triangles, to avoid exhibiting pubic hair. Other women relish the beauty of seeing their vulva with hair, or completely hairless, and find one or the other more comfortable. Depilation of the vulva is a fairly recent phenomenon in the United States, Canada, and Western Europe, but has been prevalent, usually in the form of waxing, in many Eastern European and Middle Eastern cultures for centuries, usually due to the idea that it may be more hygienic, or originating in prostitution and pornography. Shaving may include all or nearly all of the hair. Some styles retain a small amount of hair on either side of the labia or a strip directly above and in line with the pudendal cleft. Many people object to pubic shaving, which can result in cuts to the vulva and clitoris, ingrown hairs, pseudofolliculitis barbae (razor bumps) and folliculitis.[7] Since the early days of Islam, Muslim women and men have followed a tradition to "pluck the armpit hairs and shave the pubic hairs". This is a preferred practice rather than an obligation, and could be carried out by shaving, waxing, cutting, clipping, or any other method. This is a regular practice that is considered in some more devout Muslim cultures as a form of worship, not a shameful practice, while in other less devout regions it is a practice for the purpose of good hygiene. (See Islamic hygienical jurisprudence.) The reasons behind removing this hair could also be applied to the hair on the scrotum and around the anus, because the purpose is to be completely clean and pure and keep away from anything that may cause dirt and impurities.[8] The Origin-of-the-World Gustave Courbet 1866 (Musée d'Orsay)

Depilação do pelo púbico
Mais de 50% das mulheres remove o pelo púbico (18 a 24 anos) por motivos estéticos ou sexuais Depilação total com popularidade crescente O método mais usado é o “shaving” Entre 2007 e 2008, 67% das imagens da revista Playboy mostravam depilação total genital J Sex Med Oct;7(10): doi: /j x. Pubic hair removal among women in the United States: prevalence, methods, and characteristics. Herbenick D1, Schick V, Reece M, Sanders S, Fortenberry JD. Author information 1Center for Sexual Health Promotion, Indiana University, Bloomington, IN 47405, USA. Abstract INTRODUCTION: Although women's total removal of their pubic hair has been described as a "new norm," little is known about the pubic hair removal patterns of sexually active women in the United States. AIMS: The purpose of this study was to assess pubic hair removal behavior among women in the United States and to examine the extent to which pubic hair removal methods are related to demographic, relational, and sexual characteristics, including female sexual function. METHODS: A total of 2,451 women ages 18 to 68years completed a cross-sectional Internet-based survey. MAIN OUTCOME MEASURES: Demographic items (e.g., age, education, sexual relationship status, sexual orientation), cunnilingus in the past 4weeks, having looked closely at or examined their genitals in the past 4weeks, extent and method of pubic hair removal over the past 4weeks, the Female Genital Self-Image Scale (FGSIS) and the Female Sexual Function Index (FSFI). RESULTS: Women reported a diverse range of pubic hair-grooming practices. Women's total removal of their pubic hair was associated with younger age, sexual orientation, sexual relationship status, having received cunnilingus in the past 4weeks, and higher scores on the FGSIS and FSFI (with the exception of the orgasm subscale). CONCLUSION: Findings suggest that pubic hair styles are diverse and that it is more common than not for women to have at least some pubic hair on their genitals. In addition, total pubic hair removal was associated with younger age, being partnered (rather than single or married), having looked closely at one's own genitals in the previous month, cunnilingus in the past month, and more positive genital self-image and sexual function. © 2010 International Society for Sexual Medicine. 2009 Aug;6(8): doi: /j x. Epub 2009 May 5. Pubic hair and sexuality: a review. Ramsey S1, Sweeney C, Fraser M, Oades G. 1Southern General Hospital, Glasgow, Scotland. Hair is a distinguishing feature of mammals, though the persistence of visible head, axillary, and pubic hair remains anthropologically unclear. Humans throughout the ages have modified their head and body hair, but aesthetic removal of pubic hair has become the "the ultimate barometer of how fashionable you really are" in the 21st century. The aim of the article is to examine the trends in pubic hair removal and its impact on health and sexuality. A literature search was performed, with a further search performed using an Internet-based search engine. For discussion, the results have been classified into the topics of "Development and anthropology","Cultural and artistic significance", "Medical implications", "Psychological and sexual significance and popular culture", "Impact of body hair loss on sexuality" and "Style and terminology." Pubic hair removal has been common since the ancient times. Pubic hair was rarely depicted in artistic representations of the nude until the late 19th century. It is postulated that the current trend of pubic hair removal may be related to the increased accessibility of Internet-based pornography. Anecdotally, pubic hair removal may carry benefits regarding increased sexual sensation and satisfaction though there is no quantative research in this field. There is a recognized morbidity to pubic hair removal, and also a lack of standardization of terms for styles adopted. We propose a definitive grading system for male and female body hair based on the widely used Tumor Node Metastasis staging system. CONCLUSIONS: Pubic hair removal appears to be an important aspect of expressing one's sexuality and participation in sexual activity. This practice has an interesting psychosexual basis which, to date, has not yet been fully explored in sexual medicine. J Sex Med Oct;7(10): Pubic hair removal among women in the United States: prevalence, methods, and characteristics. Herbenick D, Schick V, Reece M, Sanders S, Fortenberry JD

La maja desnuda, Francisco Goya 1800. Museu do Prado, Madrid.
A maya nua tambem apresenta uma penugem discreta, socialmente mais aceite mas ainda assim arrojada para a epoca La maja desnuda, Francisco Goya Museu do Prado, Madrid.

Há três décadas, a depilação total ou quase total dos pelos pubianos fez sucesso entre as mulheres nos Estados Unidos, onde dominou os salões de beleza e a preferência popular das mulheres. Conhecida como Brazilian Bikíni Wax, a depilação total da região pubiana está perdendo lugar para o natural, com pelos mais generosos. Lady Gaga, Gwyneth Paltrow e Cameron Diaz são algumas das famosas que aderiram a moda do visual mais natural, no estilo dos anos 70. Cameron Diaz, em especial, em seu livro "The Body Book", dedicou um capítulo exclusivo sobre o assunto, onde revela que é contra a depilação íntima e exalta os pelos pubianos, argumentando que eles servem como uma cortina ao galanteio masculino, atiçam a imaginação dos amantes e criam um certo ar de mistério. No Brasil, a polêmica ficou por conta da atriz Nanda Costa, que na capa da revista Playboy, em agosto do ano passado, posou ao estilo Claudia Ohana, com a cabeleira pubiana farta, causando uma discussão de contra e a favor em aderir a moda.

Depilação genital prós contras Look” limpo e mais “sexy”
Facilita a higiene Adequa-se à roupa interior Auto-imagem genital mais positiva Motivação sexual: maior exposição vulvar Facilita a prática de sexo oral Maior sensação e satisfação sexual (não quantificada) Prurido/irritação abrasão, queimadura Ardência Cortes Nódulos Infecções genitais/ISTs Pelos encravados Foliculites liquenificação da pele dos lábios (longo prazo) Hiperpigmentação pós infllamatória Um dos maiores mitos sobre depilação íntima é que ela deve ser feita apenas por questão estética. Não mesmo. Segundo o Guia Prático de Condutas: Higiene Genital Feminina, lançado pela Febrasgo* (Federação Brasileira das Associações de Ginecologia e Obstetrícia), o excesso de pelos na região íntima pode contribuir para o acúmulo de resíduos e secreções, atraindo fungos e bactérias que podem causar corrimento, mau cheiro, ardor ou vermelhidão. “Por outro lado, não é bom remover completamente os pelos da virilha, do monte pubiano, dos grandes lábios e da região anal, já que eles também protegem contra as infecções”, avisa a ginecologista Cláudia Barquinha, da Casa de Saúde São José, no Rio de Janeiro. De acordo com ela, o ideal é que os pelos sejam aparados até a altura de um centímetro e a cada 15 dias, em média. Cada caso, um método Segundo a médica, a pele da região íntima é mais delicada em comparação à de outras partes do corpo e, por isso, é preciso ter cuidado na escolha da técnica de depilação. “Ela deve atender à necessidade de cada mulher, porém sem agredir a pele”, diz Cláudia Barquinha. Regra geral, a cera quente pode deixar a região com manchas escuras se estiver numa temperatura muito alta; a lâmina é prática, mas existe a possibilidade de cortar a pele e causar inchaço, o que acaba entupindo o poro e encravando o pelo; o creme depilatório funciona bem para quem deseja fugir da dor, porém, antes de aplicá-lo, é necessário fazer o teste em outras áreas do corpo, como o antebraço, por exemplo, para comprovar se você é ou não alérgica a algum dos ingredientes da fórmula do produto. Cuidados pós-depilação Após 24 horas da remoção dos pelos, os poros ainda estarão mais abertos do que o normal e, portanto, suscetíveis a reações alérgicas e irritações. Por isso, durante esse período, siga à risca as recomendações da ginecologista Cláudia Barquinha: - Evite os sabonetes tradicionais perfumados Eles são compostos por substâncias que aumentam o risco de alergias. O melhor é usar sabonete líquido de higiene íntima, que foi elaborado especialmente para remover o excesso de secreção e a sujeira da região e mantê-la com o pH saudável. Além disso, não agride a camada protetora da pele, o que diminui os riscos de alergia e irritação. - Invista em compressas calmantes Chá de camomila gelado, água boricada ou termal ajudam a acalmar a pele, evitando o aparecimento de foliculites (pelos encravados), ressecamento e irritação. Dados recentes apontam que 60% das mulheres americanas entre 18 e 24 anos são adeptas à depilação íntima parcial ou total, assim como 50% das que estão entre 25 e 29 anos. No entanto, uma pesquisa de Nice, na França, encontrou uma ligação entre esse tipo de depilação e o aumento de risco de uma doença sexualmente transmissível, o molusco contagioso, causada por um vírus que provoca lesões e tumores na pele. As informações são do Huffington Post. De acordo com a dermatologista Jessica Krant, de Nova York, a depilação permitiria mais área de contágio para o vírus, seja por meio da relação sexual ou pelo uso de uma toalha em comum. No entanto, a ligação entre uma coisa e outra ainda não é definitiva. "As genitais naturalmente têm pelos, e eles estão lá por alguma razão", defende a dermatologista. "Arrancar os pelos dói por um motivo: eles estão firmemente presos à pele, e são parte do corpo. Tirá-los é arrancar as raízes, o que deixa uma ferida logo abaixo da superfícia da pele." Jessica, juntamente com a dematologista Sandra Johnson, de Ark, listaram 5 problemas da depilação íntima: DST "Qualquer infecção que precise de contato para se espalhar será mais facilmente transmitida se a pele estiver danificada", diz Jessica. "Herpes, HIV, HPV e outras doenças aumentaram em número com o trauma causado na pele." Infecções Remover os pelos na depilação total, em especial, aumenta o risco de infecções. "Algumas bactérias têm acesso ao interior da pele, onde nunca deveriam chegar. Pode causar infecções externas e até piorar a celulite", diz Jessica. E se a depilação for com cera e palitos, cuidado com o uso do palito mais de uma vez. Se ele entra em contato com uma área contagiada e é devolvido ao pote de cera, é possível levar a bactéria a outras partes do corpo, como o rosto ou as axilas. Queimaduras Não é comum, mas queimaduras podem acontecer. Tanto pela temperatura da cera como pelo uso de cremes anti-idade ou para acne que contenham retinóides. De acordo com as profissionais, essa substância faz com que as células da pele se desprendam, ocasionando uma exfoliação exagerada na pele. Pelos encravados Tirar um pelo significa abrir caminho para um novo, menor e mais fraco nascer. Ele pode ficar preso abaixo da pele e causar irritações e infecções a longo prazo. Cicatriz A depilação irrita a pele, e se feita repetidamente, pode ocasionar uma irritação crônica na pele e até cicatrizes. A ginecologista Rose Amaral, do Ambulatório de Infecções Genitais e Vulvares do Hospital da Mulher, da Unicamp, discorda de Luciana, e acha que a depilação favorece a mulher e é higiênico. Ela justifica ser contra a não depilação, pois acha que os pelos retém resíduos de soluções biológicas, como suores e urina. Mas para quem aderir a moda de não se depilar, os cuidados devem ser redobrados, com uma manutenção necessária. Rose Amaral declara que, é importante manter os pelos curtos, aparados, e caprichar na higiene. Os pelos pubianos tem a mesma função dos cílios e sobrancelhas, que é a de prevenir doenças. Luciana Abbade conta que todos os pelos têm função de proteção contra agentes nocivos externos, como produtos químicos, fungos e bactérias. Infecções sexualmente transmissíveis como herpes genital e verrugas genitais, causadas por HPV, podem ser facilmente transmitidas uma vez que a barreira natural está ausente. Além disso, os pelos pubianos protegem contra vulvovaginites e outras infecções cutâneas do local, disse a ginecologista ao site.

Absorventes menstruais
Copos menstruais Absorventes menstruais Podem causar irritação ou alergia Dermatite de contacto , ao metildibromo glutaronitrilo, dioxinas, pesticidas Deve mudar-se de marca e para produtos sem cheiro Composto de Silicone cirúrgico, reutilizável Capacidade de 30 ml (fluxo é cerca de 15 ml dia) Deve ser removido de 8/8h Método económico, confortável, amigo do ambiente Em Portugal existe à venda em farmácias: Sangool Lunette Several case studies have been published examining health risks to women from use of menstrual pads.41,42,43 Common symptoms of menstrual pad use include irritation and allergic rash. Many women in these studies suffered for months before a doctor’s diagnosis determined the pads were causing the problem. In one case study, the fragrance present in the scented pad was found to be the causative agent of a rash.44 In another case study, methyldibromo glutaronitrile (MDBGN) was identified as the cause of the dermatitis. MDBGN was found to be a component of an adhesive used in the pad.45 A third study at a single gynecological practice did not identify a chemical cause, but noted that one particular brand of pads, Always, led to the symptom of itching or burning vulva in 28 women patients.46 In most cases, discontinuing use of pads, switching to unscented pads or simply changing brands led to the resolution of the rash or other symptoms. Similar to tampons, menstrual pads are regulated as medical devices. Thus no ingredient disclosure is required to help consumers choose products, meaning it’s difficult for women and their medical care providers to identify problematic ingredients. With greater ingredient disclosure, women would be able to avoid chemicals of concern and potentially prevent adverse reactions to pads from occurring. Furthermore, this information is critical in order to ensure proper regulatory oversight of chemicals used in these products. Sangool 22 euros Lunette 28,34 terra pura marshopping Associações de Ginecologia e Obstetrícia, Luciano Pompei. O absorvente interno comum vem em uma embalagem, é fininho, dá para guardar na bolsa e na troca basta jogar fora o usado e colocar um novo. No caso do copinho, a mulher vai precisar estar em um lugar com água e sabão neutro, para que possa higienizar o produto antes da reutilização. O copo deve ser trocado a cada oito horas, de acordo com o fluxo sanguíneo da mulher. "A menstruação da mulher varia de 30 ml a 100 ml, somados todos os dias do período, então um copinho com 30 ml é suficiente para conter o sangramento no período indicado pelo fabricante", explicou Pompei. "Se a mulher menstruar 15 ml em 24 horas, são cerca 5 ml a cada oito horas", disse ele. publicidade De acordo com o ginecologista e diretor clínico da Mae - Medicina e Acompanhamento Especializado para Saúde da Mulher -, Alfonso Massaguer, mulheres virgens ou com má formação vaginal, que dificulte a introdução do produto, devem preferir absorventes externos para evitar lesões na vagina. Alergias e infecções O copo para menstruação é feito de silicone cirúrgico para evitar qualquer ocorrência de irritação. "O poder de reações alérgicas do silicone é muito baixo", reforçou Pompei. O ginecologista explicou que o sangue expelido na menstruação não tem bactérias - elas ficam na vagina - no entanto, o sangue é um meio rico para a proliferação de organismos. De acordo com o ginecologista Massaguer, é importante não deixar o produto ser foco de bactérias. "Não pode colocar o copo na vagina e deixar três dias", ressaltou Pompei. Quando as bactérias da vagina vão para o sangue, se reproduzem rapidamente. A pessoa pode ter síndrome do choque tóxico, quando há contaminação de muitas bactérias. No entanto, fazendo a higienização da forma correta, "o risco é desprezível", de acordo com Pompei. Água e sabão neutro são os mais indicados para a limpeza do copo e é preciso enxaguar bem, para que o sabão não irrite a mucosa, explicou o médico. Um dos fabricantes do produto indica também ferver o copo em um recipiente com água. The Moon Cup Size A is designed for women who have given birth vaginally, while the Moon Cup Size B is meant for women who have NOT given birth vaginally. The Moon Cup is innovative, economical, comfortable, and environment-friendly. This soft, silicone menstrual cup collects the flow rather than absorbing it, so the vaginal tissues aren't dried out as they can be with disposable tampons. The Moon Cup holds up to an ounce of fluid and should be emptied several times a day; simply rinse and reinsert. The Moon Cup can last up to ten years, saving you over $800 in disposable products! A menstrual cup is one of the most convenient, economical, and environmentally friendly forms of period protection. Menstrual cups collect your flow rather than absorbing it, so you can use your cup for up to 12 hours without irritation or dryness.

Atrofia genital Figura 4
10 a 40% das mulheres pós menopausa experimentam sintomas de atrofia Apenas ¼ procura ajuda; muitas vezes sentem-se embarassadas em discutir estes assuntos … A gordura diminui, os lábios tormam-se pendulos, o capuz do clitoris retrai,a mucosa empalidece, o pH aumentae as infecções surgem A ET combinada com a actividade sexual mitigam as alterações. Figura 4 Women are very aware of the effects of ageing on the skin, with countless products designed to prevent or hide the 'signs of ageing'. What is often not recognised is the impact a woman's age has on her genitals. As these changes are not as openly discussed, women often remain unaware of them. Genital changes are often met with a mixture of surprise and anxiety. Many women are too embarrassed to discuss the changes with their doctor and so often suffer the symptoms in silence. It is estimated that 10-40% of postmenopausal women experience symptoms related to vaginal atrophy (see vaginal changes section) but that only one quarter of these women seek medical help (1). Thinning/greying pubic hair This article will examine the most common genital changes women experience with age, with a particular emphasis on vaginal atrophy. Like the hair on the head, pubic hair also tends to thin and grey with age. This is a natural process and, therefore, is not a cause for concern. For some women, however, the thinning of the pubic hair can be very disconcerting. Women may feel that their genitals are more exposed and visible. This is particularly relevant to women that may be feeling self-conscious about other changes that are occurring in the genital area (see vulval changes section). Women may also worry what their partner thinks of the changes. Women should refrain from dyeing grey pubic hair as the skin in the vulval area is extremely sensitive and can be irritated by the chemicals in the hair dye. If they do wish to dye their pubic hair they should use the services of a suitably qualified beauty salon. After the menopause, the drop in the female hormone oestrogen leads to a number of changes in the vulva. The connective tissues and fat deposits under the skin are reduced, resulting in the shrinkage of the vulva. For women this is often most noticeable in the appearance of the mons pubis (the pad of fatty tissue covered with pubic hair) which becomes less distinct. Similarly, the labia majora (outer lips) become less plump and more pendulous. The fold or hood of skin covering the clitoris may shrink and retract, giving the appearance that the clitoris is larger. The entrance to the vagina may also narrow (2). All of these changes, particularly those that are visible, can take time to adjust to. Women may find reassurance in knowing that these changes are normal signs of ageing. Vulval changes The most significant ageing related genital changes for women are those associated with the vagina. A drop in oestrogen after the menopause causes the vagina itself to become narrower and shorter. The walls of the vagina become thinner and less elastic. There is also a drop in vaginal lubrication. Women commonly report symptoms of dryness, itching, burning and general discomfort. Vaginal atrophy is the term used to describe these changes. Vaginal changes In addition to day-to-day discomfort, vaginal atrophy can also impact on a woman's sex life, with vaginal penetration being uncomfortable or even painful (referred to as dyspareunia). As the vaginal walls are thinner and less elastic, penetration can cause small tears, ulceration, bleeding and infection. If sex becomes uncomfortable or painful it can inhibit a woman's ability to orgasm. If a woman no longer find sex enjoyable, it can quickly lead to a drop in sexual desire and/or the avoidance of sex. The vagina also experiences a change in its pH level. The vagina normally has a pH level of between 3.8 and 4.5. Women with vaginal atrophy, however, have pH levels of between 6.0 and 7.5 (3). This more alkaline environment can increase a woman's risk of opportunistic infections. Non-hormonal vaginal lubricants and moisturisers can also be helpful. There are a number of gels which are designed to assist with lubrication during sex (eg., KY gel, Sylk), temporarily reducing friction and making sex more comfortable. Other products act as a vaginal moisturiser and, therefore, aim to relieve the symptoms of vaginal atrophy such as itching, burning and general discomfort (eg., Replens). These products can be purchased from pharmacies (with lubricants also available from major supermarkets). The first suggested 'treatment' recommended to women is to continue sexual activity. Sexual activity increases the blood flow to the genital area and this can improve lubrication and other symptoms. If women do not have a sexual partner, masturbation will achieve the same desired effect. Treatment for vaginal symptoms If non-hormonal products do not relieve symptoms, women can use local oestrogen (eg., cream/pessary). These products deliver a low dose of oestrogen directly through the wall of the vagina. Local oestrogen has been shown to restore normal pH levels and improve the elasticity and thickness of the vaginal tissue (4). Local oestrogen is only available on prescription. Local oestrogen is not thought to have the same side effects and risks as systemic hormone replacement therapy (eg., tablets, patches). With systemic HRT, women who have a uterus must take both oestrogen and progestogen (oestrogen-only HRT in these women can increase the risk of endometrial cancer). Local oestrogen products, however, are generally considered to be safe to use short term without added progestogen. The North American Menopause Society's position statement concludes that '[p]rogestogen is generally not indicated when low-dose estrogen is administered locally for vaginal atrophy ... If a woman is at high risk of endometrial cancer, is using a greater dose of vaginal ET, or is having symptoms (spotting, breakthrough bleeding), closer surveillance may be required' (5). It is important, therefore, that women use local oestrogen products exactly as prescribed. Women with a history of hormone dependent cancers are advised that 'management recommendations are dependent upon each woman's preferences in consultation with her oncologist' (6). Women who have found no relief with lubricants and vaginal moisturisers but who do not wish to use a hormonal product can try natural alternatives. Herbs such as nettle, comfrey root, dong quai, black cohosh, motherwort, chaste tree, witch hazel and wild yam are all used in treating vaginal symptoms, as are acidophilus capsules (7,8). There is, however, currently very limited evidence to suggest that these remedies are effective (9). There is some evidence that Vitamin E, either taken orally or applied locally is effective (10). If women are also experiencing other moderate to severe menopausal symptoms such as hot flushes, they may consider systemic HRT. It will provide relief from both the hot flushes and vaginal atrophy (local oestrogen will not relieve hot flushes). Women should discuss the risks and benefits of taking systemic HRT with their doctor. Other popular treatments include bioidentical hormones. Bioidentical hormones are often considered by women to be a safer alternative to systemic HRT. However, there is currently limited scientific evidence supporting their efficacy and safety and, therefore, they should be considered as having the same risks as systemic HRT (12). Phytoestrogens, naturally occurring compounds found in plants, are often reported as providing relief from menopausal symptoms. There is currently little evidence to suggest that phytoestrogens in either dietary intake or as a supplement will assist with vaginal atrophy (11). Women who have vaginal atrophy may find that it is reported on their Pap smear (as 'atrophic vaginitis'). If the vaginal atrophy makes the smear too difficult to reliably interpret it is considered 'unsatisfactory' and, therefore, needs to be repeated. In these cases, a woman's doctor will generally prescribe a local oestrogen cream for a period of time before repeating the smear in three to six months. The use of a local oestrogen cream before having a Pap smear can also help to reduce some of the discomfort that women with vaginal atrophy often experience when having their Pap smear taken. Vaginal atrophy and Pap smears References Kightlinger RS. Vaginal atrophy: Clinical evaluation and management The Female Patient 27 July 2007 Kelley C. Estrogen and its effect on vaginal atrophy in post-menopausal women Urol Nurs 2007; 27:1:40-45 North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society Menopause 2007; 14:3: North American Menopause Society. Ibid; 366 Cardozo L et al. Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: Second report of the Hormone and Urogenital Therapy Committee Obstet Gynecol 1998; 92:4: Willhite LA & O'Connell MB. Urogenital atrophy: Prevention and treatment Pharmacotherapy 2001; 21:4: Castelo-Branco, C. Management of post-menopausal vaginal atrophy and atrophic vaginitis Maturitas 2005; 52S:S46-S52 North American Menopause Society. Ibid; 367 Castelo-Branco, C. Ibid American College of Obstetricians and Gynecologists. No Scientific Evidence Supporting Effectiveness or Safety of Compounded Bioidentical Hormone Therapy ACOG news release 31 October 2005 Nedrow A. Complementary and alternative therapies for the management of menopause-related symptoms: A systematic evidence review Arch Intern Med 2006; 166:14:

Atrofia vulvovaginal As alterações involutivas do colagéneo, vascularização e função são progressivas no tempo. A diminuição da vascularização dimminui a lubrificação. A perda das pregas, estenose do intróito e a perda de elasticidade são mais afetados pela falta de estrogéneos do que pela idade Actividade sexual e estrogéneos tópicos preservam a integridade funcional genital da mulher menopausica A ET tópica na prevenção da atrofia genital deve ser considerada uma parte importante da medicina preventiva. +Figure 6. A 67-year-old woman (P 6016) demonstrating loss of elasticity and constriction of the vulvovaginal tissues. Figure 7. Patient A is 53 years old and stopped estrogen therapy 3 years previously (breast dysplasia). Patient B is a 79-year-old who remains on estrogen therapy. The vulva (external genital area) and vagina (internal) contain the largest tissue concentration of estrogen receptors in the female body. As a girl goes through puberty, the ovaries start producing estrogen. The vulva labia majora and labia minora thicken and develop, the mons pubis elevates, and internal genital organs develop. The vagina matures and develops a multilayered epithelium with rugae, or folds of tissue facilitating distention during intercourse. Vaginal pH, Estrogen and Genital Atrophy Vaginal pH in women of reproductive age is typically ; pH values in this range have been accepted for decades as representative of the normal vaginal ecosystem. Sufficient amounts of estrogen are required to maintain this acidic environment; specifically, adequate vaginal vascularization in the dermis and a glycogen-rich, stratified squamous epithelium, which acts in concert with lactobacilli to produce hydrogen peroxide and lactic acid. Murray A. Freedman, MS, MD In the estrogen-deficient postmenopausal woman, however, atrophy of the vaginal epithelium has been associated with vaginal dryness, and evidence is presented to suggest that vaginal pHrises to > 4.5 in 95% of women within 12 months of becoming hypoestrogenic. The homologues of the urogenital sinus in the embryo (the urethra, trigone and distal vagina) are extremely sensitive to estrogen deficiency, and contraction of the introitus becomes problematic. While lubricants may diminish dryness, it is the involutional contraction of the introitus that predisposes women to progressively worsening dyspareunia and sexual dysfunction. Of clinical importance is the fact that these untoward atrophic changes in urogenital tissues are preventable with the use of very small amounts of topical estrogen. FDA approval criteria for drugs with efficacy in preventing/treating genital atrophy include the restoration or “normalization” of vaginal pHand the Vaginal Maturation Index (VMI), both of which are considered surrogate markers for vaginal health. Other parameters of vaginal health and atrophic change were included in a “vaginal health index,” as proposed by Bachmann1 (including overall elasticity, fluid secretion, epithelial mucosa, and moisture), but measurement of vaginal pH alone is an easy, inexpensive, quantifiable, reproducible evaluation that correlates well with other laboratory evaluations of vaginal epithelium, such as the VMI.2 Figure 1. Photomicrograph depicting normal (A) and atrophic (B) vaginal epithelium. Note the absence of glands in A and B, and the paucity of blood vessels in the dermis in B. Abundant vasculature in the dermis and a stratified, glycogen-rich epithelium are also prerequisites for sufficient lubrication during the arousal phase of the female sexual response cycle (Figure 1). Because there are no glands in the vagina, per se, adequate lubrication in females is dependent upon a transudation of fluid across the epithelium, and dryness is a frequent complaint in women with genital atrophy due to insufficient estrogen. This atrophic change is frequently associated with dyspareunia, and the use of lubricants is often beneficial in such patients. But the discomfort these women experience involves far more than just vaginal dryness.While the primary purpose of this article is to explore the prevalence of genital atrophy in postmenopausal women asmeasured by a surrogate marker (vaginal pH), the impact of the involutional change at the introitus — and, consequently, upon sexuality—warrants discussion. Of the three major factors that can adversely affect sexuality in the postmenopausal woman (age, partnership issues, and ovarian and adrenal hormone deficiency),3-5 hormone deficiency (specifically estrogen) is the subject of this review. The estrogen/ genital atrophy connection is well recognized, but its prevalence is vastly underestimated. It has been reported that vasomotor symptomsmay affect up to 85% of estrogen-deficient women,6 and the National Osteoporosis Foundation estimates that 55% of untreated women over the age of 50 will develop osteoporosis. 7 There are no data, however, that accurately assess the prevalence, progression or severity of genital atrophy. Genital Atrophy and Sexuality To assess how rapidly the effects of hypoestrogenism were detectable in the vagina, the author studied 400 postmenopausal women who discontinued estrogen therapy (ET) after publication of the findings from theWomen’sHealth Initiative in July Monitoring was accomplished with a measurement of vaginal pH obtained at the patient’s routine office visit, followed by subsequent measurement after the patient had been off ET for at least 3 months but for less than 12 months. Of the 400 women, 381 (95%) had pH values > 4.5 within 12 months of discontinuing ET (Table). Ten of the 19 who maintained “normal” pH values were obese (body mass index > 30) and were producing significant amounts of endogenous estrogen (serum estradiol values > 20 pg/mL). Accordingly, the data suggest that the prevalence of demonstrable change in vaginal pH in women who are truly hypoestrogenic approaches 98%, and this change occurs within 12 months of discontinuing ET. Prevalence of Genital Atrophy after Discontinuation of ET Figure 2. Embryologic development of the genital tract at 4-6 weeks. The trigone, urethra, vulva and distal vagina (insert) are homologues of the urogenital sinus. Themost impressive clinical finding among the 400 patients studied was the rapid contraction and loss of elasticity at the introitus. In retrospect, this should not have been unexpected because it is consistent with the embryologic development of the genital tract, as represented in Figure 2. The urogenital sinus in the embryo is the anlage of the trigone, urethra, and distal vagina and vulva; these are the structures (which are of endodermal origin) that have the highest concentration of estrogen receptors in the female body.9,10 The upper vagina and other Mullerian elements (ie, the uterus) are of mesodermal origin and, as such, they are not as exquisitely sensitive to estrogen. In markedly hypoestrogenic women (serum estradiol <10 pg/mL) the vulva and vagina can be shown to exhibit early involutional change within months. Figure 3 demonstrates the morphologic change seen in the fourchette of a 55-year-old woman who had three vaginal deliveries but who discontinued ET 2 years previously. This degree of introital stenosis is also seen in much younger women who experience premature menopause; in the presence of significant estrogen deficiency (<20 pg/mL), the involutional change is progressive over time, irrespective of age. Introital Stenosis Figure 3. Contraction of the introitus in a 55-year-old woman (P 3003; 3 vaginal deliveries) who stopped hormone therapy 2 years previously. Note the early involutional vulvar and vaginal change in conjunction with marked hypoestrogenism. Contraction of the introitus in estrogen-deficient women typically occurs so insidiously that it often goes unnoticed at the annual visit. There is also concomitant but subtle loss of elasticity in the vulvovaginal tissue around the introitus. Among the 400 patients who are still being followed in the previously described study, the upper two-thirds of the vagina is far less affected by atrophy as compared with the compromise occurring at the fourchette. The vestibule actually loses much of its concavity and, as the introitus contracts, it becomes somewhat of a narrowed, fibrotic channel or tunnel. This early atrophic change at the introitus, rather than the vagina itself, is clinically quite important as it pertains to dyspareunia. Clinically, this contraction at the introitus can be confused with vaginismus, but it is actually anatomically distal to the levator muscles. This predilection for contraction and loss of elasticity of the components of the superficial urogenital triangle and carunculae hymenales is depicted in Figure 4. Figure 4. Shaded areas (green) represent involution of the medial portions of the superficial urogenital triangle (which includes the vestibular bulb as well as the bulbocavernosus and superficial transverse perineal muscles). While the insipient change in vulvovaginal morphology associated with estrogen deficiency often goes undetected during the routine examination, pain with intromission becomes a frequent complaint among such patients. Leiblum and colleagues observed and reported that both sexual activity and estrogen are critical factors in preserving the functional integrity of the vagina in postmenopausal women.11 Dyspareunia obviously predisposes these women to developing sexual dysfunction. Because the early atrophy is so demonstrable at the introitus, parity also affects the degree of compromise of the fourchette. Figure 5 shows two similar patients who had been on ET since menopause. Patient A, who discontinued ET 3 years previously and discontinued sexual activity secondary to dyspareunia, demonstrates considerable contraction of elasticity of the entire introitus. Patient B, who has remained on ET, has no dyspareunia. Figure 6 depicts a patient who had 6 vaginal deliveries and a previously spacious, parous introitus. After being off ET for 4 years and after cessation of coital activity for 3 years secondary to dyspareunia, there is considerable contraction of the introitus, lichenification of the skin and loss of elasticity. Sexual Function in the Postmenopausal Woman Figure 5. Comparison of two sexually active 65-year-old women (both P 2002). Patient A discontinued estrogen therapy 3 years previously while Patient B remained on therapy. Once this degree of lichenification and “fibrotic” change occurs, the loss of elasticity and contraction of the introitus leads to dyspareunia; disuse atrophy then tends to compound the problemand the atrophic changes may become irreversible. Figure 7 contrasts a 79-year-old woman with a 53-year-old woman. The 53-year-old P 2002 woman (7A) discontinued ET 5 years previously because of “breast dysplasia” and suffers from marked dyspareunia while continuing to attempt sexual activity with the use of lubricants. The older P 3003 woman depicted in 7B has been widowed and celibate for more than 10 years, but has continued ET and demonstrates only minimal introital compromise. Figure 6. A 67-year-old woman (P 6016) demonstrating loss of elasticity and constriction of the vulvovaginal tissues. Figure 7. Patient A is 53 years old and stopped estrogen therapy 3 years previously (breast dysplasia). Patient B is a 79-year-old who remains on estrogen therapy. Elevated vaginal pH is the result of an early epithelial change that is easily demonstrable, whereas the involutional change in the collagen, vasculature and functionality is much more subtle and progressively worsens over time. Lubricants may facilitate coital activity early on but, over time, the loss of elasticity and contraction leads to significant morphologic change and significant sexual dysfunction. This illustrates once again that the amount and degree of atrophy is far more a question of estrogen deficiency than age. Additionally, coital activity contributes significantly to the anatomic integrity of the vagina and, in the absence of both estrogen and sexual activity, compromise of the fourchette develops rather rapidly. Figure 8. Artist’s representation of the progression of atrophic change (introital stenosis) that can be anticipated in most untreated postmenopausal women. More than 95% of postmenopausal women can be expected to show a change in vaginal pH within months of discontinuing ET, and most will demonstrate signs of genital atrophy on pelvic examination.8 The findings from the investigation described in this article suggest that the prevalence may actually approach 98% in women who are truly hypoestrogenic. It also suggests that introital stenosis and loss of elasticity are affected more by estrogen deficiency than by age, and Figure 8 illustrates the progression of atrophic change that can be anticipated in most untreated postmenopausal women. Summary and Conclusions There is considerable evidence that ET, especially if combined with sexual activity, mitigates atrophic changes. Because of the exquisite sensitivity of the distal vagina, urethra and trigone to estrogen, the atrophic genitourinary changes can actually be prevented/treated by the use of gentle vaginal dilatation and very small doses of topical ET applied as infrequently as twice-weekly (personal anecdotal experience as well as participation in several current clinical trials). The clinical implications of these involutional genitourinary changes, particularly as they pertain to sexual function, are beginning to be appreciated by many practitioners and their patients. Genital atrophy is clearly a frequent consequence of estrogen deficiency, and it is a quality-of-life issue that deserves far more attention than it currently receives.12 In view of the exquisite sensitivity of the urogenital tissues to estrogen, the prevention of female genital atrophy with the use of very small amounts of topical estrogen should be considered an important part of preventive health. Murray A. Freedman, MS, MD, is Clinical Professor, Department of OB/GYN, The Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, GA References Received: December 19, Accepted: September 7, 2007. Dr. Freedman reports no potential conflicts related to the content of this article. 1. Bachmann GA, Notelowitz M, Gonzalez SJ, et al. Vaginal dryness in menopausal women: clinical characteristics. Clin Pract Sexual 1991;7: Nilsson K, Risberg B, Heimer G. The vaginal epithelium in the post menopause—cytology, histology and pH as methods of assessment. Maturitas 1995; 21: Freedman MA. Sexuality in the menopausal woman. Contemp OB/GYN 2000; 45:S Dennerstein L, Lehert P, Burger H. The relative effects of hormones and relationship factors on sexual function of women through the natural menopausal transition. Fertil Steril 2995;84: Mishra G, Kuh D. Sexual functioning throughout menopause: the perception of women in a British cohort. Menopause 2006;13: Oldenhave A, Jaszmann LJ, Haspels AA, et al. Impact of climacteric on well-being: a survey on 5213 women 30 to 60 years old. Am J Obstet Gynecol 1993; 168: National Osteoporosis Foundation. Facts. (Accessed June, 2007.) 8. Freedman MA. Genital atrophy and vaginal pH (Abstract). Menopause 2006;13: Isof CS, Batra SC, Ek A, et al. Estrogen receptors in the female lower urinary tract. Am J Obstet Gynecol 1981;141: Fosberg J. A morphologist’s approach to the vagina— age-related changes and estrogen sensitivity. Maturitas 1995;22:S Leiblum SR, Bachman GA, Kemmann E, et al. Vaginal atrophy in the post-menopausal woman: the importance of sexual activity and hormones. JAMA 1983;249: Freedman MA, Nolan TE. Genital atrophy: an inevitable consequence of estrogen deficiency. The Female Patient 1996;21:62-6. Involução do triângulo urogenital:bolbo vestibular M bulbocavernoso e transverso perineal

Atrofia vulvovaginal O diagnóstico é clínico suportado
A ET deve ser continuada enquanto sintomas presentes, podendo ser prolongada indefinidamente A ET aumenta a espessura do epitelio, diminui o pH , aumenta o fluxo sanguíneo e tem um excelente perfil de segurança não causando hiperplasia endometrial Ospemifeno é um SERM oral com efeitos estrogéneos like na vagina arovado nos EUA para tratamento da dispareunia em mulheres menopausicas com sintomas de atrofia vulvo-vaginal A atrofia genital é frequente e é subtratada. merece mais atenção dada a importância para a qualidade de vida Ospemifene effectively treats vulvovaginal atrophy in postmenopausal women: results from a pivotal phase 3 study. Menopausa 2010 May-Jun;17(3):480-6 O diagnóstico é clínico suportado pelo pH ou pelo index de maturação vaginal In your 20s and 30s, the vaginal walls are bathed in hormones making them strong and robust. But as you enter your 40s, hormone levels, namely estrogen, gradually start to decline. This causes the walls, which are comprised of mucous membranes (vaginal mucosa) to become less resilient and more susceptible to trauma. Inflammation or tears are more likely to occur which can cause pain during sex. To check for thinning vaginal walls, take a handheld mirror and observe the color inside the opening of your vagina. Deep pink signifies healthy vaginal tissue, whereas, pale or very light coloring can mean fragile vaginal mucosa. Ospemifene: first global approval. Elkinson S1, Yang LP. Author information 1Adis R&D Insight, 41 Centorian Drive, Private Bag Mairangi Bay, North Shore 0754, Auckland, New Zealand. Abstract Ospemifene (Osphena™) is an oral selective estrogen receptor modulator (SERM), with tissue-specific estrogenic agonist/antagonist effects. QuatRx Pharmaceuticals conducted the global development of the agent before licensing it to Shionogi for regulatory filing and commercialization worldwide. Ospemifene is the first non-estrogen treatment approved for moderate to severe dyspareunia in women with menopause-related vulvar and vaginal atrophy. The drug is approved in the USA, and application for EU regulatory approval is underway. This article summarizes the milestones in the development of ospemifene leading to this first approval for moderate to severe dyspareunia, a symptom of postmenopausal vulvar and vaginal atrophy. Typically, a diagnosis of vaginal atrophy can be made from clinical examination, with many women presenting with dry, glazed-looking vaginal epithelium; a thinning cervix; a loss of labial fat pad; or a vagina that has lost elasticity, has shortened, has narrowed, has become less distensible, and can be easily traumatized and irritated.5,9 Diagnosis may be further supported by pH or the vaginal maturation index (VMI), which indicates the relative proportion of parabasal cells, intermediate cells, and mature superficial cells of the vaginal squamous epithelium, and is calculated based the following formula: VMI =0.5(X2) + 1(X3), where X2=% intermediate cells and X3=% superficial cells.10 The VMI is 0%–49% in patients with an absent or low estrogenic effect, 50%–64% in patients with a moderate estrogenic effect, and 65%–100% in patients with a high estrogenic effect First-line therapies Vaginal moisturizers, lubricants, and continued sexual activity are recommended as first-line therapies for vaginal atrophy.3 However, not all over-the-counter moisturizers and lubricants are equal. There is often confusion over which products to use, and women may not feel comfortable asking the pharmacist about them. Vaginal moisturizers, such as Replens® (Lil’ Drug Store Products, Inc, Cedar Rapids, IA, USA), are designed to be used on a regular basis to reduce vaginal dryness. Replens has been shown to improve vaginal moisture, secretions, elasticity, pH, and symptoms, including dryness, itching, irritation, and dyspareunia.11,12 Lubricants, which may be water-based or silicone-based, are intended to be used during sexual activity, and each class of lubricants has advantages and limitations.13 Water-based lubricants with glycerin are the most widely available and most commonly recommended, although they may dry out and become sticky or tacky during use. Water-based lubricants without glycerin may last longer, but most must be purchased at specialty stores or online. Silicone-based lubricants are also best found at specialty stores or online; these are hypoallergenic and last longer than water-based lubricants. No single product will work for every woman, so it is advisable that patients try several and see whether one works well. Local vaginal estrogen When first-line therapies are not adequate, local vaginal estrogen may be considered. Local vaginal estrogen therapy is effective and well tolerated,3 and it is recommended over systemic estrogen therapy when treatment of vaginal atrophy is the sole aim.14 Exogenous estrogen has several important effects on the vulvovaginal tissue, including increased blood flow, increased secretions, increased thickness of the vaginal epithelium, and reduced pH, which may help restore healthy vaginal microorganisms and prevent infection. At a clinical level, local vaginal estrogen therapy has been shown to reduce vaginal discomfort and improve dyspareunia.7,15 Local vaginal estrogen products are available in the United States as vaginal creams,16,17 a vaginal ring,18 and a vaginal tablet.19 Low-dose, local vaginal estrogen therapies, such as the tablet, ring, and low-dose conjugated estrogen cream, have demonstrated endometrial safety in studies up to one year.20–22 The vaginal tablet has been associated with the lowest amount of systemic estrogen absorption,23 and serum estrogen levels in women who received 10 μg estradiol vaginal tablets remained within the normal postmenopausal range.24,25 A new ultralow concentration vaginal estriol gel (0.005%) in phase III development allows for a 10-fold reduction in the amount of estrogen administered in marketed products.26 It has been shown to be safe and effective for the treatment of postmenopausal vaginal atrophy26 and may prove to be another treatment option in the future.

Cirurgia cosmética vulvar
In conclusion, patients’ motivations for pursuing cosmetic vulvar surgery should be explored when they seek such procedures. Physicians must be aware that perceptions may be influenced by a distorted perception of normal or a desire to restore anatomy because of age and child-bearing. As physicians, we are obligated to educate our patients on the variation in vulvar anatomy and potential risks of these surgeries.1 Pode ser não ético fazer cirurgia cosmetica genital para adequar os seus genitais a um padrão estabelecido pela sociedade. Elas consideram feias as suas vulvas e que necessitam de corecção cirurgica vulvas perfeitamente normais Culturally laden perspectives about beauty and normalcy, in part, may explain this emerging trend. In western cultures, female genitalia are openly depicted in magazines, on the Internet, and in movies. These depictions contribute to a limited and idealistic view of the female genitalia. Yurteri-Kaplan. Cosmetic vulvar surgery and perception. Am J Obstet Gynecol 2012.

Cirurgia cosmética genital feminina
Resurfacing LASER Labioplastia Clitoropexia e redução do capuz Himenoplastia Amplificação do ponto G In this sense, cosmetic gynecology is just the new kid on the block, he adds. “Cosmetic vaginal surgery and vaginal rejuvenation are the latest trend in cosmetic surgery and have created controversy, debate, and emotional responses in medical and non-medical circles,” Pelosi says. Confusion exists regarding what the term “vaginal rejuvenation” means, he says. “Many use the term incorrectly to include all aesthetic vaginal/vulvar procedures, including vaginal tightening surgery to enhance sexual performance, and others think that it is a single and unique ‘magical procedure’ designed to improve sexual unction and the cosmetic appearance of the genitalia of the modern female Main article: Genital modification and mutilation The most prevalent form of genital alteration in some countries is female genital mutilation (FGM): removal of any part of the female genitalia for cultural, religious or other non-medical reasons. This practice is highly controversial as it is often done to non-consenting minors and for debatable (often misogynistic) reasons. An estimated 100 to 140 million girls and women in Africa and Asia have experienced some form of FGM.[12] Labiaplasty: Reduction of the labia minora Female genital surgery includes laser resurfacing of the labia to remove wrinkles, labiaplasty (reducing the size of the labia) and vaginal tightening. Some have likened labiaplasty to FGM.[13] In September 2007, the American College of Obstetricians and Gynecologists issued a committee opinion on these and other female genital surgeries, including “vaginal rejuvenation,” “designer vaginoplasty”, “revirgination,” and “G-spot amplification.” This opinion states that the safety of these procedures has not been documented. ACOG recommends that women seeking these surgeries need to be informed about the lack of data supporting these procedures and the potential associated risks such as infection, altered sensation, dyspareunia, adhesions, and scarring.[14] The G-Spot is enhanced or amplified using a cosmetic filler, such as Prevelle or collagen. These dermal fillers are also used to smooth facial wrinkles and restore volume to the skin. This injection, which is formulated with lidocaine anesthetic, makes the G-Spot larger and more pronounced. With the enlarged G-Spot more easily stimulated through sexual penetration, many women experience a heightening of sexual pleasure. The results last for approximately 4 to 12 month. A position paper published by the American College of Obstetricians and Gynecologists in 2007 warns that there is no valid medical reason to perform the procedure, which is not considered routine or accepted by the College; and it has not been proven to be safe or effective. The potential risks include sexual dysfunction, infection, altered sensation, dyspareunia, adhesions and scarring.[24][65] The College position is that it is untenable to recommend the procedure.[66] The procedure is also not approved by the Food and Drug Administration or the American Medical Association, and no peer-reviewed studies have been accepted to account for either safety or effectiveness of this treatment.[65] The Labia pride movement resents the ideals of female cosmetic genital surgeries: The Muff March in London, 2011 With the growing popularity of female cosmetic genital surgeries, the practice increasingly draws criticism from an opposition movement of cyberfeminist activist groups and platforms, the so-called labia pride movement. The major point of contention is that heavy advertising for these procedures, in combination with a lack of public education, fosters body insecurities in women with larger labia in spite of the fact that there is gross individual variation in the size of labia. The preference for small labia is purely a matter of fashion and is without clinical or functional significance.[15][16]

Clinicians will struggle with their cultural and personal biases as they discuss the future of cosmetic genital surgeries. These discussions require careful evaluation of the utility, benefits, and problems associated with these surgical procedures given that they have important personal and psychosocial implications for women choosing to undergo them. At the same time, thoughtful use of ethical principles, such as truth-telling, requires that these patient-provider discussions be based on the best available evidence. The principle of truth-telling requires that providers acknowledge to potential surgical candidates that the procedure is not the means for improving a relationship in peril and may not improve sexual function. Although some literature reported satisfaction rates are high, these small studies lacked methodological rigor. It is important to determine before the procedure the rationale for seeking labial reduction and expectations with regard to outcomes. It is also critical not to judge women seeking these surgeries, instead providers should educate, support, and refer women as needed. Before considering labial reduction surgery, patients should be educated about the normal variations in female genital anatomy.. providers are obligated and guided by adopted ethical principles to fully inform patients of the risks and complications of these procedures. Performing invasive surgery may impair the normal distribution of nerves and bloods vessels, which may impair genital sensation and sexual function. Further studies should be conducted to determine why women seek out these procedures, how these women are educated about the procedures, and, more importantly, what long-term effects and complications can occur with these surgeries. In addition, future studies need to control for placebo effects of the surgery on sexual function and body image. Psychiatric disorders, such as BDD, should be ruled out before invasive procedures are performed and referral made to a mental health specialist. Studies should be conducted to determine whether these procedures enhance sexual satisfaction and function. Until these studies have been completed, prospectivesurgical candidates should be educated that these procedures have not been proven to enhance well-being or sexual satisfaction and may result in scarring that can worsen outcomes. As recently stated by American College of Obstetrics and Gynecology (ACOG) [1] BI women should be informed about the lack of data supporting the efficacy of these procedures and their potential complications including infections altered sensation, dyspareunia, adhesions and scarringI^No surgical intervention that can alleviate psychological or relationship distress exists. Thus, potential candidates should be referred to community resources to assist them in the decision process. The gynecologic community as a whole should evaluate this trend and determine the principles and most importantly the evidence that will guide practice.

piercing Forma controversa de aprimoramento corporal/genital
Múltiplas razões: Estímulo sexual? Enfeite? Implica sacrifícios, cura demorada, taxa elevada de rejeição, Pode causar limitações sexuais, de vestuário e dos movimentos Triad of Evidence for Care of Women With Genital Piercings Young C, Armstrong ML, Roberta AE, Mello I, Angel E J Am Acad Nurse Pract. 2010;22:70-80 Article Summary It is increasingly frequent for healthcare providers to encounter genital piercings (GPs) in women. Women with GPs are no longer on the social fringe or part of the "punk" culture who are experimenting with behaviors that are "socially provocative." Over the past 30 years, GP has become mainstream, and women engage in it for a variety of reasons. Healthcare providers may make unfounded assumptions about these women and their reasons for seeking a GP. Knowing why many women choose GP allows the healthcare provider to better understand and support these women. The purpose of this study was to evaluate 3 dimensions of evidence for the care of women with GPs. Following a literature review, a cross-sectional study replicated previous work, using a Web-based survey. Women were recruited for the study through advertising in newspapers and through the "snowball" method. All data were collected through a Website. The resulting triad of evidence included descriptive quantitative and qualitative data about women (n = 240) with GPs, and clinical observations from 60 healthcare providers who have cared for women with GPs. The Web-based survey contained basic demographic questions (age; education; salary; religiosity; state of health; history of depression, abuse, forced sexual activity); risk behavior (age at first intercourse, sexual orientation, risk-taking, cigarette use, alcohol consumption, drugs, sexual partners, type of body piercings, tattoos); and postprocedural experiences (satisfaction, complications, activity, whether they were asked to remove jewelry). The findings were consistent with the study being replicated, as well as with previous research on this topic. Three important findings about women with GPs were validated: (1) GPs were deliberate actions, sought for personal and sexual expression; (2) women with GPs treat piercings as a normal, meaningful part of their lives that produce sexual enhancement and expression; and (3) the information about GP care for these women comes from non-health providers. New findings were that many women with GP have experienced depression (47%), abuse (physical, 18%; emotional, 27%; sexual, 14%), and forced sexual activity (35%) in their lives. The investigators suggest that the presence of GPs should not delay or limit the provision of important healthcare for women who have infections, pregnancy, or other health issues. Health-protective, as well as health-promotion, behaviors are important to reduce risks. Nurse practitioners can be effective and resourceful advocates in 3 specific areas of care: (1) responsiveness to women with GPs, (2) collaborative decision-making for the removal of jewelry, and (3) promotion of applicable patient education. Viewpoint Although I'm not convinced that this study provided more data than the original study, the implications section is very strong and provides new information that might guide clinical practice. Particularly clear are the sections that explain that women choose GP purposefully and that it is a meaningful and often therapeutic part of their lives. Genital piercing apparently enhances feelings of self-worth and somehow removes the shame or guilt related to previous life events. This finding should help the healthcare provider treat GPs with respect and understand that for these women, a GP represents more than a piece of jewelry. As a result of this understanding, healthcare providers should be more sensitive to including women in decisions to remove the jewelry when required, rather than taking a unilateral action. This discussion provides an opportunity to explore patient or provider concerns about the jewelry and offers teaching opportunities. The article also provides several useful Internet resources, such as the Association of Professional Piercers. It is clear that these researchers, one of whom is a Master Piercer, have an intense interest in this subject and have the desire to provide accurate and helpful information. However, as I read this article, I found that the way the study was reported made it needlessly difficult to understand. Much is made of the "triad of evidence," but the description of these 3 components of data is confusing. It was also difficult to tell if the study author was presenting data from the original study, comparing that data to the current study, or only reporting data from the current study. Christina piercing ou vênus piercing é um piercing genital feminino. É inserido onde os grandes lábios encontram-se.[1] Não favorece a estimulação sexual, além de ser desconfortável ao utilizar calças apertadas.[2] Não pode ser feito em todas as mulheres devido a razões anatômicas.[2] Demora de 3 a Van der Meer, G., W. W. Schultz, et al. (2008). "Intimate body piercings in women." Journal of Psychosomatic Obstetrics & Gynecology 29(4): First glimpse of the functional benefits of clitoral hood piercings Vaughn S. MillnerxVaughn S. Millner In this exploratory study, we identify a positive relationship between vertical clitoral hood piercing and desire, frequency of intercourse and arousal. There were no dramatic differences in orgasmic functioning. Clinicians can play key roles in educating patients about potential outcomes and risks of genital piercing. Piercing Genital Feminino – Tipos Piercings genitais são de longe, o mais erótico, sensual, controverso, e ultimamente … a mais popular forma de aprimoramento corporal. Há uma grande variedade de razões que as pessoas escolhem para perfurar seus genitália, seja para celebrar uma relação escravo / mestre, para aumentar a estimulação sexual, ou simplesmente para enfeitar o corpo com ainda mais brilhante joia. Dependendo do local escolhido e colocado o piercing genital, pode exigir alguns sacrifícios, incluindo as limitações sexuais, que você tem que determinar se vale ou não a pena. Esse artigo é para ajudar você a decidir se quer ou não um piercing genital, e para informá-la sobre os diferentes estilos disponíveis. Piercing Genital Feminino – Christina A Christina não é um piercing genital muito popular, devido ao seu longo tempo para a cura e alta taxa de rejeição. Christina é uma perfuração vertical através da junção em forma de V, na parte superior dos grandes lábios que sai ligeiramente acima na região púbica. O Christina também requer critérios anatômicos específicos, a fim de ser adequado para o utente. A espessura da pele a perfurar atravessa é responsável por requerer um tempo de cura mais longo do que a maioria das outras perfurações. Movimentos naturais do corpo também podem causar desconforto, e nada prático. Tempo Estimado para Cicatrização: Entre 12 e 16 Semanas. Piercing Genital Feminino – Fourchette Outra perfuração que requer apenas a anatomia direita, o fourchette é um piercing genital menos popular entre a população feminina. A joia é colocada sobre o períneo da parte inferior da abertura vaginal. A maioria das mulheres não tem uma aba extra de tecido da pele neste local, mas para aquelas que possuem, é exatamente nesse local que se insere o piercing. Esta camada de pele é muito fina e pode ser facilmente machucada e até mesmo rasgada com movimento natural, caso a jóia se enrosque em qualquer coisa. Ela também pode causar dor durante a relação sexual, pois pode retirar o piercing de dentro do canal vaginal. Tempo Estimado para Cicatrização: Entre 8 e 12 Semanas. Piercing Genital Feminino – Clitóris Horizontal O piercing genital de perfuração horizontal é o mais popular devido a sua aparência atraente. O piercing é colocado exatamente de forma correta e sua anatomia é perfeitamente adequada para esse tipo de piercing. O piercing deve ser colocada apenas para a direita, de modo que quando você está em uma posição vertical, em pé, o talão repousa no topo do clitóris. A estimulação clitoriana pode ser ainda mais inibidas por o capuz do clitóris ser recoberto completamente. Se o piercing é colocado de forma correta, quando aplicada pressão irá fornecer algum estímulo ao clitóris. Tempo Estimado para Cicatrização: Entre 6 e 8 Semanas. Piercing Genital Feminino – Clitóris Vertical O piercing vertical é a opção mais fácil, menos doloroso, mais estimulante e possui o tempo mais curto de cicatrização, se você tiver a anatomia correta para ele. É necessário que um Piercer (Profissional) examine seu corpo para determinar qual opção de perfuração se adapta ao capô do seu clitóris, sendo a opção vertical ou horizontal. A joia é inserida no tecido do capô logo acima do clitóris, também repousa facilmente sobre o clitóris, e por correr em paralelo com o contorno natural da forma da mulher. Tempo Estimado para Cicatrização: Entre 4 e 6 Semanas. Piercing Genital Feminino – Lábios Internos Mais simples e menos doloroso do que outros tipos de piercings genitais, o pequeno piercing nos lábios internos são muito populares por seu valor estético, bem como a estimulação física. Esse tipo de piercing são simples e de rápida cicatrização, o que torna possível colocar vários piercings ao longo dos lábios internos. O tecido da pele dos lábios internos são fáceis de esticar, e há menos chance de ser rejeitado e migrar para fora da pele. Tempo Estimado para Cicatrização: Entre 4 e 6 Semanas. Piercing Genital Feminino – Grandes Lábios Não é muito adequada para a maioria das mulheres, a perfuração nos grandes lábios genitais podem ser feitas como uma única perfuração ou perfurações múltiplas em um ou ambos os lados. Piercings genitais nos grandes lábios tendem a ser rejeitados (pele rejeita o piercing, empurrando a joia direita para fora) isso ocorre com mais frequência que piercings nos lábios internos. Usar roupas adequadas e higiene para prevenir de possíveis infecções. Sprays desodorantes e cremes corporais femininos devem ser evitados durante o processo de cicatrização. Tempo Estimado para Cicatrização: Entre 8 e 12 Semanas. Piercing Genital Feminino – Triângulo O piercing genital triângulo deve ser o mais original e intrigante de todos. O piercing triângulo é projetado de modo que a joia seja inserida logo abaixo do capô do clitóris. Desta forma, quando a parte dianteira do clitóris é estimulada, a parte traseira está sendo estimulada. Para que o piercing seja colocado corretamente, você deve ter pele suficiente para realmente puxar o clitóris e a área circundante de distância de seu corpo para ter espaço suficiente para a joia ser inserida por baixo. Não são muitas as mulheres se encaixam neste critério, mas para aqueles poucas afortunadas, este é realmente um piercing incrível. É também um piercing que exige grande habilidade e confiança. Tempo Estimado para Cicatrização: Entre 8 e 12 Semanas. First glimpse of the functional benefits of clitoral hood piercings Vaughn S. MillnerxVaughn S. Millner

Embora as guidelines de vulvar care não constituam isoladamente o tratamento das variadas doenças vulvares estas guidelines servem como um importante adjunto das terapeuticas convencionais e e devem ser instituidas como 1ª linha de tratamento. São medidas economicas, faceis de seguir pelas pacientes tornanado as pacientes activas parcit«cipantes do seu plano de tratamento podendo ganhar autonomia do seu plano de tratamento Although VCGs are not enough to constitute the entire scope of treatment of various vulvar disorders, these guidelines can serve as an important adjunct to conventional treatment. Further studies evaluating this role are needed. Although time consuming and requiring patient motivation, VCGs should be included as the first-line treatment for women presenting with vulvar complaints. This tool is inexpensive, easy for patients to follow, and highly successful, at the same time imparting no tangible risks. In addition, it allows for the patients to become active participants in the treatment plan and gain a certain degree of autonomy in managing their symptoms. Further studies involving larger sample sizes and Obrigada pela atenção

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