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Dr. Rachel S. Rubin on the need for more research on vaginal hormones


“It's a challenge to get funding for these types of studies, and also to have the infrastructure to carry out a lot of these big studies. But there's no question that we need more data,” says Rachel S. Rubin, MD.

In this video, Rachel S. Rubin, MD, discusses the need for further research on the benefits of vaginal hormones in the treatment of urologic conditions in women. She is first author of the 2023 American Urological Association Annual Meeting abstract “Impact of vaginal prasterone on the rate of urinary tract infections in GSM patients and those with a history of breast cancer: a retrospective cohort analysis.” Rubin is a urologist and sexual medicine specialist in private practice in Rockville, Maryland and also an assistant clinical professor in urology at Georgetown University Hospital, Washington, DC.


There is a paper that just got accepted [that was written] by colleagues of mine that looked at this product also helping with a vulvar pain condition, so pain at the level of the vaginal opening, which is very impressive because it's a vaginal insert. So the fact that it would help with urethral pain and pain in the vulvar vestibule, that's very exciting data. In terms of more studies, we would love to do more studies. It's a challenge to get funding for these types of studies, and also to have the infrastructure to carry out a lot of these big studies. But there's no question that we need more data. And we're getting more and more data all of the time coming out about the safety and the efficacy of vaginal hormones, both estrogen and DHEA, for the prevention of urinary tract infections, as well as helping urinary frequency. We have data that DHEA improves urinary urgency to the level of anticholinergics, [the latter of which] we know causes dementia, so we should be using these therapies for overactive bladder, for urinary frequency and urgency, and it should be first-line therapy, whether it's vaginal estrogen or vaginal DHEA. And we know the sexual benefits are great. First and foremost, I'm a sexual medicine doctor. This is essentially Viagra [sildenafil citrate] for women because it improves arousal, it improves orgasm, and it improves lubrication. We've had therapies for genitourinary syndrome of menopause since the 1970s. So we've actually had female Viagra before we had male Viagra. But we have a marketing problem because no one's marketing it to women in the way that says this local hormone therapy is completely safe. It is totally safe for pretty much every human on Earth whether you've had a history of blood clots, for most women with a history of breast cancer, for people with a family history of breast cancer, there is no risk from these local therapies. In fact, we need more data in women on aromatase inhibitors, but the majority of data are very positive. And so you have very safe, very effective therapies that are like Viagra, but because it's women's health and women's bladder health and women's urinary health, it hasn't gotten its day in the sun yet.

This transcription was edited for clarity.

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