(117) Postpartum Vulvovaginal Dryness: Disparities in Adequate Treatment for Postpartum Patients’ Sexual Health

Abstract Introduction Vaginal estrogen therapy (VET) use and efficacy is well established for genitourinary symptoms commonly seen in menopause. Despite the similar symptom profile dramatic hormonal shifts postpartum (PP) patients, they are not routinely offered same therapies. The pathophysiology of these PP multifactorial frequently dismissed as “normal,” even with subsequent negative effect on their quality life. Concerns regarding potential harm lactation infant development further decreases utilization. However, apprehensions may be outdated due to evolution VET, warranting review available literature. Objective To efficacy, concerns, barriers utilization VET vulvovaginal patients. Methods A systematic PubMed database spanning from January 1990 – June 2022 was performed assess relevant medical literature MeSH terms used narrow search include: [“dyspareunia” OR “vulvovaginal atrophy” “genitourinary”] AND [“hypoestrogenic state” “estrogenic endocrine disrupting compounds” “estrogen responsive tissues”] [“postpartum” “menopausal” “infant”] [“estrogen preparations” “vaginal estrogen”]. Results published (n=33) analyzed by key terms. FDA has approved a number estrogen-based formulations atrophy dysparenuia menopausal including: 7.5ug/day (vaginal ring), ultra low dose 10ug tablet), 0.01% estradiol creams, premarin (conjugated estrogen) cream, vaginal DHEA. Data patients limited varying results. Nonetheless, drastic improvement tissue thickening, lubrication, baseline elasticity within few weeks minimal applied dosage been shown. Addressing primary worries, while higher doses (>50mcg) early period negatively affect lactation, initiating after supply (at 6-8 weeks) or using lower (≤50mcg) no changes lactation. In fact, ultra-low-dose combined oral contraceptive pill (20mcg ethinyl progestins) contraception 30 days adverse impact breastfeeding. concentrations smaller, locally applied, implying less risk systemic effects. Tolerability enhanced personalized approach, prescribing smallest effective shortest duration time. Additionally, data suggests that if affected, there significant alteration infant’s growth, increase estriol breastfed infants, nor evidence long-term prolongation physiologic estrogenization. face numerous barriers, limiting access treatment, such as: varied clinical presentations, relatively high cost therapies, time providers resulting poor communication hesitation, research focused therapeutic options health concerns. Conclusions This outlines proven uses, indications, safety along scarcity current population. concurrent sexual dysfunction discomfort can devastating, supporting need connected specific needs concerns Disclosure No