Vaginal atrophy is a common condition in postmenopausal women, frequently associated with vaginal symptoms and alterations of the vaginal microbiota. This randomized study evaluated the clinical and microbiological effects of vaginal CO2 laser therapy administered alone or in combination with an oral probiotic containing L. crispatus M247 in postmenopausal women with vulvovaginal atrophy. Women were randomized (2:1) to receive vaginal laser therapy alone (laser-only group) or laser therapy plus oral probiotic for 90 days (probiotic plus laser group). Clinical efficacy was assessed through a prespecified panel of outcomes, including vaginal pH and symptom severity assessed by Visual Analogue Scale (VAS), at baseline and during follow-up up to 90 days, with Day 90 representing the main efficacy timepoint. Vaginal microbiota composition was analyzed in a subset of participants. Both groups showed improvement over time in vaginal pH and VAS scores for vaginal dryness, dyspareunia, burning, itching, and introital pain. Compared with laser alone, the probiotic plus laser group showed lower symptom scores at Day 90 in selected clinical domains, with effect estimates generally favoring the probiotic plus laser group, although confidence intervals were relatively wide for some endpoints. P-values for individual outcomes should be interpreted as nominal in the absence of prespecified multiplicity adjustment across clinical domains. For vaginal pH, both groups showed a decrease over time, but the group × time interaction was not statistically significant, indicating no clear differential temporal response. Microbiota analysis showed an increase in the relative abundance of L. crispatus and a concomitant decrease in L. iners only in the probiotic plus laser group, suggesting a shift toward a more favorable vaginal microbial profile. Overall, vaginal CO2 laser therapy was associated with clinical improvement, and adjunctive treatment with L. crispatus M247 was associated with additional benefits across selected clinical and microbiological outcomes; however, confidence intervals for several clinical estimates were relatively wide, supporting cautious interpretation and confirmation in larger blinded studies.

This review explores the use of local vaginal estrogen therapy for managing genitourinary syndrome of menopause by survivors of hormone-sensitive breast and gynaecological cancer, emphasizing its role in improving quality of life and alleviating symptoms such as vaginal dryness, dyspareunia and recurrent urinary tract infections. Treatments for hormone-sensitive cancers often cause sudden menopause, and prolonged use of endocrine therapies can worsen the symptoms of genitourinary syndrome of menopause. The syndrome is frequently under-recognized and inadequately managed, and women should be screened and educated about symptoms and treatment options, especially survivors of breast and gynaecological cancer. Shared decision-making is central to managing genitourinary syndrome of menopause in hormone-sensitive cancers, as options balance the side-effects of cancer treatments and endocrine therapies against quality of life. While nonhormonal therapies are recommended as first-line treatment, if ineffective, low-dose vaginal estrogen provides significant symptom relief and efficacy in easing genitourinary symptoms and reducing urinary tract infections with minimal systemic absorption. While caution has traditionally been suggested in estrogen-sensitive cancers, the use of vaginal estrogen therapy by women with breast cancer receiving endocrine therapy with tamoxifen or aromatase inhibitors and by women with hormone-sensitive gynaecological cancers is discussed. Interpreting safety data-especially for hormone-sensitive cancers-requires careful, individualized decision-making in collaboration with oncology teams. Individualized care is essential to balance symptom relief, patient safety and compliance with treatments, optimizing outcomes and quality of life for these patients. The paper highlights the need for additional research on long-term safety and efficacy across cancer subtypes to improve personalised care.

Episiotomy was traditionally performed routinely during vaginal delivery to prevent severe obstetric anal sphincter injuries and to shorten the second stage of labor, with the aim of improving neonatal outcomes. However, accumulating evidence has challenged these benefits. Its adverse consequences, including hemorrhagic, urinary, and infectious complications, as well as dyspareunia and psychological disorders, have prompted scientific societies to recommend a restrictive policy. Despite this consensus, clinical practices remain heterogeneous, and the potential role of episiotomy in specific situations is still being debated. This review examines the current place of episiotomy in light of recent evidence and international guidelines.

Sexual dysfunction is a common but insufficiently addressed non-motor symptom in movement disorders. While Parkinson's disease (PD) is the condition most frequently investigated, sexual dysfunction is also reported in Huntington's disease, dystonia, and other movement disorders. Clinical presentations are heterogeneous, encompassing reduced desire, erectile dysfunction, ejaculatory and orgasmic disorders, lubrication difficulties, dyspareunia, and hypersexuality. In PD, prevalence estimates vary widely across studies, largely because of differences in disease stage, cultural context, and assessment methodology. The most consistent associated factors include depression, anxiety, age, autonomic dysfunction, and motor disability. Dopaminergic treatment has a bidirectional influence, with potential benefit on hypoactive sexual symptoms but an increased risk of hypersexuality, especially with dopamine agonists. Evidence for treatment remains limited, with the strongest support for phosphodiesterase-5 inhibitors in erectile dysfunction and dopaminergic treatment adjustment in hypersexuality. Sexual dysfunction remains underrecognized in routine practice despite its major impact on quality of life and intimate relationships. Routine screening and multidisciplinary management should be encouraged in the care of patients with movement disorders.

Sexual function and fertility have become increasingly important considerations in the management of urogenital malformations due to improved long-term outcomes. Despite substantial advances in reconstructive surgery, many patients continue to experience sexual dysfunction, including erectile and ejaculatory disorders, dyspareunia, and body image concerns, which affect partner relationships and quality of life. Psychosocial factors such as shame, insufficient education, and lack of specialized sexual medicine counseling further exacerbate functional impairments and have a significant negative impact on quality of life and self-esteem. Early, individualized counseling and structured transition programs are crucial to align expectations realistically and to outline reproductive prospects. Multidisciplinary care is essential to ensure patient-centered management and to establish sexual function and fertility as integral therapeutic goals.