Epidemiology, etiology and treatment of female vaginal injury

Abstract

The preservation of vaginal anatomical structure and physiological function is critical for women's health and should not be ignored. Vaginal injuries have a negative impact on women's quality of life. Vaginal delivery is the most common cause of vaginal injuries, 53-79% of women suffer from perineal and vaginal lacerations during labor. The incident of vaginal atrophy caused by decreased estrogen in menopausal women is growing, reaching 39%. The primary medical treatment of menopause-related vaginal atrophy is estrogen, which has a recognized therapeutic effect. Severe obstetric lacerations and trauma-related vaginal damage must be identified promptly and treated surgically. Radiotherapy-induced vaginal stenosis and adhesion could be treated with a vaginal dilator, however, there is a lack of consensus on therapy plans. Furthermore, surgical closure of genitourinary fistulas arise from the tumor or vaginal delivery is technically challenging. Stem cells have been proven to be effective in treating vaginal atrophy in animal models. Traditional treatments for Mayer-Rokitansky-Küster-Hauser syndrome, which is caused by a congenital anomaly of vaginal development, include vaginal dilation and vaginoplasty with autologous tissue. However, due to poor compliance and surgical complications, tissue engineering technology has received considerable attention for vaginal reconstruction because of its preferred characteristics. Nonetheless, the biological therapy of stem cell and tissue engineering technology still faces severe challenges, without application for clinical translation. Therefore, for women with vaginal injuries, the choice of treatment should be guided by the etiology and symptom severity. Stem cell therapy and tissue engineering technology show promising application prospects for vaginal injury repair and reconstruction, in addition to medical and surgical treatments. However, it is necessary to conduct additional pre-clinical animals and clinical trials in order to provide reliable references for future clinical practice.

Keywords: Epidemiology; Etiology; Stem cell therapy; Tissue engineering technology; Vaginal injury.

Fig. 1

The etiologies of vaginal injuries. (Created with BioRender.com)

Fig. 2

Medical treatments of vaginal injuries. NOS nitric oxide synthase, VIP vasoactive intestinal polypeptide, FGF fibroblast growth factor, bFGF basic fibroblast growth factor, KGF keratinocyte growth factor (also named as FGF-7), KGFR keratinocyte growth factor receptor, HA hyaluronic acid, P-AKT phosphorylated protein kinase B, VEGF vascular endothelial growth factor, EGF epidermal growth factor, PDGF-B platelet-derived growth factor-B, TGF-β1 transforming growth factor beta1, hCTGF human connective tissue growth factor. (Created with BioRender.com)

Fig. 3

Surgical treatments for vaginal injuries. MRKH syndrome Mayer-Rokitansky-Küster-Hauser syndrome.(Created with BioRender.com)

Fig. 4

Stem cell therapy for vaginal injuries. ADMSCs adipose derived mesenchymal stem cells, HUMSCs human umbilical cord mesenchymal stem cells, BMDSCs bone marrow derived mesenchymal stem cells, ECM extracellular matrix. (Created with BioRender.com)

Fig. 5

Tissue engineering technology in the treatment of vaginal injuries. ECM extracellular matrix. (created with BioRender.com)