In the realm of medicine, conversations around vaginas have been remarkably narrow. Usually, the focus is only given either following a vaginal delivery of a child, as a ‘passing glance’ as health care professionals access the cervix for screening, or when the body of the uterus is examined for other medical procedures.
And when vaginal health is reviewed, it’s usually focused on infections such as sexually transmitted diseases and cancerous lesions.
But the vagina is a dynamic organ. For example, the many biological changes that occur throughout the menstrual cycle.
It also has its own microenvironment, a carefully balanced microbiome containing billions of bacteria. And we are only just beginning to understand the role this plays in vaginal, reproductive and public health.
The vagina’s potential as a route for diagnostics and therapeutics has largely been ignored. But now, scientists, doctors, and pharma companies have started to look at the organ in a new way.
As it can be easily self-accessed, the vagina allows for intervention anytime, anywhere. There is no need for hospital visits or invasive procedures. This gives women the benefit of near complete independence and continuous monitoring or treatment.
New developments mean the vagina could provide an easy route for delivering medication.
Already, local medication such as topical oestrogen for genito-urinary symptoms of menopause is given in the form of cream, a pessary (a tablet inserted using an applicator), or a ring inserted directly into the vagina - usually inserted by the patient.
Also, women going through assisted reproductive treatment, or trying to conceive following a miscarriage, may be prescribed the hormone progesterone as a vaginal pessary to self-insert.
One of the current problems with vaginally-inserted medications is they often result in drug leakage and increased discharge. However, one company, Calla Lily, has developed a new leak-free vaginal drug delivery platform.
This device is simple to use, which is essential when depending on patients to administer medications themselves, and also helps to alleviate dosage anxiety and other stresses.
Also currently available is a combined contraceptive vaginal ring, which releases a continuous dose of oestrogen and progestogen into the bloodstream via the vagina. But many more medications could potentially be delivered via the vagina and absorbed into the bloodstream.
The dense blood supply potentially enables systemic medications to be delivered via the vagina, which – unlike oral tablets – has the advantage of avoiding the gut.
This prevents any digestive side effects such as nausea, vomiting and diarrhoea. It also, bypasses the first metabolism in the gut and liver, thus avoiding a reduction in drug concentration.
Devices like this have huge potential, and could even be the best way to deliver medication to the vagina and nearby organs.
Also, menstrual blood collected in the vagina has great potential as a diagnostic tool.
Research is currently looking at how to use menstrual blood to detect diseases such as endometriosis, which affects 10 per cent of women. It is a chronic condition, causing significant pain and infertility, and currently takes an average of seven years to diagnose.
Building on the identification of endometriosis markers found in the womb lining, Dr Yana Asnavour of company Endometrics, states, "We have been analysing transcriptomic biomarkers of endometriosis for the past seven years and are currently optimising the pipeline for menstrual blood analysis."
The vagina is also significantly affected by infections. One of the most common is thrush, with as many as 75 per cent of women developing it at least once in their lifetime, and over 138 million women worldwide suffering from recurrent thrush.
This highlights the need for the development of a solution that enables women to check, monitor, diagnose and treat any vaginal infections or disruptions in the microbiome that may occur.
Critically, more research is needed to understand the biology of the vagina, including the microbiome and the factors affecting it.
This will enable us to better grasp potential effects of diagnostics, therapeutics and care products – such as tampons, moisturisers, and washes – on vaginal irritation, sensitisation, microbiology and Toxic Shock Syndrome, which is a rare but life threatening bacterial infection often associated with the use of tampons and other vaginal products
There can also be psychological and/or social barriers to using vaginal products that involve self-examination and insertion. Of course, like any product, there needs to be a high level of personal acceptability. However, this can be shaped by cultural sensitivities.
In Europe, for instance, the use of non-applicator tampons is far higher than in the US. If the medicinal use of the vagina is to be optimised, it’s critical for women to be deeply involved in the development of future products, to encourage a societal shift and recognise its importance and potential.
That’s a challenge that must be overcome, as the future of the vagina is one of immense potential for diagnostics, therapeutics, and self-care.
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