Vagina/vaginal

Proteins and peptides, particularly in the presence of absorption enhancers, can be successfully administered by this route, although surfactant-based enhancers are apparently not effective in the vagina. Vaginal enzymes, especially the proteases, are likely to present problems in the vaginal delivery of proteins and peptides. 

Vaginal Rings. Vaginal epithelium is readily permeable to contraceptive steroids. Since the vascular drainage of the vagina bypasses the Hver, this route of adrninistration potentially permits utilisation of dmgs that have low oral activity. 

Miconazole If the drug (cream or tablet) is administered vaginally, insert the drug high in the vagina using tiie applicator provided with the product. 

Dyspareunia may result from vaginal dryness. Water-based lubricants may provide relief for several hours after application. Moisturizers may provide relief for a longer period of time and potentially can prevent infections by maintaining the acidic environment in the vagina. Both these treatments require frequent application. 

Women with mixed UI (UUI plus SUI) or UUI plus atrophic vaginitis and/or urethritis may also benefit from the addition of a locally-administered (per vagina) estrogen to anticholinergic therapy. 

Durfee MA, Forsyth PS, Hale JA, Holmes KK Ineffectiveness of erythromycin for treatment of Haemophilus vagina/w-associated vaginitis Possible relationship to acidity of vaginal secretions. Antimicrob Agents Chemother 1979 16 635-637. 

Signs Urethral discharge Vaginal discharge Vaginal pH 4.5-6 Inflammation/erythema of vulva, vagina, and/ or cervix Urethritis... 

Female partners may experience vaginal burning, itching, or pain, which is probably related to transfer of alprostadil from the man s urethra to the women s vagina during intercourse. 

The design of vaginal, rectal, and nasal irritation studies is less formalized, but follows the same basic pattern as the primary dermal irritation test. The rabbit is the preferred species for vaginal and rectal irritation studies, but the monkey and dog have also been used for these (Eckstein et al., 1969). Both the rabbit and rat have commonly seen use for nasal irritation evaluations. Defined quantities (typically 1.0 ml) of test solutions or suspensions are instilled into the orifice in question. For the vagina or rectum inert bungs are usually installed immediately thereafter to continue exposure for a defined period of time (usually the same period of hours as future human exposure). The orifice is then flushed clean, and 24 h after exposure it is examined and evaluated (graded) for irritation using the scale in Table 11.1. 

Few, if any, products are administered via the vagina that are intended for systemic absorption. Thus, this route has not been as widely studied and characterized as others. On the other hand, large numbers of different products (douches, spermicides, antiyeast agents, etc.) have been developed that require introduction into the vagina in order to assert their localized effects. Increased research into different birth control and antiviral prophylaxis will result in more vaginal products in the future. All these must be assessed for vaginal irritation potential, and this serves as an example of the other tissue tolerance issues. 

Postmortem Procedures. Rabbits are euthanized by lethal dose of a barbiturate soon after the last vaginal irritation scores are collected. The vagina is opened by longitudinal section and examined for evidence of mucosal damage such as erosion, localized hemorrhage, and so on. No other tissues are examined. No tissues are collected. After the macroscopic description of the vagina is recorded, the animal is discarded. 

Overview of Study Design. Four groups of five adult rabbits each receive a single vaginal exposure daily for 10 days. The genitalia are examined daily. Animals are then euthanized and the vagina is examined macroscopically and microscopically. 

Oestradiol and progesterone regulate the structural and functional changes in oviducts, uterus, cervix and vagina that occur during the menstrual cycle. They provide conditions in the oviduct for the upward motility of sperm, and the downward movement of ova, and also conditions favourable for fertilisation in the oviduct and implantation in the uterus. Another effect is to stimulate vaginal secretions. 

Figure 19.14 Diffusion of oxygen from the vaginal smooth muscle into the lumen of the vagina. Increased contractions of the smooth muscle during coitus and especially during an orgasm increase the flow of blood through the muscle and hence increase the diffusion of oxygen into the lumen, where it is reguired by spermatozoa for mitochondrial ATP generation (see below).

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