If oestradiol cream is being used to help with urinary stress incontinence, should it be used in the lower third of the vagina or higher up or does it not matter?
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From Jean Hailes Medical Director and Gynaecologist Dr Elizabeth Farrell AM.
The indications for use of vaginal oestrogens are vaginal atrophic symptoms, including vaginal dryness and lack of lubrication with penetrative sex, recurrent urinary infections and urinary urgency.
Vaginal oestrogens are not indicated for stress urinary incontinence.
The vagina has a dual blood supply and has a complex venous plexus. The veins of the lower third of the vagina, especially the anterior vaginal wall, flow into the haemorrhoidal and pudendal internal venous plexus, whereas the upper vagina veins flow via the uterovaginal plexus into the iliac veins.
To improve all the indications listed above it is appropriate to apply the vaginal oestrogen into the lower third of the vagina. The woman can apply it with either the applicator or manually along the anterior vaginal wall.
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