Vaginal health and well ageing during all stages of women’s life

The genital area is becoming more and more the object of new attentions and targeted treatments are developed to support its functionality and beauty. The female world is closer to the awareness that the health of this intimate area should be considered an integral part of the beauty routine of every woman according to the new «well-ageing» approach. As face, hair and body are constantly exposed to hectic life, external agents and daily stress, even the vulvovaginal area suffers the consequences and the process of the physiological aging, modifying its tissue structures, leading to vulvovaginal dryness and irregular skin desquamation, loss of strength, elasticity, extensibility and density, loss of tissues brightness. A new approach, combining two ingredients, has been studied to improve vaginal wellness condition. Research Article Vaginal health and well ageing during all stages of women’s life Letteria Greco1*, Marco Fontana2, Enzo Berardesca3 and Maurizio Barbieri Carones4 1Sinerga Group, Via della Pacciarna 67, Gorla Maggiore, (VA), 21050, Italy 2Sinerga SPA, Via della Pacciarna 67, Gorla Maggiore, (VA), 21050, Italy 3Dermatological Institute S. Maria and S. Gallicano, IRRCS Via Chianesi 53, 00144, Rome, Italy 4University of Milan, Via della Commenda 12, 20122, Milan, Italy Received: 28 January, 2020 Accepted: 17 April, 2020 Published: 18 April, 2020 *Corresponding author: Letteria Greco, Sinerga Group, Via della Pacciarna 67, Gorla Maggiore, (VA), 21050, Italy, E-mail:


Introduction
The vagina is a female reproductive organ that changes over the life cycle of a woman. It has different functions, in response to hormonal changes during puberty, menstruation, pregnancy, and menopause. This organ is responsible for menstruation, immune defense (acidic pH, local fl ora, and chemical signaling work as protection against harmful pathogens, cause of infections and most common called vaginitis), reproduction functions as collector of sperm and canal for birth and for sexual intercourse and pleasure. Morphology of vaginal area is shown in Figure 1. The morphology of this organ changes during all different periods of woman life, especially after menopause [1,2].
In addition to the effects caused by the physiological aging, the vulvovaginal area is subject to further stressing events that occur in the woman's life even at younger age such as: -Oral contraceptive intake, causing vaginal dryness; Figure 1: Morphology of vaginal area. The labia minora have been drawn apart, Cliotirs, Vestibule, Urethral orofi ce, Vaginal orifi cie, hymen [2]. https://www.peertechz.com/journals/international-journal-of-dermatology-and-clinical-research Citation: Greco  -After menopause reduced vaginal secretions, increased pH, collagen and water content decrease [3].
Changes in anatomy of vulvovaginal area are resumed in Table I. It is because of all this changes, occurring during woman life, that is extremely important to prevent, maintain and treat vulvovaginal area in order to keep a healthy ageing and wellbeing of female intimate zone. moistening in the case of infl ammation and preservation of water equilibrium. It is also widely effective in the treatment of skin diseases due to the preservation of tissue consistency, facilitating the cellular migration in cases of infl ammation and also the process of improvement and regeneration of damaged tissues. It has also been object of a study to relief Postmenopausal Vulvovaginal Atrophy in patients with genital discomfort due to postmenopausal estrogen lack [4].
Hyaluronic acid with three different molecular weights is used to provide a complete moisturization, from the upper to the inner layer of the skin. Hyaluronic acid is contained in several cosmetic preparations for facial, neck, eye skin care and body care. It is used as skin hydrating and conditioning agent thanks to its unique capacity in retaining water [5,6].
Regarding the blend of Trehalose and ceramides, Trehalose has been classifi ed as a kosmotrope or water-structure maker, which is the interaction between trehalose/water is much stronger than water/water interaction and may be involved in its bioprotective action and is also considered a natural hydrating agent. Furthermore, ceramide acts as a water modulator and a permeability barrier by forming multilayered lamellar structures with other lipids between cells in the stratum corneum. The use of this specifi c blend is particularly suitable to regenerate skin barrier, through hydration and fi lm forming effects [7].

Material and methods
Women under 40 -Formula 1

In vivo test
Aim of this test is to evaluate whether the tested product

Mons Pubis
Protruding triangular region, limited laterally by the inguinal folds and at the bottom with the labia majora.
Reduction of tonicity of the pubic area which becomes more protuberant and sagging.
Labia Minora Very innervated and very sensitive.
Their tissue begins to lose volume, becomes thinner and loses its elasticity and reduces its lubricating power.
Labia Majora Rich in adipose tissue, sweat glands and hair follicles.

Vulvar Vestibule
Area enclosed in the labia minora and external to the vagina and is covered by a reddish mucosa with a delicate consistency.

Perineum
A set of ligaments, connective tissue and muscle tissues and controls sexual activity.
Its muscular structures weaken and give less support.

Objective of the study
Aim of this study is to fi nd the right solution for intimate All patients were extensively informed of the study design and hypothesis and a signed consent was obtained.
Furthermore, a Scientifi c Technical Committee has evaluated the study and its ethical acceptance.

Discussion
Hyaluronic acid is a natural polysaccharide that represents an important part of the extra-cellular matrix of the skin and cartilage. It is able to storage large amounts of water molecules and has a key role due to the properties of formation and conservation of extra-cellular infl ation, skin Citation: Greco     A self -assessment from the patients is also performed. Formula 2 has proved to have an effect in improving moisturization, turgidity, compactness, tone, colour of the vaginal skin. In particular, +9.43% of vascularization and cutaneous trophism (improved skin color) and +5.54% of skin lightness have been observed. Furthermore, the product has proved to have a very good acceptability from patients.

Menopause period -Formula 3
In vitro test

Collagen and elastin dosage
The aim of the test is to assess whether formula 3, at different concentrations, is able to increase the production of collagen and elastin in vitro. Test method is the same for elastin and collagen, and has been performed separately for each parameter.
The test was performed on human fi broblasts (NHDF) cultured in MEM (minimal essential medium) supplemented with fetal bovine serum (10%) and glucose (4.5 g/l) and incubated at standard culture conditions (37°C, 5% CO2). Good cell culture practices were used. A cell viability assay was performed prior the elastin dosage in order to choose the concentrations to use for the analysis of collagen and elastin. The cell viability was evaluated through a MTT test [7]. The cells were treated with the chosen concentrations of the tested product and the positive control (PC). Cells not treated with the sample are the negative controls. The content of elastin was determined by ELISA (enzyme-linked immunosorbent assay), a plate-based assay technique designed for detecting and quantifying substances such as peptides, proteins, antibodies and hormones [8].
In an ELISA assay a specifi c antigen for the elastin is

Soothing effect
The aim of the test is to assess whether the tested product is able to reduce the production of cytokines in vitro in a biological model of reconstructed human vaginal epithelium.
To this purpose we tested its ability in reducing the synthesis of interleukin-1 (IL-1).
IL-1 is one of the most well-known infl ammatory markers.
Interleukin-1 plays a key role in infl ammation and keratinocyte activation [9]. IL-1 family is a group of 11 cytokines: interleukin (IL) 1 alpha (IL-1) and 1 beta (IL-1) isoforms are the most investigated. Indeed the infl ammatory process is initiated by IL-1, but is propagated and maintained by both isoforms.
Overexpression of both interleukines is positively correlated with some skin disease as psoriasis, atopic dermatitis, skin cancer and skin phototoxicity, etc [10].

Repairing effect
The aim of the test was to evaluate the potential repairing action of the tested product on reconstructed human vaginal epithelium (HVE). The cell viability was evaluated through a MTT test [7]. The tissues were left in growth medium for at least 2 hours (37°C, 5% CO2) before treatment. The tissues were stimulated with SLS. A group of tissues was then treated with the tested sample for 60 minutes at room temperature. Control tissues (NCs) were not stimulated with SLS and were maintained in phosphate buffer (PBS). On a group of tissues the product was tested in the absence of stimulation to verify that the sample itself did not alter the viability of the tissues. Each experiment was conducted in triplicate. In HVE tissues stressed and treated with the tested formula, the viability resulted 26.3% higher than the one of the stimulated and untreated tissues (86.40% vs 68.41%). This results in a repairing action.

In vivo test
Aim of this test is to evaluate whether formula 3 is tolerated on the vaginal skin and on the mucosae, and if the product has an effect in improving moisturization, turgidity, compactness, tone, colour of the vaginal skin. Formula's acceptability is evaluated too. 15 female subjects, aged 50 and 65 , in menopause, were selected for the test. Volunteers used the product once per day for 28 days, applying a thin layer to the external genitalia and on the perineum. A self -assessment from the patients is also performed. Formula 3 has proved to have an effect in improving moisturization, turgidity, compactness, tone, colour of the vaginal skin. In particular, +8.47% of vascularization and cutaneous trophism (improved skin color) and +6.10% of skin lightness have been observed. Furthermore, the product has proved to have a very good acceptability from patients.

Results
From this study we obtained evidences that using products based on Hyaluronic acid and on a blend composed by Trehalose and ceramides, specifi cally designed for intimate wellness and