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International Urogynecology Journal

, Volume 24, Issue 4, pp 537–543 | Cite as

The vagina as a route for drug delivery: a review

  • Sushma SrikrishnaEmail author
  • Linda Cardozo
Review Article

Abstract

Overactive bladder (OAB) syndrome has a significant deleterious impact on quality of life. After conservative therapy and bladder retaining, antimuscarinic drugs remain the mainstay of OAB management. Oral therapy is associated with frequent side effects, leading to the development of alternative agents and formulations or the use of novel routes of drug administration, such as the vaginal route. The vagina is often ideal for drug delivery because it allows the use of lower doses, maintains steady drug administration levels, and requires less frequent administration than the oral route. With vaginal drug administration, absorption is unaffected by gastrointestinal disturbances, there is no first-pass effect, and use is discreet. The aim of this review is to provide a background overview of vaginal development, anatomy, and physiology and the effect this has on the use of this route for both local and systemic drug delivery, with special reference to OAB management. Vaginal therapy continues to be an underused route of drug delivery. Vaginal administration allows nondaily, low, continuous dosing, which results in stable drug levels and may, in turn, achieve a lower incidence of side effects and improve patient compliance. These benefits must be balanced against inherent patient or physician bias against using this route and the need to overcome cultural, personal, and hygiene-related barriers to this form of therapy. More sophisticated and programmable vaginal rings are being developed for systemic delivery of therapeutically important macromolecules, such as antimuscarinic therapy in OAB management.

Keywords

Overactive bladder Antimuscarinics Oxybutynin Anatomy Embryology of vagina Drug delivery 

Notes

Conflicts of interest

Sushma Srikrishna:speaker honorarium, Recordati; consultant, Astellas; travel grant to attend ICS from Boston Scientific, Recordati. Dudley Robinson: consultant for Astellas, Pfizer, Gynaecare, Ferring; speaker honorarium Astellas, Pfizer, and Gynaecare; meeting expenses from Astellas and Pfizer. Linda Cardozo: consultant, Astellas, Pfizer, Teva, Ethicon, Merck, Lilly; speaker honorarium, Astellas, Pfizer; trial participation Astellas, Pfizer; research grant, Pfizer

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Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  1. 1.Department of UrogynaecologyKing’s College HospitalLondonUK

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