Uncover the physical and emotional pain of vaginal atrophy
including dyspareunia

In a large survey, dyspareunia was reported to be one of the most bothersome symptoms of VVA12

VVA symptoms reported by postmenopausal women IN THE REVIVE SURVEY*,12

Symptom Percentage of women reporting
Vaginal dryness 55%
Pain during intercourse (dyspareunia) 44%
Vaginal irritation 37%
Vaginal tenderness 17%
Bleeding during intercourse 8%
Pain during exercise 2%

* The REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) Survey was a 2-week study with postmenopausal women (N=8081) in the United States, revealing knowledge about and impact of VVA symptoms on their lives.

Adapted from Wysocki et al. 2014.12

The survey also showed that for approximately 1 in 4 postmenopausal women, the discomfort and pain of their VVA symptoms diminished their enjoyment of life12

Changes in sex steroid physiology at menopause linked to dyspareunia11

The science of intracellular metabolism has revealed the role of Dehydroepiandrosterone (DHEA)16

  • After menopause, circulating sex hormones from the ovaries drop to biologically insignificant levels17,18
  • DHEA becomes a significant source for steroidogenesis16–18
  • However, reduced DHEA levels are often insufficient to maintain the vaginal wall epithelium—and can contribute to dyspareunia18

Vaginal wall atrophy contributes to dyspareunia11,12

Adapted from and courtesy of Blausen.com.

  • The vaginal epithelium thins, which may cause pruritus, soreness, and a stinging pain in the vaginal/vulvar area7
  • Changes in the number of superficial and parabasal cells in the vagina lead to reduced moisture and elasticity12
  • Increases in vaginal pH may result in symptoms such as itching and irritation12
  • There’s a significant decrease in the vascularity of the lamina propria reducing its premenopausal function of becoming engorged with blood during sexual arousal, which led to lubrication4,13
  • Smooth muscle atrophy occurs in the muscularis layer, and after ovariectomy, as observed in a mammalian study, a significant decrease in the thickness of the muscularis was demonstrated2,4,13

Even after menopause, a woman’s vaginal epithelium maintains its ability to generate local estrogens and androgens that can be used by the vaginal wall.17

Can a women’s body generate its own local sex hormones?

Discover the role of DHEA

References

1. Nappi RE, Kingsberg S, Maamari R, Simon J. The CLOSER (CLarifying Vaginal Atrophy’s Impact On Sex and Relationships) survey: implications of vaginal discomfort in postmenopausal women and in male partners. J Sex Med. 2013;10(9):2232-2241. 2. Berger L, El-Alfy M, Martel C, Labrie F. Effects of dehydroepiandrosterone, Premarin and Acolbifene on histomorphology and sex steroid receptors in the rat vagina. J Steroid Biochem Mol Biol. 2005;96(2):201-215. 3. Goldstein I, Dicks B, Kim NN, Hartzell R. Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women. Sex Med. 2013;1(2):44-53. 4. Goldstein I. Female sexual function and dysfunction. In: Raz S, Rodriguez L, eds. Female Urology. 3rd ed. Philaelphia, PA: Saundes Elsevier;2008:505-524. 5. Goldstein I. Recognizing and treating urogenital atrophy in postmenopausal women. J Womens Health (Larchmt). 2010;19(3):425-432. 6. Jannini EA, d’Amanti G, Lenzi A. Histology and immunohistochemical studies of female genital tissue. In: Goldstein I, Meston CM, Davis S, Traish A, eds. Women’s Sexual Function and Dysfunction: Study, Diagnosis, and Treatment. Boca Raton, FL: CRC Press;2005:125-133. 7. Mac Bride MB, Rhodes DJ, Shuster LT. Vulvovaginal atrophy. Mayo Clin Proc. 2010;85(1):87-94. 8. Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society. Menopause. 2013;20(9):888-902. 9. Labrie F, Martel C, Pelletier G. Is vulvovaginal atrophy due to a lack of both estrogens and androgens? Menopause. 2017;24(4):452-461. 10. Labrie F. DHEA after menopause: sole source of sex steroids and potential sex steroid deficiency treatment. Menopause Manag. 2010;19:14-24. 11. Castelo-Branco C, Cancelo MJ, Villero J, Nohales F, Juliá MD. Management of post-menopausal vaginal atrophy and atrophic vaginitis. Maturitas. 2005;52(Suppl 1):S46-S52. 12. Wysocki S, Kingsberg S, Krychman M. Management of vaginal atrophy: implications from the REVIVE Survey. Clin Med Insights Reprod Health. 2014;8:23-30. 13. Semmelink HJ, de Wilde PC, van Houwelingen JC, Vooijs GP. Histomorphometric study of the lower urogenital tract in pre- and post-menopausal women. Cytometry. 1990;11(6):700-707. 14. Sturdee DW, Panay N; International Menopause Society Writing Group. Recommendations for the management of postmenopausal vaginal atrophy. Climacteric. 2010;13(6):509-522. 15. American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Gynecology. ACOG Practice Bulletin No. 119: Female sexual dysfunction. Obstet Gynecol. 2011;117(4):996-1007. Reaffirmed 2015. 16. Labrie F, Bélanger A, Pelletier G, Martel C, Archer DF, Utian WH. Science of intracrinology in postmenopausal women. Menopause. 2017 Jan 16. doi: 10.1097/GME.0000000000000808. 17. Archer DF, Labrie F, Bouchard C, et al; VVA Prasterone Group. Treatment of pain at sexual activity (dyspareunia) with intravaginal dehydroepiandrosterone (prasterone). Menopause. 2015;22(9):950-963. 18. Labrie F, Archer DF, Koltun W, et al; VVA Prasterone Research Group. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause. 2016;23(3):243-256. 19. Berger L, El-Alfy M, Labrie F. Effects of intravaginal dehydroepiandrosterone on vaginal histomorphology, sex steroid receptor expression and cell proliferation in the rat. J Steroid Biochem Mol Biol. 2008;109(1-2):67-80. 20. Labrie F, Luu-The V, Labrie C, Simard J. DHEA and its transformation into androgens and estrogens in peripheral target tissues: intracrinology. Front Neuroendocrinol. 2001;22(3):185-212. 21. Portman DJ, Gass ML; Vulvovaginal Atrophy Terminology Consensus Conference Panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Maturitas. 2014;79(3):349-354. 22. Galinsky AM, Waite LJ. Sexual activity and psychological health as mediators of the relationship between physical health and marital quality. J Gerontol B Psychol Sci Soc Sci. 2014;69(3):482-492.