Intravaginal DHEA, by a strictly local action, exerts beneficial effects on both vaginal atrophy symptoms and sexual...

Following complete cessation of estrogen secretion by the ovaries at menopause, all estrogens and practically all androgens are made from dehydroepiandro-sterone (DHEA) of adrenal/ovarian origin. Although being an inactive molecule itself, DHEA is transformed at various levels and ratios into estrogens and/or androgens only in the tissues that possess the required cell-specific steroidogenic enzymes with minimal or no release of the active hormones in the blood according to the mechanisms of intracrinology. Vaginal atrophy affects 50% of postmenopausal women from 50 to 60 years of age and 72% of women 70 years and older.

At the standard 12-week time interval, 0.5% DHEA caused a 45.9±5.31 (p<0.0001 vs. placebo) decrease in the percentage of parabasal cells, a 6.8%±1.29% (p<0.0001 vs. placebo) increase in superficial cells, a 1.3±0.13 unit (p<0.0001 vs. placebo) decrease in vaginal pH and a 1.5±0.14 score unit (p<0.0001 vs. placebo) decrease in the severity of the most bothersome symptom. Similar changes were observed on vaginal secretions, color, epithelial surface thickness and epithelial integrity. In addition to the effects of intravaginal DHEA on the symptoms and signs of vaginal atrophy, a time- and dose-dependent improvement in the four domains of sexual function was observed, namely desire, arousal, orgasm and pain at sexual intercourse.

The present data indicate that combined androgenic/estrogenic stimulation in the three layers of the vagina exerts important beneficial effects on sexual function in women without systemic action on the brain and other extravaginal tissues.