Dyspareunia (GSM/VVA)

Genitourinary Syndrome of Menopause (GSM) and Vulvovaginal Atrophy (VVA)



Menopause occurs at about 50 years of age, when the ovaries stop producing estrogens. The serum DHEA concentration, on the other hand, has already decreased on average by 60% by the time of menopause.

GSM, Vulvovaginal Atrophy (VVA), vaginal dryness of menopause and sexual dysfunction represent a constellation of symptoms affecting approximately 50% of postmenopausal women.

GSM is defined as a series of symptoms and signs associated with a decrease in serum DHEA involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra and bladder. The syndrome may include but is not limited to: genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort and pain; as well as urinary symptoms of urgency, dysuria and recurrent urinary tract infections. Depression and anxiety can be associated with VVA/GSM.

Women may present with some or all of the signs and symptoms, which can be bothersome. The clinical studies of Endoceutics are based upon the important discovery by Endoceutics that the lack of DHEA is the true cause of the problems of menopause.

The combined hormonal deficiency of both estrogens and androgens made intracellularly from DHEA results in a thinning of the vaginal wall and a decrease in lubrication. The vaginal mucosa becomes less hydrated and less elastic with dryness and pain at sexual activity.

Contrary to hot flashes which are usually temporary and eventually cease, even in the absence of treatment, the problems associated with vulvovaginal atrophy usually increase with age in the absence of treatment. This menopausal problem can seriously affect quality of life in a large proportion of women, including an increase in vaginal and urinary infections.

Approximately 50% of postmenopausal women complain about vulvovaginal atrophy, with the incidence increasing with age. Despite their symptoms, only about 3% of affected women seek treatment for various reasons, most commonly because of the fear of potential estrogen-related side effects. Consequently, about 97% of the women who suffer from vulvovaginal atrophy symptoms are left without treatment for a large part of their lives.

Symptoms and Signs of VVA

Vulvovaginal atrophy results in a thinning of all three layers of the vaginal wall (epithelium, lamina propria and muscularis) and a decrease in vaginal lubrication and elasticity. These changes can cause vaginal dryness and, importantly, pain during sexual activity. Also known as dyspareunia, the pain varies in intensity from one woman to another. The pain may or may not be accompanied by bleeding at intercourse.

Vulvovaginal atrophy may also result in irritation and itching of variable intensity. Some women suffering from irritation and itching do not necessarily relate it to vulvovaginal atrophy, but rather to an inflammatory reaction, allergy, or vaginal infection which can be present in a significant proportion of women. 

Vulvovaginal atrophy can also be accompanied by serious complications like bladder and possibly kidney infections.

Current Treatments of Vulvovaginal Atrophy 

While both estrogens and androgens which are both involved in vaginal health are missing at menopause and continue to decrease thereafter, treatment of the problems related to the hormonal deficiency of menopause have so far been exclusively based upon estrogens. In fact, the treatment of vulvovaginal atrophy has always been limited to estrogens taken orally or applied locally in the vagina. It is only recently, through the discoveries of Endoceutics, that it is recognized that both estrogens and androgens are involved in the normal anatomy and functioning of the vagina.

Endoceutics approach

A results-oriented approach and the implementation of effective solutions.

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