title: The effects of hypoestrogenism on the vaginal wall: interference with the normal sexual response.
abstract: BACKGROUND
  The sexual response depends on the adequate function of all systems related to the genital and extra-genital organs. Physiological conditions such as menopause can interfere with sexual expression because of central and peripheral changes. Genital effects of estrogen include vaginal trophism, lubrication, and local pleasure sensation in the sexual arousal phase. Hypoestrogenism causes changes in the four layers of the vaginal wall that may result in dyspareunia and a loss in the quality of the genital arousal response.
  
  
  OBJECTIVE
  The purpose of this review is to highlight the changes in the vaginal wall caused by hypoestrogenism, its possible relationship with dyspareunia, and its repercussions for genital arousal. Treatments for hypoestrogenism are also discussed.
  
  
  METHODS
  We evaluated the data available in PubMed (1982-2008) and surveyed the reference list for relevant studies. Two reviewers analyzed the data independently. A study was considered to be of high quality if it had all three of the following characteristics: (i) prospective design; (ii) valid data; and (iii) adequate sample size. Reviews and experimental animal studies were also considered.
  
  
  METHODS
  Normal genital morphology, hypoestrogenism and hormone replacement therapy were the focus of the studies reviewed in this paper.
  
  
  RESULTS
  Atrophy of the vaginal wall may be associated with dyspareunia and genital sexual arousal disorder, but psychological and sociocultural aspects must also be considered. Regardless, however, local estrogen therapy is useful in improving vaginal wall trophism and, thus, in improving the sexual response.
  
  
  CONCLUSIONS
  There are many possible alterations in the structure of the vaginal wall that are related to estrogen deficiency that may require medical intervention beyond the usual strategies used to attain adequate sexual function. Physicians should attempt to treat these alterations, and more research is needed to elucidate the physiopathology of dyspareunia and genital sexual arousal physiology.
authors.affiliation: Ribeirão Preto School of Medicine, University of São Paulo-Department of Gynaecology and Obstetrics, Ribeirão Preto, Brazil. luciaalvess@yahoo.com.br
authors.forename: Lucia Alves da Silva
authors.initials: LA
authors.lastname: Lara
authors.forename: Bernardo
authors.initials: B
authors.lastname: Useche
authors.forename: Rui Alberto
authors.initials: RA
authors.lastname: Ferriani
authors.forename: Rosana Maria
authors.initials: RM
authors.lastname: Reis
authors.forename: Marcos Felipe Silva
authors.initials: MF
authors.lastname: de Sá
authors.forename: Mauricio Mesquita Sabino
authors.initials: MM
authors.lastname: de Freitas
authors.forename: Julio César
authors.initials: JC
authors.lastname: Rosa e Silva
authors.forename: Ana Carolina Japur de Sá
authors.initials: AC
authors.lastname: Rosa e Silva
mesh_terms: D001284:Atrophy / Q000188:drug therapy / Q000473:pathology; D004414:Dyspareunia / Q000188:drug therapy / Q000453:epidemiology; D004967:Estrogens / Q000172:deficiency* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008593:Menopause / Q000502:physiology; D008875:Middle Aged; D011446:Prospective Studies; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy / Q000503:physiopathology*; D020018:Sexual Dysfunctions, Psychological / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D014621:Vagina / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology*
chemical_list: D004967:Estrogens