Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women.
OBJECTIVE
The objective of this study was to provide evidence that the transformation of DHEA into both androgens and/or estrogens locally in cells of the three layers of the vagina (epithelium, lamina propria, and muscularis) would have effects of greater impact, including effects on sexual function, than only effects on superficial epithelial cells as achieved with estrogens.


METHODS
This prospective, randomized, double-blind, and placebo-controlled phase III clinical trial has evaluated the effect of daily local intravaginal application of Prasterone (dehydroepiandrosterone; DHEA) for 12 weeks on the domains of sexual dysfunction, namely, desire/interest, arousal, orgasm, and pain at sexual activity, in 216 postmenopausal women with moderate to severe symptoms of vaginal atrophy.


RESULTS
A time- and dose-dependent improvement of the four domains of sexual function was observed. At the 12-week time interval, the 1.0% DHEA dose led, compared with placebo, to 49% (P = 0.0061) and 23% (P = 0.0257) improvements of the desire domains in the Menopause Specific Quality of Life and Abbreviated Sex Function questionnaires, respectively. Compared with placebo, the Abbreviated Sex Function arousal/sensation domain was improved by 68% (P = 0.006), the arousal/lubrication domain by 39% (P = 0.0014), orgasm by 75% (P = 0.047), and dryness during intercourse by 57% (P = 0.0001).


CONCLUSIONS
By a local action in the vagina, DHEA applied daily at doses at which serum steroids remain well within normal postmenopausal values exerts relatively potent beneficial effects on all four aspects of sexual dysfunction. Such 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.
Labrie
Fernand
F
Laval University Hospital Research Center and Laval University, Quebec, Canada. Fernand.Labrie@endoceutics.com
Archer
David
D
Bouchard
Céline
C
Fortier
Michel
M
Cusan
Leonello
L
Gomez
José-Luis
JL
Girard
Ginette
G
Baron
Mira
M
Ayotte
Normand
N
Moreau
Michèle
M
Dubé
Robert
R
Côté
Isabelle
I
Labrie
Claude
C
Lavoie
Lyne
L
Berger
Louise
L
Gilbert
Lucy
L
Martel
Céline
C
Balser
John
J
D000282:Administration, Intravaginal; D000328:Adult; D000368:Aged; D001284:Atrophy; D003687:Dehydroepiandrosterone / Q000172:deficiency / Q000494:pharmacology / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007989:Libido / Q000187:drug effects* / Q000502:physiology; D008875:Middle Aged; D017698:Postmenopause / Q000187:drug effects* / Q000502:physiology / Q000523:psychology; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D020018:Sexual Dysfunctions, Psychological / Q000188:drug therapy* / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires; D014621:Vagina / Q000187:drug effects* / Q000473:pathology
D003687:Dehydroepiandrosterone