The vagina as source and target of androgens: implications for treatment of GSM/VVA, including DHEA

Abstract

The vagina is traditionally thought of as a passive organ in the female reproductive system, serving primarily as a passageway for menstrual blood, sexual intercourse and childbirth. However, recent research has shed light on the vagina’s role as an endocrine organ that plays a crucial role in female hormonal balance and overall health. Particularly, growing evidence shows that the human vagina can be considered both as source and target of androgens, in view of the novel concept of ‘intracrinology’. Besides the well-known role of estrogens, androgens are also crucial for the development and maintenance of healthy genitourinary tissues in women. As androgen levels decline with age, and estrogen levels fall during the menopausal transition, the tissues in the vagina, together with those in the urinary tract, become thinner, drier and less elastic, leading to a variety of uncomfortable and sometimes painful symptoms, clustered in the genitourinary syndrome of menopause (GSM). Given the lack of testosterone-based or androstenedione-based products approved by regulatory agencies to treat GSM, the possibility of using intravaginal prasterone, which works by providing a local source of dehydroepiandrosterone (DHEA) to the vaginal tissues, appears to be a targeted treatment. Further studies are needed to better assess its safety and efficacy.

摘要

阴道传统上被认为是女性生殖系统中的一个被动器官, 主要作为经血、性交和分娩的通道。然而, 最近的研究揭示了阴道作为内分泌器官的作用, 内分泌器官在女性荷尔蒙平衡和整体健康中起着至关重要的作用。特别是, 越来越多的证据表明, 鉴于“内分泌学”的新概念, 人类阴道可以被视为雄激素的来源和靶点。除了众所周知的雌激素作用外, 雄激素对女性健康泌尿生殖组织的发育和维持也至关重要。随着年龄的增长, 雄激素水平下降, 而雌激素水平在更年期过渡期间下降, 阴道中的组织以及泌尿道中的组织变得更薄、更干燥、弹性更小, 导致各种不舒服甚至有时疼痛的症状, 集中在更年期泌尿生殖综合征（GSM）中。鉴于缺乏监管机构批准用于治疗GSM的基于睾酮或基于雄烯二酮的产品, 使用阴道内普列酮的可能性似乎是一种有针对性的治疗方法, 该方法通过向阴道组织提供脱氢表雄酮（DHEA）的局部来源来发挥作用。需要进一步的研究来更好地评估其安全性和有效性。

Keywords:

• Genitourinary syndrome of menopause
• prasterone
• dehydroepiandrosterone
• vulvovaginal atrophy
• androgens in women
• intracrinology
• female sexual dysfunction
• vagina

Potential conflict of interest

The authors declare no conflict of interest concerning the manuscript contents. L.V. received scientific research grants, advisory board attendance and speaker honoraria from Therascience, Theramex, Bayer Schering Pharma, Intercept, Lipocine, Ibsa and Freya Pharma Solutions.

Source of funding

This research was supported by a ‘Progetti di Rilevante Interesse Nazionale’ [PRIN 2017S9KTNE] to Prof. G. Rastrelli.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.