DHEA: A New Treatment for Painful Sex and Vaginal Dryness

Vaginal treatment stays local and reduces symptoms

Painful sex affects relationships. Mache Seibel

It's difficult to talk about painful sex and vaginal dryness. You may be one of the many women who find it embarrassing to bring it up with their healthcare provider and it can create intimacy problems with your partner. Many of my patients avoid sex due to pain and until I ask them about it or they tell me about it, don't realize there are effective treatments available; many of their partners avoid sex so they won't cause them pain.

Basically, it's an avoidance-avoidance situation and that isn't good for self-esteem, mental health or relationships.

This problem is caused by lower estrogen levels. Not only do the ovaries almost completely stop making estrogen after menopause; the adrenal glands slow down the production of a precursor hormone called dehydroepiandrosterone or DHEA.  With less DHEA produced from the adrenal glands to turn into estrogen, estrogen levels drop even lower.

A new study published in the September issue of the journal Menopause studied the use of vaginal DHEA. The medication is called Prasterone. The scientist studied 255 women from 24 cities across the United States and nine cities in Canada who were between 40 and 75 years and who complained of painful sex. The women were randomly assigned to receive either a Prasterone suppository or a placebo suppository every day for 12 weeks. The dose was 0.50% DHEA (6.5 milligrams (mgs)).

The results were very promising. Over the 12 weeks of the study the women improved their symptom of painful sex by 46%. Vaginal dryness decreased by 42% and vaginal secretions increased significantly.  The vaginal tissue also got slightly closer to a premenopausal level of acidity or pH. Using the vaginal DHEA did not cause the blood levels of estrogen to increase above the usual level for postmenopause and did not cause the lining of the uterus to change from estrogen produced in the vagina.

So what happens in the vagina stays in the vagina.

This is a very helpful study. Right now there are two prescription options for treatment of vaginal dryness – one is estrogen taken vaginally or otherwise, and the other is ospemifene, which is a SERM or selective estrogen receptor modulator and taken orally. Other SERMS you may know are tamoxifen and Evista. There are also over the counter options such as Replens, which also lowers vaginal pH and increases vaginal moisture.

It has been estimated that about 60% of women have painful sex and vaginal dryness. The condition is also called vulvo-vaginal atrophy or more recently, genitourinary syndrome of menopause. If you consider that the US Census Bureau estimated in 2010 there were about 116 million women in the United States over the age of 45 and 925 million women over age 45 in the world, this is a huge problem that doesn't get the attention it deserves. According to this study, the percentage of women with genitourinary syndrome of menopause increases from about 50% of women from ages 50-60 years to about 72% older than age 70.

However, only 10 to 20% of women seek medical attention for this problem and it is only about 7% of women are ever treated. That is really unfortunate and unnecessary.

If you have a problem with painful sex or vaginal dryness, try over the counter remedies. If they don't work for you by one to three months, talk with your healthcare provider about other options. There are effective treatments out there and available. You've just heard about one more.

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