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Climacteric. 2019 Feb;22(1):65-72. doi: 10.1080/13697137.2018.1535583. Epub 2018 Dec 17.

Treatment of moderate to severe dyspareunia with intravaginal prasterone therapy: a review.

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a Columbus Center for Women's Health Research , Columbus , OH , USA.
b Sermonix Pharmaceuticals , Columbus , OH , USA.
c Department of Obstetrics and Gynecology , New York University School of Medicine , New York , NY , USA.
d Department of Obstetrics, Gynecology, and Reproductive Sciences , University of California , San Francisco , CA , USA.
e Sutter East Bay Medical Foundation , Berkeley , CA , USA.


The loss of sex steroids (e.g. estradiol, dehydroepiandrosterone [DHEA], progesterone) that causes menopause commonly affects a woman's general health and produces bothersome physical changes that may interfere with normal sexual and genitourinary functioning. Although both over-the-counter and prescription treatments are available, there remains a large unmet need, as less than 10% of women are treated. Adrenal DHEA and its sulfate are the most abundant steroids in humans. Here we review the development of intravaginal prasterone, the synthetic equivalent to endogenous DHEA. Prasterone is approved by the US Food and Drug Administration for the treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy, due to menopause. Prasterone has been shown to decrease the pain associated with dyspareunia, and to improve vaginal pH, as well as superficial and parabasal cell counts, while maintaining serum hormone levels within the range of those seen in normal postmenopausal women. Unlike other menopausal prescription therapies, intravaginal prasterone does not carry a boxed warning, thus allowing the clinician and patient to engage in meaningful and reassuring discussion around a new approach that treats this common, debilitating condition.


Dehydroepiandrosterone; dyspareunia; genitourinary syndrome of menopause; menopause; prasterone; vulvovaginal atrophy

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