Pathogenetic mechanisms and modern approaches to the treatment of vulvovaginal atrophy and dyspareunia in postmenopausal women

DOI

https://dx.doi.org/10.18565/aig.2025.279

Nazarova N.M., Devyatkina A.R., Prilepskaya V.N., Akopyan A.S., Sycheva E.G., Mezhevitinova E.A.
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia

Relevance: Sexual dysfunction associated with vulvovaginal atrophy (VVA) in postmenopausal women is a significant medical and social problem. Estrogen and androgen deficiency leads to structural and functional changes in the urogenital tissues, represented by dryness, dyspareunia and an increased risk of urinary tract infections. The intracrinologic approach using dehydroepiandrosterone (DHEA)/prasterone provides local tissue repair through intracellular synthesis of estradiol and testosterone without systemic hormonal effects, making it a promising alternative to traditional therapy.
Materials and methods: The analysis of domestic and foreign literature was conducted using keywords to study and summarize modern research on methods of treating genitourinary syndrome of menopause (GSM, VVA, dyspareunia) with the assessment of the role of intravaginal DHEA/prasterone.
Results: A review of scientific data demonstrates that intravaginal prasterone promotes vaginal epithelial restoration, normalizes pH, improves sexual function, and reduces dyspareunia. We also notice a lack of systemic hormonal effects, including a neutral effect on the endometrium and mammary glands, and its effectiveness in preventing urinary tract infections.
Conclusion: Intravaginal DHEA/prasterone represents a physiologically reasonable alternative to traditional estrogens in the treatment of vulvovaginal atrophy. Its intracrine mechanism of action provides a local therapeutic effect without systemic stimulation of hormone-dependent organs. Further research should be aimed at the assessment of long-term effects and improvement of dosing regimens as part of a personalized approach to correcting vulvovaginal atrophy.

Authors’ contributions: All authors made significant contribution to the article conduction, read, and approved the final version before publication. Nazarova N.M. – study concept, foreign articles translation, processing and analysis of materials, text conduction; Devyatkina A.R. – collection of publications, processing and analysis of materials, text conduction, foreign articles translation; Akopyan A.S. – collection of publications, processing and analysis of materials, foreign articles translation; Sycheva E.G., Mezhevitinova E.A. – text editing; Prilepskaya V.N. – study concept, text editing, approval of the manuscript for publication.
Conflicts of interest: The authors declare no conflict of interest.
Funding: The study had no sponsorship support.
For citation: Nazarova N.M., Devyatkina A.R., Prilepskaya V.N., Akopyan A.S., Sycheva E.G.,
Mezhevitinova E.A. Pathogenetic mechanisms and modern approaches to the treatment of
vulvovaginal atrophy and dyspareunia in postmenopausal women.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (11): 62-68 (in Russian)
https://dx.doi.org/10.18565/aig.2025.279

vulvovaginal atrophy

dehydroepiandrosterone

DHEA

prasterone

dyspareunia

intracrinology

GSM

Full text (in Russian)

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Инструкция по применению лекарственного препарата для медицинского применения Интрароса®. ЛП-N=(004049)-(РГ-RU) от 19.12.2023. Доступно по: https://grls.pharm-portal.ru/grls/a3f8d1ea-b7ec-4307-be3e-e73d11b24a3b#summary [Instructions for use of the medicinal product for medical use Intrarosa®. LP-N=(004049)-(RG-RU) dated 19.12.2023. Available at: https://grls.pharm-portal.ru/grls/a3f8d1ea-b7ec-4307-be3e-e73d11b24a3b#summary (in Russian)].

Received 02.10.2025

Accepted 24.11.2025

Niso M. Nazarova, Dr. Med. Sci., Leading Researcher, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health
of Russia, 117997, Russia, Moscow, Oparina str., 4, n_nazarova@oparina4.ru, https://orcid.org/0000-0001-9499-7654
Anastasia R. Devyatkina, obstetrician-gynecologist, PhD student, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4, grinasta26@mail.ru, https://orcid.org/0009-0006-1742-7555
Vera N. Prilepskaya, Dr. Med. Sci., Professor, Honored Scientist of the Russian Federation, Head of the Scientific Polyclinic Department, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4, v_prilepskaya@oparina4.ru,
https://orcid.org/0000-0003-3993-7629
Aida S. Akopyan, obstetrician-gynecologist, Applicant, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4, aida.doctor@mail.ru, https://orcid.org/0009-0006-7277-5202
Elena G. Sycheva, PhD, doctor at the Scientific Polyclinic Department, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4, el.bona@mail.ru, https://orcid.org/0000-0002-2527-7853
Elena A. Mezhevitinova, Dr. Med. Sci., Leading Researcher at the Scientific Polyclinic Department, V.I. Kulakov National Medical Research Center for Obstetrics,
Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4, mejevitinova@mail.ru, https://orcid.org/0000-0003-2977-9065

Pathogenetic mechanisms and modern approaches to the treatment of vulvovaginal atrophy and dyspareunia in postmenopausal women

Nazarova N.M., Devyatkina A.R., Prilepskaya V.N., Akopyan A.S., Sycheva E.G., Mezhevitinova E.A.

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