Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy.
Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy.
Climacteric. 2023 Aug;26(4):309-315. doi: 10.1080/13697137.2023.2213827. Epub 2023 Jun 8.
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.
传统上，阴道被认为是女性生殖系统中的一个被动器官，主要作为月经血、性行为和分娩的通道。然而，最近的研究揭示了阴道作为内分泌器官的作用，它在女性激素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“胞内学科”的新概念，人类阴道可以被视为雄激素的来源和靶器官。除了众所周知的雌激素作用外，雄激素对女性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，而在绝经过渡期间雌激素水平下降，阴道组织以及尿路组织变得更薄、更干燥且弹性更小，导致出现各种不适甚至有时是疼痛的症状，这些症状聚集在绝经后泌尿生殖系统综合征（GSM）中。由于缺乏经监管机构批准的基于睾酮或雄烯二酮的产品来治疗 GSM，因此使用阴道内普拉睾酮的可能性似乎是一种有针对性的治疗方法，它通过向阴道组织提供局部脱氢表雄酮（DHEA）的来源起作用。需要进一步的研究来更好地评估其安全性和疗效。
