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Menopause Leading to Increased Vaginal Wall Thickness in Women with Genital Prolapse: Impact on Sexual Response

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ABSTRACT Introduction. 

Hypoestrogenism causes structural changes in the vaginal wall that can lead to sexual dysfunction. A reduction in vaginal wall thickness has been reported to occur after menopause, although without precise morphometry. Aim. 

To measure vaginal wall thickness in women with genital prolapse in normal and hypoestrogenic conditions and to correlate sexual dysfunction with vaginal wall thickness and estradiol levels. Methods. 

Surgical vaginal specimens from 18 normoestrogenic and 13 postmenopausal women submitted to surgery for genital prolapse grades I and II were examined. Patients were evaluated for FSH, estradiol, prolactin, glycemia, and serum TSH levels. For histological analysis, samples were stained with Masson's trichrome and hematoxylin-eosin. Sexual function was assessed by the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Main Outcome Measures. 

GRISS questionnaire, histological analysis, morphometric methods, Masson's trichrome. Results. 

The vaginal wall was thicker in the postmenopausal than premenopausal group (2.72 ± 0.72 mm and 2.16 ± 0.43, P = 0.01, and 2.63 ± 0.71 mm and 2.07 ± 0.49 mm, P = 0.01, for the anterior and posterior walls, respectively). These thicknesses seem to be due to the muscular layer, which was also thicker in the postmenopausal group (1.54 ± 0.44 and 1.09 ± 0.3 mm, P = 0.02, and 1.45 ± 0.47 and 1.07 ± 0.44 mm, P = 0.03, for the anterior and posterior wall, respectively). The vaginal epithelium was thinner in the middle segment than in the proximal one in the posterior wall (0.17 ± 0.07 mm, 0.15 ± 0.05 mm, 0.24 ± 0.09 mm, P = 0.02). There was no correlation between coital pain, vaginal wall thickness, and estradiol levels in either group. Conclusion. 

The vaginal wall is thicker after menopause in women with genital prolapse. In this study, vaginal thickness and estrogen levels were not related to sexual dysfunction. da Silva Lara LA, Ribeiro-Silva A, Rosa-e-Silva JC, Chaud F, Silva-de-Sá MF, Meireles e Silva AR, and Rosa-e-Silva ACJS. Menopause leading to increased vaginal wall thickness in women with genital prolapse: impact on sexual response. J Sex Med 2009;6:3097–3110.
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Keywords: Dyspareunia; Hypoestrogenism; Morphometry; Sexual Dysfunction; Vagina; Vagina Wall

Document Type: Research Article

Affiliations: 1: São Paulo University—Department of Pathology, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, SP, Brazil; 2: São Paulo University—Department of Neurosciences, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, SP, Brazil

Publication date: 2009-11-01

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