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

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.

Vaginal Microbiome and Epithelial Gene Array in Post-Menopausal Women with Moderate to Severe Dryness

“…The muscular layer of the vaginal wall tends to be thicker in postmenopausal than premenopausal women, while the epithelial layer is much thinner [17]. Having developed a method to use Affymetrix arrays to read epithelial cell gene expression changes in the vagina [18], we applied this here and found down-regulation of genes involved in maintaining proliferation and barrier function of the vaginal epithelium in the dryness group.…”

Effects of Ovariectomy and Dehydroepiandrosterone (DHEA) on Vaginal Wall Thickness and Innervation

“…The vaginal wall is composed of a stratified epithelium, a lamina propria, a smooth muscle layer, and adventitia that were considered to be under the exclusive control of estrogens [26,29]. In the traditional thinking, vaginal atrophy is limited to changes in the external layer of the vagina that can be corrected by estrogens [30]. The area of the lamina propria that was markedly decreased following OVX was not completely restored by DHEA (around 69% of the value measured in intact animals).…”

Changes in Female Sexual Function following Anterior with and Without Posterior Vaginal Mesh Surgery for the Treatment of Pelvic Organ Prolapse

“…Most of the literature has suggested that sexual dysfunction is more common in the postmenopausal population [16], while most women undergoing POP repair fall into this age group. The application of hormone therapy may have an impact on sexual function, especially in women with the use of topical estrogen [17].…”