Could Local Estrogen Therapy Impact the Sexual Function of Women with Pelvic Organ Prolapse?

Postmenopausal women are at increased risk of experiencing pelvic organ prolapse (POP), a condition in which one of the pelvic organs like the bladder, uterus, top of the vagina, or bowel drops from its usual location and into the vagina. Many women describe POP as the feeling of having a bulge in their vagina. It can cause pain, discomfort, urinary or bowel problems, and impaired sexual function.

With regard to sexual function, women with POP may feel self-conscious about their genitals (especially if the prolapsed organ is visible) and/or experience pain during sexual intercourse. Additionally, POP can sometimes dampen genital sensations, making stimulation less pleasurable than it was before. All of these factors may result in women with POP avoiding or limiting sexual activity with their partners.

Since sexuality is an important component of many people’s quality of life, treatment options for improving sexual function and sexual satisfaction are often being explored. Many studies have shown that local estrogen therapy can have a positive effect on the sexual functioning of postmenopausal women.

Local estrogen therapy involves applying an estrogen cream directly onto or into the vagina. Estrogen levels are important for women’s sexual function because estrogen is a hormone that supports good lubrication and healthy, flexible vaginal tissues. Given the effectiveness of local estrogen therapy in treating other female sexual health conditions like genitourinary syndrome of menopause (GSM), a recent randomized controlled trial investigated its potential effectiveness in improving the sexual function of women with POP.

A total of 120 postmenopausal women with POP participated in the study. The women were randomly assigned to the local estrogen cream group (60 women) or the placebo cream group (60 women). Each group was instructed to insert their respective creams with an applicator into their vaginas once a day for one week, every other day for one week, and twice a week for four weeks. (The trial lasted six weeks).

The researchers used the sexual function domain of the German version of the Pelvic Floor Questionnaire to assess the participants’ sexual function at baseline and after the six-week treatment period. At the six-week check-in, just over half of the women (55%, 66/120) were sexually active.

Unfortunately, the authors found no significant difference between the sexual functioning of the women in the local estrogen therapy group and those in the control group. This suggests that local estrogen therapy did not have a beneficial impact on the sexual health of the women suffering from POP, though further research is needed to strengthen (or challenge) this result.

At this point, however, women with POP should consider other proven treatment options for their condition such as physical therapy, pessaries (devices placed in the vagina to support the pelvic organs), or surgery.

References:

Marschalek, M.L., Bodner, K., Kimberger, O., Morgenbesser, R., Dietrich, W., Obruca, C., Husslein, H., Umek, W., Koelbl, H., & Bodner-Adler, B. (2022). Sexual Function in Postmenopausal Women With Symptomatic Pelvic Organ Prolapse Treated Either with Locally Applied Estrogen or Placebo: Results of a Double-Masked, Placebo-Controlled, Multicenter Trial. The Journal of Sexual Medicine, 19(7), 1124-1130. DOI: https://doi.org/10.1016/j.jsxm.2022.04.007