Objective
Menopause is often accompanied by vaginal discomfort including burning, itching, dryness and spontaneous or provoked pain. While direct effects of estrogen withdrawal on vaginal cells are implicated, surgical menopause in rodents causes autonomic and sensory nerves to proliferate, suggesting that indirect effects mediated by changes in vaginal innervation may contribute. We assessed whether post-menopausal women display hormone-dependent changes in vaginal innervation.
Methods
Vaginal biopsies from 20 postmenopausal women undergoing surgery for stress urinary incontinence and pelvic organ prolapse were fixed and immunostained for the pan-neuronal marker, PGP9.5, the sympathetic marker tyrosine hydroxylase, the parasympathetic marker vasoactive intestinal polypeptide, and the sensory nociceptor marker calcitonin gene-related peptide. Innervation density was measured as apparent percentage of section area occupied by immunofluorescent axons. Specimens were grouped according to whether participants received systemic hormone therapy (HT), topical (vaginal) HT, or no HT.
Results
Women not receiving HT showed relatively high levels of total innervation, with most axons expressing tyrosine hydroxylase or vasoactive intestinal polypeptide immunoreactivity. In patients receiving systemic HT, overall innervation was reduced, as were presumptive parasympathetic, sympathetic and sensory axon populations. Topical HT elicited more dramatic reductions in innervation than systemic HT.
Conclusions
Hormone therapy reduces autonomic and sensory vaginal innervation density, which may in part contribute to relief from vaginal discomfort. Moreover, topical therapy is more effective than systemic therapy, which may help explain the greater improvement reported with topical as compared to systemic HT.