Is Intrarosa (prasterone) used to increase sex drive?

From the Guidelines

Intrarosa (prasterone) is not specifically approved to increase sex drive, but it may have a secondary benefit of improving sexual desire in postmenopausal women with moderate to severe dyspareunia due to vulvovaginal atrophy. Intrarosa is a vaginal insert containing prasterone (also known as dehydroepiandrosterone or DHEA) that is FDA-approved to treat moderate to severe dyspareunia (painful intercourse) due to vulvovaginal atrophy in postmenopausal women. According to a study published in the Journal of the National Comprehensive Cancer Network 1, vaginal androgens (ie, DHEA, also known as prasterone) can also be considered for vaginal dryness or pain with sexual activity, and several studies have shown DHEA to be effective at reducing dyspareunia in postmenopausal individuals.

Some key points to consider:

• The standard dosage is one vaginal insert (6.5 mg of prasterone) administered once daily at bedtime.
• Improvements in symptoms typically begin within 2-4 weeks of starting treatment, though full benefits may take 8-12 weeks.
• If a woman is specifically concerned about low sexual desire, she should discuss this with her healthcare provider, as other treatments like Addyi (flibanserin) or Vyleesi (bremelanotide) are specifically approved for hypoactive sexual desire disorder.
• A randomized controlled trial of 464 survivors of breast or gynecologic cancer showed that vaginal DHEA led to significant improvements in sexual desire, arousal, pain, and overall sexual function, although a plain moisturizer also improved symptoms 1.
• The safety data for the use of androgen-based therapy in survivors of hormonally mediated cancers are limited, and the FDA label for prasterone warns that exogenous estrogens are contraindicated in women with a history of breast cancer 1.

Overall, while Intrarosa may have a secondary benefit of improving sexual desire, it is not specifically approved for this indication, and other treatments may be more effective for women with hypoactive sexual desire disorder.

From the Research

Intrarosa for Sex Drive

• Intrarosa (prasterone) is a synthetic form of dehydroepiandrosterone (DHEA) indicated for the treatment of vulvovaginal atrophy (VVA) in postmenopausal women presenting with moderate to severe symptoms 2.
• The primary use of Intrarosa is to treat dyspareunia, a symptom of VVA, which is characterized by painful sexual intercourse 3.
• While Intrarosa may improve sexual function by reducing pain and discomfort associated with dyspareunia, its primary indication is not specifically for increasing sex drive 2, 3.
• Studies have shown that Intrarosa can improve vaginal health, reduce pain during sex, and increase vaginal lubrication, which may indirectly enhance sexual function and overall sexual experience 4, 5, 6.
• However, there is no direct evidence to suggest that Intrarosa is used to increase sex drive, and its effects on libido are not well-studied 2, 3.

Mechanism of Action

• Intrarosa works locally in the vagina to improve vaginal health and reduce symptoms of VVA, without significantly affecting serum hormone levels 2, 5, 6.
• The local action of Intrarosa is thought to be due to the conversion of DHEA to estrogen and androgen metabolites, which helps to restore vaginal health and reduce symptoms of VVA 2, 5, 6.

Clinical Evidence

• Clinical trials have demonstrated the efficacy of Intrarosa in improving symptoms of VVA, including dyspareunia, vaginal dryness, and vaginal pH 2, 3, 5, 6.
• These studies have shown that Intrarosa is well-tolerated and effective in reducing symptoms of VVA, with minimal systemic absorption and few adverse events 2, 3, 5, 6.