A Systematic Review of Intravaginal Testosterone for the Treatment of Vulvovaginal Atrophy

Robin J. Bell, MBBS, PhD, MPH, FAFPHM; Farwa Rizvi, MBBS, MPH; Rakabul M. Islam, MPH, PhD; Susan R. Davis, MBBS, PhD, FRACP


Menopause. 2018;25(6):704-709. 

In This Article


To identify all clinical trials of intravaginal administration of testosterone for VVA, we searched Scopus, MEDLINE, EMBASE, and the Cochrane Library databases on July 26, 2017, using the key words testosterone and vagina*. We limited the search to human studies published in English and re-ran the search before the final selection. The bibliographies of all identified clinical trials, reviews, and commentaries were checked for other relevant trials. We included all studies that reported urogenital and sexual function symptom outcomes after intravaginal testosterone therapy. We excluded animal studies, reviews, commentaries, case studies, conference presentations, studies using nonvaginal administration, single-arm combined therapy, and studies in which neither urogenital nor sexual symptom outcomes were reported.

The initial titles retrieved through the search were independently screened by three review authors (FR, RMI, and RJB). The abstracts of the studies identified as potentially eligible were reviewed by RJB and SRD, and the data independently extracted and cross-checked by these two authors. The following data were extracted from each of the included studies: characteristics and number of participants, study design, type and dose of the intervention, study duration, outcome measures (particularly measures of vaginal health), and also blood levels of estradiol and testosterone. The quality of the studies was judged on the basis of having a control group, randomization, and blinding, and also the use of objective measures of outcome. The study outcomes included objective and subjective measures of VVA and sexual function. Due to the varied study designs, lack of a control or placebo group in three studies, and inconsistent outcome reporting, we were unable to undertake a meta-analysis. Our findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews checklist.[14]