Genitourinary menopause syndrome (GSM) is a chronic, progressive condition, which results from the effects of estrogenic and androgenic deficiency typical of menopausal age. It involves the genitourinary district and occurs with an extremely wide range of signs and symptoms. Dyspareunia, both superficial and deep, is among the main and most distressing symptoms of the GSM. Over the decades, different therapeutic approaches have been developed, aimed at improving the symptomatology and thus the quality of life of women, such as local estrogenic therapy, which until now has been considered the gold standard of GSM treatment. A new Prasterone formulation has recently been approved, which is biochemically and biologically identical to that of the endogenous human DHEA, an inactive steroid precursor that can be converted into estrogen and androgen into vaginal cells. The rationale of the use of prasterone is the theory of intracrinology, which is the proven ability of vaginal cells to convert an inactive compound into an active form. This molecule, absorbed locally, determines only a minimum increase in circulating hormonal values, which remains be- low the threshold of physiologic levels for menopausal women.