Vulvoscopy Changes of the Vulva, Vestibule and Vagina With Daily Ospemifene in Women With Dyspareunia From VVA

Ospemifene is indicated for post-menopausal women diagnosed with vulvar vaginal atrophy (VVA)
and dyspareunia. While ospemifene clinically significantly reduces pain associated with
dyspareunia, there has been little prospective documentation using vulvoscopy with detailed
photography of the visible changes to the vulva, vestibule and vaginal region with daily
administration of 60 mg ospemifene in post-menopausal women with VVA and dyspareunia. This
study will include a total of 6 prospective photographic sessions of the vulva, vestibule and
vagina over the 20 weeks administration of 60 mg ospemifene in the study. Comparisons will be
made of baseline photography (vulvoscopy session 0) with photography at 4 weeks (vulvoscopy
session 1), 8 weeks (vulvoscopy session 2), 12 weeks (vulvoscopy session 3), 16 weeks
(vulvoscopy session 4) and 20 weeks (vulvoscopy session 5).

Currently there have been limited prospective studies using vulvoscopy with detailed
photography demonstrating visible changes to the vulva, vestibule and vagina following oral
administration of 60 mg ospemifene in post-menopausal women with VVA and dyspareunia.
Information regarding visible changes to the vulva, vestibule and vagina may be very
important to the patient and to the health care provider to best understand the beneficial
effects of ospemifene and to ensure patient compliance with treatment.

Inclusion Criteria:

1. Subject provides written informed consent and HIPAA authorization before any study
procedures are conducted

2. Subject is female

3. Subject is aged 21-80 years

4. Subject has a body mass index (BMI) < 37 kg/m2

5. Subject is menopausal either naturally (at least 12 months amenorrheic) or 6 weeks
after a bilateral salpingo-oophorectomy prior to natural menopause subjects with
hysterectomy only must have a serum Follicle Stimulating Hormone > 40
milli-International unit /mL

6. Subject has vulvovaginal atrophy with dyspareunia

7. Subject has had a normal mammogram within the last 6 months

8. Subject has normal pap smear within last 6 months

9. Subject has an endometrial stripe ≤ 4 mm within the last 6 months if she has a uterus

10. Subject agrees to comply with the study procedures and visits.

Exclusion Criteria:

1. Subject has a hypersensitivity to any of the ingredients of ospemifene

2. Subject has used ospemifene in the past

3. Subject has documented or suspected breast cancer, history of heart attack or stroke

4. Subject has clinically significant findings on physical examination

5. Subject has uncontrolled hypertension

6. Subject has any chronic medical condition or psychologic disorder that the Principal
Investigator feels makes her ineligible for the study

7. Subject is currently on local or systemic androgen therapy including local or systemic
testosterone (washout 14 days for local or topical androgen or non-depot injection, 1
month for depot, 6 months for pellet

8. Subject is currently on local or systemic estrogen therapy or androgen therapy
(washout 14 days for vaginal estrogen, 60 days for oral/transdermal therapy)

9. Subject is currently using a Selective Estrogen Receptor Modulator (SERM) or products
that have estrogenic or anti-estrogenic effects within last month

10. Subject currently using itraconazole, ketoconazole, digitalis or alkaloids heparin or
strong cytochrome P 450 3A4 inhibitors

11. Subject has a history of substance abuse within 12 months prior, or consuming > 14
alcoholic drinks per week

12. Subject has received an investigational drug within 30 days prior to signing consent

13. Subject has any condition or exhibits behavior that indicates to the Principal
Investigator that the Subject is unlikely to be compliant with study procedures and
visits.