Vulvovaginal atrophy of menopause and its impact on sexual function in an Italian clinical cohort of post-menopausal women.

The aim of current study was to estimate the impact of vulvovaginal atrophy (VVA) on sexual function in a clinical population of Italian postmenopausal women. Women aged 45-75 years with at least one VVA symptom completed three questionnaires: Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI) and Female Sexual Distress Scale revised (FSDS-R). A gynaecological examination was performed for VVA confirmation. Among the 1,066 evaluable patients, VVA was confirmed in around 90% of the sample. Sexual function impairment was significantly higher in patients with confirmed VVA as observed by significant differences in the sexual function component of the DIVA questionnaire (p = .014), the FSDS-R (p < .0005), and the FSFI (p < .0005), as well as for all the FSFI subdomains: desire (p < .0005), arousal (p < .0005), lubrication (p < .0005), orgasm (p < .0005), satisfaction (p < .0005) and pain (p < .0005). Significant impairment of sexual function was demonstrated in Italian postmenopausal women who were clinically confirmed with signs of VVA through gynaecological examination.IMPACT STATEMENTWhat is already known on this subject: At least half of postmenopausal women report VVA associated symptoms with significant impact on sexual function and ultimately on sexual activity.What the results of this study add: As compared with patients without confirmed VVA, the negative impact on sexual function was significantly higher in patients with confirmed VVA. This difference was observed for the sexual function component (DIVA-C) of the DIVA questionnaire, for the overall FSDS-R result, and for the overall FSFI score, as well as for all the FSFI subdomains (desire, arousal, lubrication, orgasm, satisfaction and pain).What the implications are of these findings for clinical practice and/or further research: An impairment of sexual function is significantly associated with VVA diagnosis in Italian post-menopausal women, especially when diagnosis was objectively confirmed by clinical signs of VVA visible in the gynaecological examination. In addition, this study demonstrates that inquiring about VVA using a structured questionnaire may increase the diagnosis of VVA related changes in sexual function.

Vaginal Health: Insights, Views & Attitudes survey in Latin America (VIVA-LATAM): focus on Brazil.

OBJECTIVE: A previous survey investigated postmenopausal vaginal atrophy in a sample of women across Latin America. To help implement a tailored approach to improve postmenopausal care and outcomes in Brazil, we consider results from the survey for this country. METHODS: A total of 2509 postmenopausal women resident in Argentina, Brazil, Chile, Colombia, or Mexico completed an online questionnaire. The Brazilian cohort comprised 504 women. RESULTS: Over half of the Brazilian cohort (56%) reported experiencing symptoms of vaginal atrophy; most described them as moderate or severe (76%), and almost half (48%) experienced symptoms for at least 1 year. Three-quarters of the Brazilian cohort (75%) were unaware of the chronic nature of the condition. Upon experiencing symptoms of vaginal atrophy, 92% had visited a health-care provider to discuss treatment options. Overall, 56% were aware of some form of local hormone therapy and 40% of those affected by vaginal atrophy had used such treatment. CONCLUSION: Postmenopausal women in Brazil are likely to benefit from increased awareness of the symptoms of vaginal atrophy. Health-care providers can potentially improve outcomes by helping women to understand the chronic nature of the condition and available treatment options. Women may be open to education pre menopause, before symptoms occur.

The Humanistic and Economic Impact of Vaginal Dryness in Premenopausal, Perimenopausal, and Postmenopausal Women.

Background: Vaginal dryness is a highly prevalent condition. Much of previous research has focused on postmenopausal women. The aim of this study was to evaluate the impact of vaginal dryness on a predominantly premenopausal sample of women. Methods: The study was conducted online. Participants with self-reported vaginal dryness completed the Work Productivity and Activity Impairment (WPAI) scale, and a generic quality-of-life instrument, the assessment of quality of life instrument (AQoL)-4D. Information regarding sociodemographics was also collected. National (United Kingdom) median age-specific weekly wages were used to derive the economic cost of vaginal dryness. Results: A total of 524 women completed the study. The average age was 40.18 years (range 18-70 years) and just under 62% of the sample was premenopausal. Around 40% of women reported severe or very severe vaginal dryness. The average AQoL-4D score was 0.584 (standard deviation [SD]: 0.286) and decreased in line with level of severity (p = 0.014). Quality of life was not related to either age (p = 0.14) or menopausal status (p = 0.055). Of those women in employment (n = 369), 16.5% (SD: 24.3%) of their working hours were lost due to vaginal dryness; work impairment level was 34.4% (SD: 31.8%). The average lost weekly wage was £67.82 (SD: £130.88). The estimated average loss to employers was £82.56 (SD: £109.38) with a total weekly loss of £31,622. Conclusions: This study has shown the significant impact vaginal dryness has on premenopausal and postmenopausal women in terms of quality of life and economic burden, as well as the potential cost of this condition to society.

Symptoms, attitudes and treatment perceptions of vulvo-vaginal atrophy in UK postmenopausal women: Results from the REVIVE-EU study.

OBJECTIVES: To describe the attitudes and perceptions of postmenopausal women from the United Kingdom regarding menopause, vulvo-vaginal atrophy and its therapeutic management. STUDY DESIGN: Post hoc analysis of the United Kingdom population from the REVIVE-EU Study. MAIN OUTCOME MEASURES: The survey contained questions about women's knowledge of menopause and vulvo-vaginal atrophy symptoms, impact on their life and sexual activities, communication with healthcare professionals and treatments. RESULTS: The most frequent symptom of menopause was hot flushes (75%). Vulvo-vaginal atrophy symptoms had a significant impact on participants' ability to enjoy sexual intercourse (66%), spontaneity (62%) and ability to be intimate (61%); however, only 68% of women had been to their healthcare professional for advice. Half of the sample expected that doctors would initiate a discussion of menopausal symptoms and sexual health, but was in fact rare (5%). Only 27% were under current treatment without a clear therapy pattern, of which 43% used vaginal over-the-counter treatments, 28% prescription (Rx), and 13% both. Efficacy was the main limitation for over-the-counter treatments, while for Rx products were side effects and safety. Women highlighted the restoring of the natural condition of the vagina as the main goal for a treatment (35%). Many United Kingdom women did not feel the need to see any healthcare professional for their gynaecological symptoms. Overall satisfaction with treatment was only 44%. CONCLUSIONS: Vulvo-vaginal atrophy remains underdiagnosed and undertreated in United Kingdom. There is a lack of coherent discussion about vulvo-vaginal atrophy symptoms with clinicians. Many United Kingdom healthcare professionals could improve proactive communication with patients about vulvo-vaginal atrophy.

Prevalence of depression and anxiety in women newly diagnosed with vulvovaginal atrophy and dyspareunia.

OBJECTIVE: To quantify the association between vulvovaginal atrophy and depression, major depressive disorder, and anxiety. METHODS: Women with vulvovaginal atrophy from the Truven Health MarketScan Commercial and Medicare Supplemental Databases (01/2010-09/2016) with ≥365 days of continuous insurance coverage before and after the first vulvovaginal atrophy/dyspareunia diagnosis (index date) were selected. Women with vulvovaginal atrophy were matched 1:3 to women without (controls) according to age, calendar year, health plan, and region. The study period spanned from 12 months before to 12 months after index date. The ratios of diagnosed depression, major depressive disorder, and anxiety among women with vulvovaginal atrophy and the controls were calculated. Logistic regressions adjusting for proxies of menopause were used to compare prevalence. RESULTS: In all, 125,889 women with vulvovaginal atrophy and 376,057 controls were included (mean age 60.7 [45-101]). The prevalence of depression, major depressive disorder, and anxiety was higher among women with vulvovaginal atrophy compared with controls (23.9% vs 18.9%, 6.3% vs 4.7%, 16.6% vs 11.3%), with prevalence ratios of 1.26, 1.33, and 1.47, respectively (all P < 0.0001). Highest prevalences and differences were observed in younger women. Findings were consistent when analyzing newly diagnosed conditions. When adjusting for proxies of menopause (insomnia, vasomotor symptoms, dysuria, and estrogen therapy), vulvovaginal atrophy remained significant (prevalence odds ratios; depression 1.23, major depressive disorder 1.22, anxiety 1.39; all P < 0.0001). CONCLUSIONS: Vulvovaginal atrophy is associated with a significantly higher prevalence/incidence of depression, major depressive disorder, and anxiety. The higher prevalence/incidence and greater differences in younger women highlight the need for a multidisciplinary approach and early diagnosis/management of vulvovaginal atrophy.

Vulvovaginal atrophy in women after cancer.

The number of women surviving longer after a cancer diagnosis is increasing. This means that more awareness regarding their health is required. This review will focus on vulvovaginal atrophy (VVA)/genitourinary syndrome of menopause, one of the most distressing adverse iatrogenic effects of the menopause, secondary to cancer therapies. The cancer therapies themselves, such as radiotherapy, chemotherapy, and surgery, have a direct impact on the lower genital tract which interplays with the ensuing hypoestrogenic state of the menopause. Symptoms of VVA are still under-reported and undertreated as neither clinicians nor patients are forthcoming in discussing the problem, despite its profound negative impact on quality of life. In terms of treatment of VVA, this review will look at the use of various options, including estrogen post cancer diagnosis, as well as considering newer emerging therapies such as dehydroepiandrosterone, ospemifene, and laser. The care of a woman post cancer diagnosis should be a multidisciplinary responsibility. However, further research is required into emerging treatment options as well as long-term safety data, to ensure all health-care providers and women are fully informed and confident to effectively address the impact of VVA post cancer diagnosis.

Validation of the Turkish version of the International Consultation on Incontinence Questionnaire-vaginal symptoms (ICIQ-VS).

INTRODUCTION AND HYPOTHESIS: The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) was developed and validated in 2006 to evaluate vaginal symptoms, sexual matters, and quality of life of patients. This study aimed to validate the Turkish version of ICIQ-VS. METHODS: The English version of the questionnaire was translated into Turkish. On the basis of the pelvic organ prolapse quantification (POP-Q) system, symptomatic women with ≥ 2 grade pelvic organ prolapse (POP) were included in the symptomatic (patient) group and asymptomatic women with ≤ 1 grade POP in the asymptomatic (control) group. The questionnaire was administered three times: after the first examination of the women (T1), 3 weeks after T1 (T2), and 3 months after the POP surgery (T3). RESULTS: A total of 111 women were included in the study (symptomatic group, n = 53; asymptomatic group, n = 58). The missing data were ˂ 2%; the test-retest reliability was between 0.807 and 0.963, and the differences between the symptomatic and asymptomatic women were significant (p ˂ 0.001). A significant positive correlation existed between POP-Q and the vaginal symptom score, sexual matter score, and quality-of-life score (rs = 0.844, 0.393, and 0.698, respectively; p < 0.001). The Cronbach's alpha was 0.72 for the vaginal symptom score and 0.73 for the sexual matter score. The sensitivity to change was significant (p ˂ 0.05). The effect size values of the vaginal symptom score, sexual matter score, and quality-of-life score were 2.55, 2.33, and 1.56, respectively. CONCLUSION: The Turkish version of ICIQ-VS was successfully validated in this study, and a newer version of the questionnaire was made available for assessing vaginal symptoms, sexual matters, and quality of life of patients with POP.

Physical after-effects of colposcopy and related procedures, and their inter-relationship with psychological distress: a longitudinal survey.

OBJECTIVE: To estimate prevalence of post-colposcopy physical after-effects and investigate associations between these and subsequent psychological distress. DESIGN: Longitudinal survey. SETTING: Two hospital-based colposcopy clinics. POPULATION: Women with abnormal cytology who underwent colposcopy (±related procedures). METHODS: Questionnaires were mailed to women 4, 8 and 12 months post-colposcopy. Details of physical after-effects (pain, bleeding and discharge) experienced post-colposcopy were collected at 4 months. Colposcopy-specific distress was measured using the Process Outcome-Specific Measure at all time-points. Linear mixed-effects regression was used to identify associations between physical after-effects and distress over 12 months, adjusting for socio-demographic and clinical variables. MAIN OUTCOME MEASURES: Prevalence of post-colposcopy physical after-effects. Associations between the presence of any physical after-effects, awareness of after-effects, and number of after-effects and distress. RESULTS: Five-hundred and eighty-four women were recruited (response rate = 73, 59 and 52% at 4, 8 and 12 months, respectively). Eighty-two percent of women reported one or more physical after-effect(s). Multiple physical after-effects were common (two after-effects = 25%; three after-effects = 25%). Psychological distress scores declined significantly over time. In adjusted analyses, women who experienced all three physical after-effects had on average a 4.58 (95% CI: 1.10-8.05) higher distress scored than those who experienced no after-effects. Women who were unaware of the possibility of experiencing after-effects scored significantly higher for distress during follow-up. CONCLUSIONS: The prevalence of physical after-effects of colposcopy and related procedures is high. The novel findings of inter-relationships between awareness of the possibility of after-effects and experiencing multiple after-effects, and post-colposcopy distress may be relevant to the development of interventions to alleviate post-colposcopy distress. TWEETABLE ABSTRACT: Experiencing multiple physical after-effects of colposcopy is associated with psychological distress.

Macro-regional variation in attitudes toward and experiences of vulvar and vaginal atrophy among Italian post-menopausal women: a post hoc analysis of REVIVE survey data.

Italian participants in the European REVIVE survey reported that vaginal and vulvar atrophy (VVA) impaired various aspects of their lives, notably the ability to enjoy sex. The aim of the present study was to explore regional differences in knowledge, experiences, and treatment of VVA in the Italian REVIVE sample (n = 1000), which was analyzed according to region of residence. While many respondents were unfamiliar with the VVA condition, most could relate their VVA symptoms to the menopause. The rate of diagnosis of VVA was twice as high in Central Italy as in the North-East. For individual VVA symptoms, 25.4-41.6% of respondents judged that the symptom had worsened over time. There were no significant regional differences for symptoms in terms of reported rate, change in severity, impact on sexual activity, or health-care visits. Testosterone cream and OTC medication based on hyaluronic acid showed significant regional differences in lifetime rates of use. In Italy, there are modest regional differences in knowledge, diagnosis, and treatment of VVA, some of which may be explained by inter-regional differences in health care. Further efforts are needed to ensure that Italian women are properly informed about VVA and have access to appropriate health care and treatments.

Effects of ultralow topical estriol dose on vaginal health and quality of life in postmenopausal women who underwent surgical treatment for pelvic organ prolapse.

OBJECTIVE: To evaluate the efficacy of low concentrations of vaginal estriol gel in postmenopausal women with pelvic static disorders before and after vaginal surgical treatment, assessing vaginal health, sexual function, and quality of life (QoL). METHODS: Women affected by genital prolapse were enrolled. Vaginal health, QoL, and sexual function were investigated at baseline (T0), before surgery (T1), and 13 weeks after surgery (T2). At baseline, participants were randomized 1:1. Women in group A (38 women) were treated daily with vaginal gel containing 50 µg estriol for 12 weeks and women in group B (37 women) did not receive any estrogen treatment. After this period and before surgery, a first examination was carried out (T1). One week after surgical treatment, group A underwent randomization 1:1 to group A1 repeating estriol vaginal gel for 12 weeks, and group A2 discontinuing the estrogen treatment. The second follow-up examination (T2) was performed at the 13th week after surgery. RESULTS: All aspects of vaginal health improved in group A on estriol before surgery with respect to baseline (P < 0.001). After surgery, 17 participants of group A1, 16 of group A2, and 30 of group B completed the study. Group A1 (on estriol plus surgery) further improved with respect to the presurgery estriol treatment (P < 0.01). Moreover, group A2 (T2) experienced a worsening of vaginal health versus intragroup presurgery estriol treatment (P < 0.01), and versus intergroup surgical estriol treatment (P < 0.05). QoL improved in women only after surgery, with (P < 0.01) or without (P < 0.05) estriol treatment. Finally, the sexual function of participants on estriol before surgery did not change. On the contrary, it improved after surgery in both participants on estriol (P < 0.001) and without estriol (P < 0.01). Moreover, surgical estriol participants had a better score than surgical no-estriol participants (P < 0.05). CONCLUSIONS: Estriol vaginal gel (0.005%) administration significantly improved the vaginal health of natural postmenopausal women before and after vaginal surgery. Both sexual health and QoL also significantly improved after surgery.

An Internet-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors: results of a pilot study.

OBJECTIVE: Previous studies demonstrated that a cognitive behavioral therapy (CBT) program delivered in group sessions is effective in alleviating treatment-induced menopausal symptoms in women with breast cancer, but also that in-person CBT is inconvenient for some women and can result in low levels of program compliance. A promising, alternative approach is to use the Internet to make this form of CBT more accessible and feasible for patients. The objective of this study was to evaluate the feasibility and to generate preliminary data on the efficacy of a guided, Internet-based CBT program. METHODS: Twenty-one participants with treatment-induced menopausal symptoms started the guided Internet-based CBT program. Self-report questionnaires were completed at baseline and at 10 weeks (posttreatment). Counselors' evaluations were obtained via interviews. Primary outcomes were program usage, compliance rates, and participant and counselor satisfaction. Secondary outcomes were overall levels of endocrine symptoms and hot flush/night sweats problem rating. RESULTS: Ninety percent of participants completed the program as planned. Satisfaction rates were high among participants and counselors. Small revisions to the program were advised. There was a significant decrease over time in overall levels of endocrine symptoms and hot flush/night sweats problem rating. CONCLUSIONS: These findings suggest that an Internet-based CBT program for women with treatment-induced menopausal symptoms is feasible and promising in terms of efficacy. The efficacy of the CBT program is currently being investigated in a larger randomized controlled trial.

A negative view of menopause: does the type of symptom matter?

OBJECTIVES: To assess the association between the type of symptom and women's self-reported view of menopause. METHODS: The study was conducted at Mayo Clinic, Rochester MN, between January 2006 and October 2014. Women aged 40-64 were included. Data from 1420 women were analyzed in a cross-sectional design. The Menopause Health Questionnaire was used for symptom assessment. Odds ratios (ORs) and population attributable risk (PAR) (OR × percent frequency) were calculated for each symptom. Logistic regression analyses were performed with the view of menopause as the dependent variable. RESULTS: Anxiety (2.34), depressed mood (2.24), irritability (2.22), vaginal itching (2.27), crying spells (2.1) and breast tenderness (2.08) were associated with highest odds of having a negative view of menopause. Highest PAR (population impact) symptoms were anxiety (22.27), weight gain (20.66), fatigue (20.28) and irritability (19.41). Hot flushes and night sweats, although common, were not associated with a negative view of menopause (OR 1.3 and 1.16; PAR 3.85 and 4.42, respectively). CONCLUSION: Mood symptoms, vaginal itching, weight gain, breast tenderness and fatigue, although less common than hot flushes, were noted to have greater association with a negative view of menopause. Specifically addressing these symptoms during menopausal consultation may improve patient satisfaction and outcomes.

Medical and patient attitude towards vaginal atrophy: the AGATA study.

OBJECTIVES: To provide data on current management of vaginal atrophy (VA) in a nationwide setting. METHODS: A cross-sectional, multicenter study was made in 913 postmenopausal women consulting 22 gynecological outpatient services. VA was diagnosed with a combination of subjective symptoms and objective evaluations. Women with a previous diagnosis and those with a new diagnosis of VA filled additional questionnaires regarding modalities of VA management and reasons for missing diagnosis, respectively. RESULTS: 730/913 (80%) women had ever had a diagnosis of VA. In 274 (37.5%), the diagnosis was made prior to, and in 456 (62.5%) during the investigation. Of women with a new VA diagnosis, 81.1% had never discussed their symptoms with the health-care practitioner (HCP), and 78.7% (n = 359) had never been questioned by an HCP. Of women with a previous VA diagnosis, 90.2% had been treated with systemic (10.1%), local hormonal (49.4%) or local non-hormonal (30.5%) therapy. At the time of investigation, 61.9% of these women had stopped treatment, with only 3.3% having been successfully cured. CONCLUSIONS: VA is highly prevalent in postmenopausal women. Its current management and treatment seem to be highly unsatisfactory and can be improved by medical sensitization and patient education.

Attitudes and perceptions towards vulvar and vaginal atrophy in Italian post-menopausal women: Evidence from the European REVIVE survey.

OBJECTIVES: To achieve a deeper understanding of the attitudes and perceptions of Italian post-menopausal women (PMW) regarding vulvo-vaginal atrophy (VVA). STUDY DESIGN: As part of the EU REVIVE study, an online survey was conducted in four European countries; the Italian arm comprised 1000 participants from representative regions of Italy. MAIN OUTCOME MEASURES: The perceptions, experiences and needs of Italian PMW in relation to sexual and vaginal health. RESULTS: The most frequent VVA symptom was vaginal dryness (78%). Usually, the severity of symptoms was similar to or worse than when they first appeared. This was particularly true for dyspareunia, the most bothersome symptom (76%). VVA symptoms had a significant impact on Italian participants' ability to achieve pleasurable relations (74%) and spontaneity (70%). Although 75% of participants were still sexually active, their sex drive had been reduced by a third because of VVA. Women expected that doctors would start a discussion of menopausal symptoms and sexual health, but this was rarely the case (11%). Most women had been treated with a vaginal over-the-counter (OTC) product. Women who had discussed their condition with a physician were more likely (68%) to be under treatment for VVA than those who had not (36%). Low compliance was associated with symptom improvement (23%), not having annoying symptoms (22%), and the impossibility if restoring the vagina to normal (14%). Common reasons for treatment dissatisfaction were related to route of administration or discomfort. Lack of efficacy and fear of a hormone effect were perceived as the main limitations for OTC and local estrogen products, respectively. CONCLUSIONS: Despite the commonness of VVA and its significant impact on quality of life, the condition remains underdiagnosed in Italy. Discussion of symptoms with doctors influences the diagnosis, and patients' satisfaction with available treatments is not high.

The REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey in Europe: Country-specific comparisons of postmenopausal women's perceptions, experiences and needs.

OBJECTIVES: To achieve a better comprehension of the variability of perceptions, experiences and needs in terms of sexual and vaginal health in postmenopausal women (PMW) from four different European countries. METHODS: An internet-based survey was conducted in Italy, Germany, Spain and the United Kingdom with a total surveyed population of 3768 PMW aged between 45 and 75 years. RESULTS: The UK sample was significantly older, with almost a quarter of participants over 65 years of age, and had the highest proportion of women experiencing recent vulvar and vaginal atrophy (52.8%). The majority of Italian and Spanish participants were receiving VVA treatment, whereas in the UK only 28% of PMW were on medication. The most common menopausal symptom was vaginal/vulvar dryness, with almost 80% of participants reporting it in all the countries except the UK (48%). On the other hand, vaginal/vulvar irritation was more frequently reported in the UK (41%). The percentage of participants with a partner was lower in the UK (71%), as was the monthly rate of sexual activity (49%). In the UK, the proportion of participants who had seen a healthcare professional for gynaecological reasons in the last year was lower than in other countries (27% vs. ≥50%), as was the proportion who has discussed their VVA symptoms with them (45% vs. ∼67%). In this sense, UK PMW waited for a longer before asking for help (especially for pain with intercourse and dryness). The main issues relating to VVA treatment difficulties expressed by participants were administration route in the UK, efficacy in Germany, and side-effects in Italy. CONCLUSIONS: Although all European women shared the same expectation of improving the quality of their sex lives, the opportunity for that varied among different countries in relation to the healthcare system and to the effective communication achieved with healthcare professionals when managing VVA.

Vaginal estrogen use and effects on quality of life and urogenital morbidity in postmenopausal women after publication of the Women's Health Initiative in New York City.

OBJECTIVE: In the years after the 2002 publication of results from the Women's Health Initiative study, there has been a reluctance to prescribe hormone therapy to symptomatic postmenopausal women and confusion over its duration and method of prescription. The main concerns are the risks of cardiovascular events and breast cancer. However, local vaginal estrogen (VE) may provide benefits without systemic effects. METHODS: This study investigates the use and effects of VE on quality of life and urogenital morbidity among women who stopped hormone therapy after the Women's Health Initiative and compares them with women who continued hormone therapy. Three groups were compared: group 1, women who have remained on HT/ET; group 2, women who have resumed HT/ET after stopping for at least 6 months, and group 3, women who have stopped HT/ET and have not resumed. RESULTS: Overall, ever use and present use of VE were most prevalent in women who reported dyspareunia (ever, P = 0.003; present, P = 0.005) and vaginal dryness (ever, P = 0.001; present, P = 0.004). VE use was significantly more probable for women in group 3 than for women in the other groups (group 3 [3.5%] vs. group 1 [17.7%] and group 2 [16.7%]; P = 0.002). Women in group 3 who used VE reported significantly higher sexual quality of life (using the sexual domain of the Utian Quality of Life Scale) compared with women in group 3 who did not use VE (P = 0.007). There was no difference in the incidence of urinary tract infections between the three groups (group 1, 22.9%; group 2, 26.3%; group 3, 25.5%). The percentage of women who were either married or living in a marriage-like relationship did not differ between the three groups (group 1, 68.4%; group 2, 78.6%; group 3, 78.8%). CONCLUSIONS: Women who report dyspareunia and vaginal dryness are more likely to use VE. Women who do not use systemic therapy but use VE score significantly higher on the sexual quality-of-life scale than women not using VE.

Vulvovaginal symptoms prevalence in postmenopausal women and relationship to other menopausal symptoms and pelvic floor disorders.

OBJECTIVE: The primary objective of this study was to use the Vulvovaginal Symptom Questionnaire (VSQ) to estimate the prevalence and examine the emotional, lifestyle, and sexual impact of vulvovaginal symptoms in postmenopausal women. METHODS: We administered the VSQ, a previous validated instrument to 358 postmenopausal women recruited from primary care physician offices and local senior centers. The first seven questions of the VSQ comprise the symptom subscale (itching, burning, hurting, irritation, dryness, discharge, and odor). Women who answered "Yes" to any of the first seven symptom questions were considered to have vulvovaginal symptoms. RESULTS: Two hundred seventy-nine women were recruited from primary care offices and 79 women were recruited from senior centers. One hundred eighty-three postmenopausal women (51.1%; 95% CI 45.9%, 56.3%) reported at least one vulvovaginal symptom. The most common symptom was being dry 35.8% (n/N = 128/358). Ten percent of women (n/N = 38/358) reported five or more symptoms and 6% of women reported all seven symptoms in the last week. For women reporting one or more vulvovaginal symptoms, 40.4% (n/N = 74/183) reported emotional impact (Yes to ≥1 out of 4 emotional impact subscale items) and 32.8% (n/N = 60/183) reported lifestyle impact (Yes to ≥1 out of 5 lifestyle impact subscale items) from these symptoms. For sexually active women reporting vulvovaginal symptoms, 75.3% (n/N = 67/89) reported sexual impact (Yes to ≥1 out of 4 sexual impact subscale items). Vulvovaginal symptoms were associated with increased co-occurrence of specific pelvic floor disorders, including pelvic organ prolapse (P = 0.001), anal incontinence to solid stool (P = 0.001), urinary frequency (P = 0.02), urgency urinary incontinence (P = 0.001), and dysuria (P < 0.001). CONCLUSIONS: Vulvovaginal symptoms are common and present in over 50% of postmenopausal women. Sizeable proportions of women with vulvovaginal symptoms report emotional, lifestyle, and sexual impact from these symptoms.

Predictors of impact of vaginal symptoms in postmenopausal women.

OBJECTIVE: This study aims to identify factors associated with greater impact of vaginal symptoms on the functioning and well-being of postmenopausal women. METHODS: Postmenopausal women who reported vaginal dryness, itching, irritation, or pain with sexual activity completed the multidimensional Day-to-day Impact of Vaginal Aging (DIVA) questionnaire and underwent assessment of multiple sociodemographic and clinical factors that have the potential to influence the impact of vaginal symptoms. Multivariable linear regression analyses examined relationships between selected participant characteristics and DIVA scale scores assessing symptom impact on activities of daily living, emotional well-being, self-concept and body image, and sexual functioning. RESULTS: Among 745 symptomatic participants, the mean (SD) age was 56 (9) years, and 66% were racial/ethnic minorities. Women with comorbid depression reported greater impact of vaginal symptoms on all dimensions of functioning and well-being measured by the DIVA questionnaire (11%-22% estimated increase in impact scores associated with every three-point increase in Hospital and Anxiety Depression Scale scores). Women with urinary incontinence also reported greater impact of vaginal symptoms on activities of daily living, emotional well-being, and self-concept and body image (27%-37% estimated increase in impact scores). Age, partner status, frequency of sexual activity, general health, and body mass index also predicted greater impact on at least one domain. CONCLUSIONS: Findings suggest that special efforts should be made to identify and treat vaginal symptoms in postmenopausal women known to have depression or urinary incontinence, as these women may experience greater impact of vaginal symptoms on multiple domains of functioning and quality of life.

The Association Between Vulvovaginal Atrophy Symptoms and Quality of Life Among Postmenopausal Women in the United States and Western Europe.

BACKGROUND: Vulvovaginal atrophy (VVA) is a condition associated with decreased estrogenization of the vaginal tissue, which can result in vaginal dryness, irritation, and dyspareunia. This study quantified the burden associated with VVA symptoms across the United States and Europe and compared this burden with other chronic conditions. METHODS: Data were analyzed from the International Women's Health Study, a cross-sectional Internet survey of women aged 40-75 years in the United States and Europe. All postmenopausal women aged 40-75 years were included in the analyses (Germany n=970, Spain n=294, France n=1054, Italy n=387, United Kingdom n=1096, United States n=3267). VVA symptom severity (none, mild, moderate, severe) was assessed using the Menopause Rating Scale and included in general linear models to predict EuroQol-5D (EQ-5D) quality of life scores. RESULTS: The prevalence of VVA symptoms varied between 40.00% (Germany) and 54.42% (Spain), with half of women reporting their symptoms as either moderate or severe. Pooling data from all countries together, each incremental level of severity (none through severe) was associated with a significant decrement in EQ-5D scores (none=0.84 vs. mild=0.81 vs. moderate=0.79 vs. severe=0.74; p<0.05). The decrements in EQ-5D scores associated with moderate to severe VVA symptoms were comparable to those observed in other serious conditions including arthritis, chronic obstructive pulmonary disease, asthma, and irritable bowel syndrome. CONCLUSIONS: VVA symptoms are associated with clinically meaningful decrements in quality of life that may be comparable to serious conditions such as arthritis, chronic obstructive pulmonary disease, asthma, and irritable bowel syndrome. Improved management of VVA symptoms may be required to alleviate the impact of VVA on the quality of life of affected women.