Impact of vulvovaginal health on postmenopausal women: a review of surveys on symptoms of vulvovaginal atrophy

Figures & data

Table 1 Key survey-based studies

Survey-based study	Respondents	Design	Vulvovaginal symptoms considered	Prevalencea
Vaginal Health: Insight, Views, and Attitudes (VIVA)^Citation8	3520 women aged 55–65 years in Canada (500), Denmark (500), Finland (500), Norway (520), the United Kingdom (500), and the United States (500)	Online survey	Vaginal discomfort (dryness, itching, burning or soreness in the vagina, involuntary urination, or vaginal pain in connection with touching and/or intercourse)	45% in total sample; 51% in the United States
Women’s Voices in the Menopause^Citation7	4264 women aged 55–65 years in Canada (1016), Finland (606), Sweden (604), the United Kingdom (1008), and the United States (1012); 98% postmenopausal	Online survey	Vaginal discomfort (dryness, smarting pain, itching, involuntary urination or pain in the vagina in connection with touching and/or intercourse)	39% in total sample; 43% in the United States
Santoro and Komi^Citation5	2290 postmenopausal women aged 45 to 89 years in the United States	Online survey (Internet access provided to those who lacked it)	Vaginal discomfort, such as dryness, pain, irritation, itching, or similar symptoms (currently or in the past)	45% in the United States
Levine et al^Citation18	1480 sexually active postmenopausal women aged 40–65 years in the United States	Online survey (Internet access provided to those who lacked it)	Vaginal dryness, vaginal itching, vaginal irritation, pain on urination, vaginal pain associated with sexual activity, or vaginal bleeding associated with sexual activity, if experienced at least once within the prior 4 weeks	57% in the United States
Cumming et al^Citation16	2547 peri- or postmenopausal women (self-classified)	Voluntary, online, convenient open survey on www.menopausematters.co.uk	Dyspareunia secondary to vaginal dryness	56% in the total sample
Cumming et al^Citation17	1026, 1072, and 1002 women in three separate surveys (proportions of pre-, peri-, or postmenopausal respondents varied by survey)	Three voluntary, online, convenient open surveys on www.menopausematters.co.uk	Vaginal discomfort	63% in the total sample
REvealing Vaginal Effects At mid-Life (REVEAL) survey^Citation6	1006 postmenopausal women (with subanalysis of 255 women who reported pain during sexual intercourse) and 602 HCPs who treat postmenopausal women	Phone survey of patients and online survey of HCPs	Vaginal dryness (including itching and burning); vulvar/vaginal pain; incontinence of urine, gas, or bowels; vaginal infections; loss of sexual interest or desire; difficulty with lubrication and arousal; physical discomfort or pain inside the vagina during sexual activity; difficulty reaching climax or ability to feel sensation; physical discomfort or pain on the outer genitals during sexual activity	47% vaginal dryness, 10% vulvar/vaginal pain, 28% incontinence, 7% vaginal infections, 45% loss of sexual interest, 38% difficulty with lubrication and arousal, 22% physical discomfort or pain inside the vagina during sexual activity, 25% difficulty reaching climax or ability to feel sensation, 10% physical discomfort or pain on the outer genitals during sexual activity

Note:

a Prevalence is reported for postmenopausal women only in surveys that also assessed pre- or perimenopausal women.

Abbreviation: HCP, health care provider.

Table 2 Self-reported reasons for not discussing vulvovaginal health or dyspareunia with HCP

Reason	Language used in survey	Rate among respondents	Reference
Embarrassment	“It makes me uncomfortable/embarrassed.”	47% of those with vaginal discomfort	Women’s voices in the Menopause^Citation7
	“I am embarrassed.”	39% of those who have not talked to an HCP about dyspareunia	REVEAL^Citation6
	Embarrassed about sexual problems^Citation23	59% of women who did not seek help were at least moderately embarrassed	PRESIDE^Citation35
Belief that nothing can be done	“It’s just part of growing older.”	39% of those with vaginal discomfort	Women’s voices in the Menopause^Citation7
	“There is nothing than can be done medically to help me.”	26% of those who have not talked to an HCP about dyspareunia	REVEAL^Citation6
Belief that it is an inappropriate topic to discuss with an HCP	“I do not think other people want to hear about my vaginal problems.”	59% of those with vaginal discomfort	Women’s Voices in the Menopause^Citation7
	“It is private and does not concern others.”	41% of those with vaginal discomfort	Women’s Voices in the Menopause^Citation7
	“It is not an appropriate discussion to have with an HCP.”	23% of those who have not talked to an HCP about dyspareunia	REVEAL^Citation6

Abbreviations: HCP, health care provider; REVEAL, Revealing vaginal Effects at Midlife study; PRESIDE, Prevalence of Female Sexual Problems Associated with Distress and Determinants of Treatment Seeking study.

Table 3 Clinical findings indicating vulvovaginal atrophy

• Pale, smooth, shiny, or friable/unrugated epithelium

• Loss of elasticity of genital skin

• Vulvar dermatoses, lesions, or erythema

• Urethral caruncle or polyps

• Low serum estrogen levels

• Elevated vaginal pH ≥ 5.5

• Thinning of endometrial uterine lining

• Change in cytology of vaginal cells to primarily parabasal and intermediate cells

Note: Data from^43–45.

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