Attitudes and approaches to vaginal atrophy in postmenopausal women: a focus group qualitative study

Figures & data

Figure 1 (a) Personality types based on social (x-axis) and personal (y-axis) dimensions; (b) motivation by personality type

Table 1 Coping strategies for menopausal women with vaginal atrophy

Grouping	Characteristics	Exemplary quote
Adventurers	• Do not want to be limited by responsibilities; freedom and spontaneity are important • Sexuality is important; experimental and more daring • VA limits ability to do what they want to do when they want to do it, including sex • Actively seek solutions to enable them to live life the way they want to	Getting older is OK, but I want to get older and still feel hot
Fighters	• Maintain and control independence; do not want to display a fragile side • Very independent and individualistic; may be perfectionists or compensate by being very individual and eclectic • Sexuality is about being whole as women; want to be in charge • Try to master menopause; may actively seek a solution to VA • Suffer because they are not in control, especially if not prepared for symptoms of VA	I still tell my children, 'Your mother is a woman and a person also'
Happy-go-luckies	• Positive outlook; at ease with themselves • Focus on opportunities that menopause brings; embrace the newfound freedom and maximize life by living it to the fullest • Sexuality is a way to have fun, explore new sensations, and feel close and connected with their partners • Able to find ways around the problem of VA and have open communication with partner • May use humor to cope	I might be going through all this, but it's not the end of the world. I have the hope [that] things will sort themselves out in the future
Nurturers	• Fulfilment comes from helping others; being in a partnership and at the center of the family (e.g. as mother and grandmother) is key • Sex is a way to maintain a close and harmonious connection with a partner, but friendship is more important • VA is less impactful because connection and intimacy are more important than penetration	I was quite sad when my periods ended, but my grandchildren gave me the continuity that helped me to move on
Submissive security seekers	• Feel like their aging bodies have betrayed them • Hold traditional values and think being a woman means making sacrifices and is a burden • May have a victim mentality • Sex is a duty rather than something to be enjoyed; may never have been sexually satisfied • VA is another part of aging to be suffered in silence	I feel limitations of my body more than I used to. My body is letting me down. I am in an irreversible decline

VA, vaginal atrophy

Figure 2 Predominant personality types by location

Table 2 Personality-based approaches to vaginal atrophy treatment

Type	Behavior	Treatments used	Barriers	Influences	Characteristics of ideal treatment
Adventurers	• Actively seek solutions to ensure they can fulfill their needs, including sexual	• Pharmaceutical and non-pharmaceutical • Sex aids	• Might not be aware of all the options • HCP may be a gatekeeper	• Friends • Internet (websites, media, social networks)	• Long-lasting • Does not eliminate spontaneity or interrupt the moment
Fighters	• Seek empowerment through information • Weigh the risks and benefits	• Anything proven in scientific study	• Lack of options or information	• Physician as primary source • Internet (high-end medical resources rather than social media)	• Scientifically validated • Efficacious
Happy-go-luckies	• Live in the moment; do not dwell on symptoms	• Minimum required to keep them going • Lubrication	• Focus on the positives leads to lack of urgency	• Friends • HCP (if HCP-initiated)	• Easy to remember • Not too complex
Nurturers	• Maintain an intimate relationship with partner, not necessarily involving sex but rather emotional dependency	• Familiar sexual aids (lubrication and saliva) • Foreplay	• Acceptance • Feeling that VA is inevitable • Partner's understanding	• Partner • Friends and family	• Efficacious • Safe for their partner • Does not affect spontaneity
Submissive security seekers	• Avoidant strategy – abstinence is common • Suffer in silence with VA	• Typically none	• Embarrassment • Lack of self-confidence • Not comfortable with their sexuality	• Limited due to poor acknowledgement that they are suffering	• Doctor-recommended • Not applied in front of partner; discreet • Does not require much exploration of vaginal area

VA, vaginal atrophy; HCP, health-care provider.