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Vaginal problems diminish quality of life but often go unreported

15 November 2019

New survey documents high incidence of vulvovaginal atrophy and the negative effect on quality of life in postmenopausal women.

With symptoms such as dryness, burning, or itching of the vagina, vulvovaginal atrophy is estimated to affect up to 98% of postmenopausal women, many of whom will fail to report symptoms to their healthcare providers or seek help. A new survey demonstrates the negative effect of these symptoms on quality of life. The study results are published online today in Menopause, the journal of The North American Menopause Society (NAMS).

Vulvovaginal atrophy (VVA) is caused by a reduction in circulating estrogen and androgen levels after menopause that leads to thinning vaginal walls, less elasticity, and lower lubrication levels. In about 50% of postmenopausal women, VVA leads to symptoms such as vaginal dryness, which is the most frequent and a major contributor to sexual dysfunction. Because of a lack of education, many women view these symptoms as a natural part of the aging process and fail to report them to their healthcare providers.

Although few studies have been conducted to understand the relationship between VVA symptoms and quality of life (QOL), some survey data suggest that VVA is associated with a clinically significant effect on QOL comparable to that seen in conditions such as arthritis, asthma, and irritable bowel syndrome. The objective of the European Vulvovaginal Epidemiology Survey (EVES) was to describe the prevalence of VVA. More recent work based on a subanalysis of the EVES study focused on assessing the correlation of VVA symptoms with QOL of postmenopausal women. The survey results from more than 2,000 women were published in the article "The burden of vulvovaginal atrophy on women's daily living: implications on quality of life from a face-to-face real-life survey."

The authors of the article conclude that severe VVA symptoms have a direct association with worsened QOL in postmenopausal women. They suggest that healthcare providers recognize the effect of these symptoms as equivalent to those of other conditions and pathologies for which there is greater awareness.



This subanalysis of the European Vulvovaginal Epidemiology Survey study aimed to assess the correlation of vulvovaginalatrophy (VVA) symptoms and severity, when confirmed by objective gynecologic examination, with the quality of life of postmenopausal women.


Women aged 45 to 75 years with confirmation of last menstrual period more than 12 months before, who attended menopause or gynecology centers, were included. Those women had at least one VVA symptom filled in a group of questionnaires, including EuroQol-EQ-5D-3L and Day-to-Day Impact of Vaginal Aging (DIVA). To confirm the VVA diagnosis, an objective gynecologic examination was also performed.


Of a total of 2,160 evaluable women, 66.3%, 30.5%, and 11.2% suffered from severe vaginal, vulvar, and urinary symptoms, respectively. VVA was confirmed in more than 90% of the participants. Mean (±SD) EQ-5D-3L score was 0.892 ± 0.144 and mean (±SD) score on the associated visual analog scale was 71.7 ± 16.0. Mean (±SD) DIVA score was 0.922 ± 0.653. For both EQ-5D-3L and DIVA, the overall scores and most of the dimensions/components were statistically significantly worse for women with severe VVA symptoms (vulvar and urinary) compared with women not affected by severe symptoms. Quality of life questionnaires showed worse scores in women where the diagnosis of VVA was confirmed by gynecologic examination.


Severe VVA symptoms showed a direct association with worse quality of life in postmenopausal women. This important effect on the quality of life of many women should be recognized as equivalent to those from other conditions and pathologies of which there is greater awareness.


 Nappi RE, Palacios S, Bruyniks N, Particco M, Panay N; EVES Study investigators. The burden of vulvovaginal atrophy on women's daily living: implications on quality of life from a face-to-face real-life survey. Menopause. 2018 Nov 12. doi: 10.1097/GME.0000000000001260. [Epub ahead of print]

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