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Symptom severity and quality of life in the management of vulvovaginal atrophy in postmenopausal women

      Highlights

      • Despite the available treatments, relief of symptoms of vulvovaginal atrophy in postmenopausal women remains unsatisfactory.
      • A better knowledge of the association between treatments, quality of life and symptoms may help disease management.
      • Postmenopausal women with vulvovaginal atrophy receiving treatment complained of higher number and more severe symptoms.
      • Women on systemic treatment had fewer and milder symptoms and presented with better vaginal and vulvar health.
      • The treatment of vulvovaginal atrophy should be initiated at early stages of the disease to prevent irreversible changes.

      Abstract

      Objectives

      To evaluate the association between treatments for vulvovaginal atrophy (VVA) and symptom frequency and severity, quality of life (QoL) and sexual functioning in postmenopausal women.

      Study design

      Cross-sectional survey conducted in postmenopausal women aged 45–75 years. Data on demographic and clinical variables, as well as vaginal, vulvar and urinary symptoms were collected. The EuroQoL questionnaire (EQ5D3L), the Day-to-Day Impact of Vaginal Aging (DIVA), the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale - revised (FSDS-R) were filled out.

      Main outcome measures

      Association between treatments for VVA and symptom frequency.

      Results

      Women on VVA treatment presented with more severe symptoms. The sexual function score was higher in the treated women (FSFI: 15.6 vs 16.7; p = 0.010), as was the score for sexual distress (FSDS-R: 9.2 vs 12.3, p < 0.0005). The systemic hormone group presented with fewer VVA symptoms, lower vaginal impact (DIVA), and better sexual function (FSFI and FSDS-R) and vaginal health. The rates of sexual distress and vulvar atrophy were higher in the non-hormonal treatment group. No significant differences were found according to treatment duration.

      Conclusions

      Postmenopausal women with VVA receiving treatment complained of more severe symptoms than those untreated. Women on systemic treatment had fewer and milder VVA symptoms and presented with better vaginal and vulvar health than women on other treatments. Many women request effective local treatment too late, when VVA symptoms are already severe. Our data suggest that VVA treatments should ideally be initiated when symptoms commence and cause distress, rather than later, when symptoms may have become more severe and even a cause of intolerable distress for the woman.

      Keywords

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