Research Article| Volume 124, P55-61, June 2019

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


      • 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.



      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.


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Panay N.
        • Fenton A.
        Vulvovaginal atrophy–a tale of neglect.
        Climacteric. 2014; 17: 1-2
        • Nappi R.E.
        • Biglia N.
        • Cagnacci A.
        • Di Carlo C.
        • Luisi S.
        • Paoletti A.M.
        Diagnosis and management of symptoms associated with vulvovaginal atrophy: expert opinion on behalf of the Italian VVA study group.
        Gynecol. Endocrinol. 2016; 32: 602-606
        • Mac Bride M.B.
        • Rhodes D.J.
        • Shuster L.T.
        Vulvovaginal atrophy.
        Mayo Clin. Proc. 2010; 85: 87-94
        • Nappi R.E.
        • Palacios S.
        • Particco M.
        • Panay N.
        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.
        Maturitas. 2016; 91: 81-90
        • Kingsberg S.A.
        • Wysocki S.
        • Magnus L.
        • Krychman M.L.
        Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey.
        J. Sex. Med. 2013; 10: 1790-1799
        • Nappi R.E.
        • Palacios S.
        Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause.
        Climacteric. 2014; 17: 3-9
        • DiBonaventura M.
        • Luo X.
        • Moffatt M.
        • Bushmakin A.G.
        • Kumar M.
        • Bobula J.
        The association between vulvovaginal atrophy symptoms and quality of life among postmenopausal women in the United States and Western Europe.
        J. Womens Health (Larchmt). 2015;
        • Sturdee D.W.
        • Panay N.
        • International Menopause Society Writing Group
        Recommendations for the management of postmenopausal vaginal atrophy.
        Climacteric. 2010; 13: 509-522
        • North American Menopause Society
        The 2012 hormone therapy position statement of: The North American Menopause Society.
        Menopause. 2012; 19: 257-271
        • Palacios S.
        • Mejía A.
        • Neyro J.L.
        Treatment of the genitourinary syndrome of menopause.
        Climacteric. 2015; 18: 23-29
        • Wurz G.T.
        • Kao C.-J.
        • DeGregorio M.W.
        Safety and efficacy of ospemifene for the treatment of dyspareunia associated with vulvar and vaginal atrophy due to menopause.
        Clin. Interv. Aging. 2014; 9: 1939-1950
        • McLendon A.N.
        • Clinard V.B.
        • Woodis C.B.
        Ospemifene for the treatment of vulvovaginal atrophy and dyspareunia in postmenopausal women.
        Pharmacotherapy. 2014; 34: 1050-1060
        • Shin J.J.
        • Kim S.K.
        • Lee J.R.
        • Suh C.S.
        Ospemifene: a novel option for the treatment of vulvovaginal atrophy.
        J. Menopausal Med. 2017; 23: 79
        • Labrie F.
        • Derogatis L.
        • Archer D.F.
        • Koltun W.
        • Vachon A.
        • Young D.
        • Frenette L.
        • Portman D.
        • Montesino M.
        • Côté I.
        • Parent J.
        • Lavoie L.
        • Beauregard A.
        • Martel C.
        • Vaillancourt M.
        • Balser J.
        • Moyneur É.
        Members of the VVA prasterone research group, effect of intravaginal prasterone on sexual dysfunction in postmenopausal women with vulvovaginal atrophy.
        J. Sex. Med. 2015; 12: 2401-2412
        • Karcher C.
        • Sadick N.
        Vaginal rejuvenation using energy-based devices.
        Int. J. Womens Dermatol. 2016; 2: 85-88
        • Palacios S.
        • Nappi R.E.
        • Bruyniks N.
        • Particco M.
        • Panay N.
        • EVES Study Investigators
        The European Vulvovaginal Epidemiological Survey (EVES): prevalence, symptoms and impact of vulvovaginal atrophy of menopause.
        Climacteric. 2018; 21: 286-291
        • Palma F.
        • Della Vecchia E.
        • Cagnacci A.
        • As the Writing Group of the AGATA study
        Medical and patient attitude towards vaginal atrophy: the AGATA study.
        Climacteric. 2016; 19: 553-557
        • Palma F.
        • Volpe A.
        • Villa P.
        • Cagnacci A.
        • As the writing group of the AGATA study
        Vaginal atrophy of women in postmenopause. Results from a multicentric observational study: the AGATA study.
        Maturitas. 2016; 83: 40-44
        • Group Euro Qol
        EuroQol--a new facility for the measurement of health-related quality of life.
        Health Policy. 1990; 16: 199-208
        • Huang A.J.
        • Gregorich S.E.
        • Kuppermann M.
        • Nakagawa S.
        • Van Den Eeden S.K.
        • Brown J.S.
        • Richter H.E.
        • Walter L.C.
        • Thom D.
        • Stewart A.L.
        Day-to-Day Impact of Vaginal Aging questionnaire: a multidimensional measure of the impact of vaginal symptoms on functioning and well-being in postmenopausal women.
        Menopause. 2015; 22: 144-154
        • Wiegel M.
        • Meston C.
        • Rosen R.
        The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores.
        J. Sex Marital Ther. 2005; 31: 1-20
        • Derogatis L.
        • Clayton A.
        • Lewis-D’Agostino D.
        • Wunderlich G.
        • Fu Y.
        Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder.
        J. Sex. Med. 2008; 5: 357-364
        • Bachmann G.
        Urogenital ageing: an old problem newly recognized.
        Maturitas. 1995; : S1-S5
        • Leiblum S.
        • Bachmann G.
        • Kemmann E.
        • Colburn D.
        • Swartzman L.
        Vaginal atrophy in the postmenopausal woman: the importance of sexual activity and hormones.
        JAMA. 1983; 249: 2195-2198
        • Nappi R.E.
        • Palacios S.
        • Panay N.
        • Particco M.
        • Krychman M.L.
        Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey.
        Climacteric. 2016; 19: 188
        • Moral E.
        • Delgado J.L.
        • Carmona F.
        • Caballero B.
        • Guillán C.
        • González P.M.
        • Suárez-Almarza J.
        • Velasco-Ortega S.
        • Nieto C.
        As the writing group of the GENISSE study, Genitourinary syndrome of menopause. Prevalence and quality of life in Spanish postmenopausal women. The GENISSE study.
        Climacteric. 2018; 21: 167-173
        • Tan O.
        • Bradshaw K.
        • Carr B.R.
        Management of vulvovaginal atrophy-related sexual dysfunction in postmenopausal women: an up-to-date review.
        Menopause. 2012; 19: 109-117
        • Dennerstein L.
        • Dudley E.C.
        • Hopper J.L.
        • Guthrie J.R.
        • Burger H.G.
        A prospective population-based study of menopausal symptoms.
        Obstet. Gynecol. 2000; 96: 351-358
        • Archer D.F.
        Efficacy and tolerability of local estrogen therapy for urogenital atrophy.
        Menopause. 2010; 17: 194-203
        • Utian W.H.
        • Maamari R.
        Attitudes and approaches to vaginal atrophy in postmenopausal women: a focus group qualitative study.
        Climacteric. 2014; 17: 29-36
        • Pitkin J.
        British Menopause Society medical advisory council, BMS – consensus statement.
        Post Reprod. Health. 2018; 24: 133-138