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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Article info
Publication history
Published online: March 18, 2019
Accepted:
March 15,
2019
Received in revised form:
March 12,
2019
Received:
November 23,
2018
Identification
Copyright
© 2019 Published by Elsevier B.V.
