Vulvar and vaginal atrophy (VVA) is common in postmenopausal women, but many are unaware of the condition and do not discuss their symptoms with healthcare providers, according to American researchers.
The study also examined women’s use of and feelings about VVA treatments.
VVA refers to changes in the vaginal and vulvar regions after menopause. Declines in estrogen levels cause vaginal walls to become thinner and less flexible. Symptoms of VVA include painful intercourse, vaginal dryness, and irritation. It is estimated that up to half of women experience VVA symptoms to some degree. Those symptoms can interfere with sexual activity and enjoyment of life.
VVA is chronic and does not resolve on its own. Some women use over-the-counter vaginal lubricants and moisturizers for relief. Prescription hormonal therapies are also available.
The study involved 3,046 postmenopausal women with VVA symptoms. Their mean age was 60.6. Each woman completed a questionnaire and provided information on her VVA awareness, VVA’s impact on her daily life, communication with her healthcare provider about VVA, and her experience with VVA treatments.
Awareness of VVA was low. A third of the women said they didn’t know what was causing their symptoms. Twenty-four percent did not associate their symptoms with menopause. Sixty-two percent were not familiar with VVA and over half of the women who were aware had only heard of VVA after their symptoms began. Many women thought their symptoms would eventually go away.
Communication about VVA between women and healthcare providers was low as well. Fifty-six percent of the women had discussed their symptoms with a provider. Women were reluctant to broach the subject and, in most cases, providers did not start the discussion either. Only 13% of the women said their healthcare provider had brought up the subject.
VVA affected the women’s quality of life. Fifty-nine percent of them said that symptoms interfered with their enjoyment of sex. Problems with sleep, general enjoyment of life, and temperament were also noted.
Forty percent of the women used some form of VVA treatment, such as over-the-counter lubricants or moisturizers, prescription hormonal treatments, or herbal remedies. Safety was on the minds of many women, however, and some were wary of estrogen therapies because of side effects and breast cancer risk.
Treatment did not always help. The most common reason for discontinuing treatment was the lack of effectiveness. Some women also found the treatments messy and inconvenient.
The researchers suggested that improved patient-provider communication could help women with VVA. “[Healthcare providers] need to become more familiar with the diagnosis, assessment, and treatment of VVA and must be cognizant of and more proactive about initiating the [healthcare provider]-patient dialogue,” they wrote.
Discussing VVA, along with safety concerns and treatment expectations could help women better understand and cope with the condition.
The study was first published online in May in The Journal of Sexual Medicine.
The Journal of Sexual Medicine
Kingsberg, Sheryl A., PhD, et al.
“Vulvar and Vaginal Atrophy in Postmenopausal Women: Findings from the REVIVE (REal Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) Survey”
(Full-text. First published online: May 16, 2013)