Adverse impacts of vulvovaginal atrophy found for quality of life

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Symptoms linked to vulvovaginal atrophy (VVA) adversely impacting quality of life are seen in a significant proportion of postmenopausal women, according to a recent study published in Cureus.

VVA is reported in approximately half of postmenopausal women, leading to a multitude of urinary, genital, and sexual symptoms. Decreasing estrogen levels in the blood, often occurring during menopause, lead to VVA.

Since the life expectancy of women has increased, these patients are expected to be impacted by symptoms of menopause for a greater proportion of their lives. Therefore, it is necessary to perform subjective and objective assessments of VVA in both clinical and research contexts.

Symptoms of VVA may range from mild to severe discomfort and are influenced by time, patient age, parity, menopause type, vaginal delivery, frequency of coital activity, other medical conditions, and cigarette smoking. VVA will not recede without proper management since it is a chronic illness in the postmenopausal period.

Currently, VVA is underdiagnosed and undertreated, and understanding on vaginal health remains lacking. To evaluate VVA incidence in postmenopausal women in a rural setting, investigators conducted a cross-sectional study.

Participants included postmenopausal women aged 45 to 75 years with at least 1 vaginal symptom attending the Outpatient Department. A pretested questionnaire was utilized to obtain participant data including time since last menstruation, recent sexual activity history, marital status, comorbidities, lifestyle, and parity.

The vaginal symptom Bothersomeness Scale was used to evaluate symptoms such as vaginal dryness, soreness, irritation or burning, itching, pain or bleeding during intercourse, pain during penetration, pain during exercise, discharge, urinary incontinence, increased urgency, frequent urination, other urinary difficulties, lower abdominal pain, postcoital cystitis, and recurrent urinary tract infections.

Symptoms were rated on a 5-level scale, with 0 indicating not at all and 4 indicating extremely. Higher scores indicated increased discomfort. Additionally, VVA was confirmed through a gynecological clinical examination.

Of participants, 34% were aged 56 to 60 years and only 6% were aged 71 to 75 years. Having 2 children was reported by 38%, more than 2 children by 36%, and a single child by 23%.

Comorbidities were reported in 87% of patients, and only 3% were nulliparous. Coffee consumption was reported by 54%, alcohol consumption by 17%, and smoking by 7%.

The most commonly reported symptom was vaginal dryness in 77% of patients. Not being bothered by vaginal dryness was reported by 23% of patients, while approximately 19% were extremely impacted. For irritation or burning, 28% were not bothered and 9% were extremely bothered.

For itching, 27% of patients were not bothered and 11% were extremely bothered. These rates were 33% and 0%, respectively, for pain during intercourse, 34% and 1%, respectively, for pain during penetration, 46% and 1%, respectively, for bleeding during intercourse, and 26% and 9%, respectively, for vaginal discharge.

Not being bothered by pain during exercise was reported by 40%, while 2% were extremely bothered. These rates were 43% and 8%, respectively, for urinary incontinence, 32% and 10%, respectively, for urinary frequency, 45% and 2%, respectively, for recurrent urinary tract infections, 44% and 1%, respectively, for postcoital cystitis, and 44% and 1%, respectively, for lower abdominal pain.

Mild discomfort caused by VVA symptoms was reported by 50% of patients, moderate discomfort by 48%, and extreme discomfort by 2%. Sexual functioning with a history of recent sexual activity was the most affected quality of life domain, with a mean of 2.00 ± 0.55.

When evaluating frequency using the Vaginal Health Index, a score under 15 indicated atrophy of the vagina. A score of 11 to 15 was reported by 51% of patients, 21 to 25 by 5%, under 5 by 7%, between 5 and 10 by 21%, and 16 to 20 by 16%.

These results indicated a significant proportion of women are severely impacted by VVA symptoms. Investigators recommended further research to assess regional variations in women’s experiences.

Reference

Ulhe SC, Acharya N, Vats A, Singh A. Study of vulvovaginal atrophy and genitourinary syndrome of menopause and its impact on the quality of life of postmenopausal women in Central India. Cureus. 2024;16(2):e54802. doi:10.7759/cureus.54802