Impact of vulvovaginal atrophy on sexual function in postmenopausal women

For postmenopausal women with at least one vulvovaginal atrophy (VVA) symptom, the presence of physician-confirmed VVA is linked to significant impaired sexual function, according to a study from the European Vulvovaginal Epidemiological Survey (EVES). Published in Menopause, it showed that the two most common symptoms of impaired sexual function with VVA are dryness (87.6%) and pain during intercourse (66.8%).

“VVA is chronic, progressive with age and with hormonal deprivation, which is associated mainly with low estrogens with menopause, but also a slight decline of androgen with age,” said principal investigator Rossella Nappi, MD, PhD, a professor of ob/gyn at the University of Pavia in Italy. “VVA affects around 50% of postmenopausal women and has a dramatic impact on sex and quality of life. However, it is largely undiagnosed and undertreated, due to lack of communication and poor recognition of the burden in daily practice.”

Over the years, Dr. Nappi has attempted to understand how to fill this gap, but most importantly how to help women recognize the symptoms of VVA and assist healthcare providers in detecting the signs, in order to tailor the right treatment to relieve the condition.

The survey queried 2,403 evaluable women, ranging in age from 45 to 75 (mean 59.0 years and being menopausal for 9.9 years), between May 2015 and March 2016, of whom 2,160 had at least one symptom related to VVA. All participants attended one of 46 menopausal/gynecological centers in Italy and Spain and had their last menstruation more than 12 months prior.

The women completed the following three questionnaires: Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI), and Female Sexual Distress Scale revised (FSDS-R).

The negative impact on sexual function was significantly higher in women with confirmed VVA than in women without confirmed VVA, as evaluated with the sexual function component (DIVA-C) of the DIVA questionnaire (P  =  0.013).

Statistically significant differences (P  <  0.0005) were also detected in the scores for overall FSDS-R, overall FSFI and for all six FSFI subdomains: desire, arousal, lubrication, orgasm, satisfaction, and pain.

In addition, 65.9% of the overall cohort was currently sexually active. “But there was a nonsignificant trend for a lower sexual activity assessed as a dichotomic ‘yes/no’ category in the group of women with confirmed VVA as compared with the women without confirmed VVA: 65.4% vs. 70.7%, respectively (P = 0.114),” Dr. Nappi told Contemporary OB/GYN.

On the other hand, there was a significant association between being sexually active and the severity of certain particular symptoms, especially those related to intercourse, such as pain or bleeding. “Symptoms were more severe in the sexually non-active population,” she said.

Also, compared to the sexually non-active group, the group of sexually active women had a higher number of previous treatments for VVA (P < 0.0005) and more frequently used lubricants instead of moisturizers (P < 0.0005).

“I continue to be astounded by the epidemic condition of VVA among postmenopausal women, in spite of the treatments available to effectively relieve the condition, such as local estrogen therapy, prasterone or the novel oral selective estrogen receptor modulator (SERM) ospemifene,” Dr. Nappi said.

She noted that the evidence that women with more severe symptoms take specific treatments “underscores the fact that women wait too long before reaching out for help and that possibly healthcare professionals do not ask about VVA in a timely fashion.”

She believes it is important that women be treated early in the trajectory of VVA, “before the condition becomes so severe to significantly interfere with sexual function and quality of life; however, even the best treatment cannot reverse years of suffering and sexual inactivity.”

Her hope is that having better insight into VVA will help the medical community to uncover it in the office, as is the case with osteoporosis and cardiovascular risks. 

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Dr. Nappi reports no relevant financial disclosures.

References:

Source: Particco M, Djumaeva S, Nappi RE, Panay N, Palacios S. The European Vulvovaginal Epidemiological Survey (EVES). Menopause. 2020;27(4):423-429. doi:10.1097/gme.0000000000001496