ORIGINAL ARTICLE Received 25-08-2011© 2012 International Menopause Society Revised 07-11-2011DOI: 10.3109/13697137.2011.647840 Accepted 20-11-2011
Correspondence: Professor R. E. Nappi, Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause Unit, Departmentof Obstetrics and Gynecology, IRCCS ‘S Matteo Foundation’, University of Pavia, Piazzale Golgi 2, 27100 Pavia, Italy
, resulting from reduced transudation through thevaginal epithelium and reduced cervical gland secretions.Indeed, when vaginal atrophy is present in menopausalwomen, vaginal dryness is commonly the ﬁrst symptomreported
. The number of women reporting vaginal drynessincreases from early to late perimenopause
, and the preva-lence subsequently increases as women advance through thepostmenopausal years
. Other symptoms of vaginal atrophytypically include irritation, itching, discharge and, amongsexually active women, dyspareunia and other forms of sexual dysfunction
. In addition, urinary symptoms (suchas frequency, urgency, nocturia, dysuria, incontinence andrecurrent infections)
occur more frequently when vaginalatrophy is present. In a United States-based survey of women
Ovarian failure during menopause produces a marked declinein estrogen levels that affects many organ systems
. However,the urogenital tract – speciﬁcally, the vagina, urethra, bladder,trigone and pelvic ﬂoor muscles
– is particularly sensitive toestrogen deprivation
, and a lack of local estrogen is theprimary cause of atrophy in these tissues and structures
. Asa result, approximately 50% of postmenopausal women willexperience symptoms relating to urogenital atrophy, withsubsequent impact on sexual function and quality of life
.Vaginal atrophy associated with estrogen depletion becomesclinically apparent 4–5 years after the menopause
. Chronicreduction in estrogen levels ultimately leads to vaginal
Vaginal Health: Insights, Views & Attitudes(VIVA) – results from an international survey
R. E. Nappi and M. Kokot-Kierepa*
Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause Unit, Department of Obstetrics andGynecology, IRCCS ‘S Matteo Foundation’, University of Pavia, Pavia, Italy; *
Novo Nordisk FemCare AG, Zurich, Switzerland
ATTITUDE, MENOPAUSE, POSTMENOPAUSE, SURVEY, VAGINAL ATROPHY, VAGINAL HEALTH
To assess knowledge of vaginal atrophy among women using the Vaginal Health: Insights,Views & Attitudes (VIVA) survey.
A structured online questionnaire was used to obtain information from 3520 postmenopausalwomen aged 55–65 years living in Great Britain, the United States, Canada, Sweden, Denmark, Finland, andNorway.
In total, 45% of women reported experiencing vaginal symptoms. Only 4% of women attributedthese symptoms to vaginal atrophy, and 63% failed to recognize vaginal atrophy as a chronic condition.Overall, 44% of respondents did not have a gynecologist, but this percentage varied between countries. Mostwomen (75%) felt that vaginal atrophy had a negative impact on life, but this perception also showedcountry-speciﬁc differences. Most Finnish respondents (76%) were satisﬁed with the amount of informationavailable about vaginal atrophy, compared with just 37–42% of women from other countries. Most womenused over-the-counter products for vaginal atrophy symptoms, but speciﬁc means of treating the underlyingcause were less well known. Almost half (46%) of all respondents lacked knowledge about local estrogentherapy, with women in Great Britain, the United States and Canada being most likely to lack knowledge of such treatment. Overall, 30% of women would consider taking local estrogen therapy, with vaginal tabletsbeing the preferred option in all countries.
Postmenopausal women have a low understanding of vaginal atrophy. Medical practitionersshould proactively raise this topic, help patients to understand that vaginal atrophy is a chronic condition,and discuss treatment options. Country-speciﬁc approaches may be required.
C l i m a c t e r i c D o w n l o a d e d f r o m i n f o r m a h e a l t h c a r e . c o m b y N o v o N o r d i s k A / S ( A C T I V E ) o n 0 1 / 1 0 / 1 2 F o r p e r s o n a l u s e o n l y .