Assess vulvovaginal symptoms by level of associated distress

Key takeaways:

• More than half of participants who reported vaginal dryness experienced this symptom at least 4 days per week.
• Pain with vaginal penetration had varied frequency, ranging from once a month to once weekly.

Menopausal women experience multiple vulvovaginal symptoms with variations in quantity, severity and frequency, which cause significant interference in daily life, according to a post hoc analysis published in Menopause.

“People usually have more than one type of vulvovaginal discomfort associated with menopause, and symptoms occur with varying frequency — though most are likely to be exacerbated by sexual activity,” Caroline M. Mitchell, MD, MPH, associate professor of obstetrics, gynecology and reproductive biology and director of the vulvovaginal disorders program at Massachusetts General Hospital, Boston, told Healio. “Focusing on a single symptom, such as dryness or pain, doesn’t account for all that a person experiences after menopause — it may be more important to focus on how symptoms affect a person’s daily life and well-being.”

Mitchell and colleagues conducted a post hoc analysis of the MsFLASH Vaginal Health Trial, a randomized trial of vaginal treatments for vulvovaginal symptoms. In this trial, 302 postmenopausal women (mean age, 60.9 years) who reported at least one moderate to severe vulvovaginal symptom of genitourinary syndrome of menopause were included. Participants reported on the severity, frequency and location of itch, dryness, pain and soreness, irritation, pain with penetration, vaginal discharge, urinary incontinence and urinary urgency.

Of 302 participants, most experienced multiple vulvovaginal symptoms, including itching (n = 166), pain or soreness (n = 230), irritation (n = 220), dryness (n = 285) and vaginal burning (n = 141).

One month before enrollment, participants completed a detailed questionnaire on the severity and frequency of a variety of different symptoms of genitourinary syndrome of menopause. The mean number of moderate to severe vulvovaginal symptoms experienced was 3.4.

The most often reported vulvovaginal symptom across all categories of severity was vaginal dryness (94%). However, pain with vaginal penetration was frequently rated as severe by 40% of participants. The symptom with the highest frequency was vaginal dryness, with 53% of participants who reported vaginal dryness experiencing this symptom 4 or more days per week and vaginal burning, which was reported by 47% of participants who noted experiencing this symptom once per week.

Of those reporting pain with vaginal penetration, 35% reported experiencing this symptom once a month, 38% reported it two to three times per month, 6% reported it four or more times per month, 10% reported it once weekly, 8% reported it two to three times per week and 3% reported it four or more times per week.

Eighty percent of participants reported that at least one vaginal symptom occurred during or after sex, whereas 43% reported experiencing at least one vulvar symptom during or after sex. Both urinary incontinence (67%) and urinary frequency (43%) were the most reported urinary issues.

“Until there is clear understanding of genitourinary syndrome of menopause causal pathways, measuring genitourinary syndrome of menopause distress or bother may remain the single most important metric,” the researchers wrote.

According to Mitchell, moving forward it will be important to understand the impact of vulvovaginal symptoms on people’s well-being, quality of life and sexual health to better assess whether treatment is beneficial.

For more information:

Caroline M. Mitchell, MD, MPH, can be reached at caroline.mitchell@mgh.harvard.edu.