VULVOVAGINAL ATROPHY: SYMPTOMS, IMPACT ON EMOTIONAL WELL-BEING, QUALITY, AND SEXUAL FUNCTION

Background. Vulvovaginal atrophy (VVA) at menopause is a complex of symptoms associated with the development of atrophic and dystrophic processes in estrogen-dependent vaginal tissues. VVA symptoms, such as vaginal dryness, itching, burning, and dyspareunia, are observed in 40-57% of postmenopausal women. Objective: to study the impact of the symptoms of VVA on emotional well-being, quality of life, and sexual function in postmenopausal women. Subjects and methods. The survey covered 100 women aged 40 to 75 years with a postmenopausal duration of 1 to 35 years. A study group consisted of 63 patients with diagnostically verified vulvovaginal atrophy (Group 1); a control group comprised 37 patients (Group 2). The survey involved questionnaire interviewing and laboratory diagnosis. All the patients underwent cytological examination of the vaginal wall, followed by estimation of the epithelial maturation index and vaginal pH. Results. VVA symptoms were present in two groups and statistically similar. The most common complaint was dryness reported by 60% of the respondents. As in previously conducted surveys, our respondents felt embarrassed because of vaginal discomfort (41.3 and 54.1% in Groups 1 and 2, respectively; p = 0.218), which had in turn a negative impact on the women’s emotional status. Some patients noted a decreased desire to interact with others (9.5 and 13.5 in Groups 1 and 2; p = 0.540) and deterioration of daily activity due to the presence of VVA symptoms (30 and 20% in Groups 1 and 2; p=0.218). When analyzing the quality of their sexual life, the investigators considered the indicators of only the women who were married or those who reported to have a sexual partner (Subgroups 1a and 2a). The patients of these two subgroups were age-matched (53±3.3 and 53±7.0; p = 0.749). In both the first and second subgroups, the women experienced discomfort during sexual intercourses: pain, dryness, and postcoital bleeding. During sexual intercourses, Subgroup 1a women significantly more frequently observed pain and dryness (p = 0.021 and p = 0.046). Because of this, it was possible that the patients of this subgroup were less sexually active. Among them, only 21 (44.68%) patients continued to lead a sex life; among the patients without VVA (Subgroup 2a), 24 (74.41%) women had a regular sex life (p = 0.002). More than half of the patients in Subgroup 1a reported that the symptoms of VVA were a reason for refusing to enter into intimate relationship (p = 0.021), as well as decreased libido, which in turn negatively affected interpersonal relations between the partners. Conclusion. Vaginal dryness, itching, burning, and dyspareunia frequently bother postmenopausal women, irrespective of whether they have VVA. The presence of these symptoms upsets women and causes embarrassment, which has a negative impact on their emotional status and self-rating. Vaginal discomfort deteriorates daily activity in postmenopausal women and decreases a desire to interact with others. Pain and dryness during sexual intercourses are significantly more common in women with laboratorily verified VVA, which was a reason for refusing to enter into intimate relationship and negatively affected interpersonal relations between the partners. The women with VVA had a regular sex life twice less than those in the control group.

vulvovaginal atrophy, vaginal dryness, dyspareunia, quality of life, postmenopause