Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women

Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Menopause (Impact Factor: 3.36). 07/2008; 15(4 Pt 1):661-6. DOI: 10.1097/gme.0b013e31815a5168
Source: PubMed


The relationship between vulvovaginal atrophy and female sexual dysfunction is unclear. We investigated this association among sexually active postmenopausal women.
The Menopause Epidemiology Study is a cross-sectional, population-based study of women 40 to 65 years old in the United States chosen from a source population selected by random digit dialing and probability sampling. We focused on sexually active postmenopausal women (N = 1,480) for our analyses. Vulvovaginal atrophy was defined as one or more of the following: vaginal dryness, itching, irritation; pain on urination; or pain or bleeding on intercourse. The Arizona Sexual Experience Survey was used to define female sexual dysfunction. Sexual dysfunction subtypes for desire, arousal, and orgasm difficulties were individually scored. We evaluated demographic, behavioral, reproductive history, and medication covariates for effect modification and confounding. Multivariate logistic regression was used to assess the relationship between vulvovaginal atrophy and female sexual dysfunction.
The prevalence of vulvovaginal atrophy (57%) and female sexual dysfunction (55%) was high. Women with female sexual dysfunction were 3.84 times more likely to have vulvovaginal atrophy than women without female sexual dysfunction (95% CI: 2.99-4.94). Hot flashes modified the association between vulvovaginal atrophy and desire difficulty. Educational level modified the association between vulvovaginal atrophy and arousal difficulty. Parity modified the association between vulvovaginal atrophy and orgasm difficulty.
This large population-based study provides evidence of an association between vulvovaginal atrophy and overall female sexual dysfunction and its subtypes. Therapies aiming to reduce symptoms of one condition may also relieve symptoms of the other.

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    • "These symptoms also re-occur within 12 months of discontinuation of postmenopausal hormone therapy.9 Atrophy associated dyspareunia is often associated with the sexual distress and other complaints of sexual dysfunction.10,11 Reactive lowered desire is common as well as direct impact on the marital relationship. "
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    ABSTRACT: Vulvovaginal atrophy (VVA) and dryness are common symptoms of the decline in endogenous production of estrogen at menopause and often result in dyspareunia. Yet while 10% to 40% of women experience discomfort due to VVA, it is estimated that only 25% seek medical help. The main goals of treatment for vaginal atrophy are to improve symptoms and to restore vaginal and vulvar anatomic changes. Treatment choices for postmenopausal dyspareunia resulting from vulvovaginal atrophy will depend on the underlying etiology and might include individualized treatment. A number of forms of vaginal estrogen and manner of delivery are currently available to treat moderate to severe dyspareunia caused by VVA. They all have been shown to be effective and are often the preferred treatment due to the targeted efficacy for urogenital tissues while resulting in only minimal systemic absorption. Both healthcare professionals and patients often find it difficult to broach the subject of sexual problems associated with VVA. However, with minimal effort to initiate a conversation about these problems, healthcare providers can provide useful information to their postmenopausal patients in order to help them each choose the optimal treatment for their needs and symptoms.
    Preview · Article · Aug 2010 · International Journal of Women's Health
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    ABSTRACT: The purpose of the present investigation was to assess sexual function among middle-aged women and determine related risk factors (personal and partner) for sexual dysfunction. In this cross-sectional study, women aged 40-59 years were requested to fill out the Female Sexual Function Index (FSFI) and a general demographic questionnaire containing personal and partner data. A total of 409 women with a mean age of 47 +/- 5.3 years were surveyed. Of these, 42.1% were premenopausal, 24.4% perimenopausal and 33.5% postmenopausal. At the time of survey, 10.5% of women were hysterectomized, 1.5% used psychotropic drugs, and 9.8% were on hormone therapy (HT) for the menopause; 28.1% had less than 12 years of schooling and 80.4% had only one partner at the moment of survey. Among their male partners, 7.3% abused alcohol, 10.3% had erectile dysfunction, 11.2% premature ejaculation and 63.83% were faithful partners. Mean (+/- standard deviation) scores for the FSFI domains were: desire (3.7 +/- 1.2), arousal (3.1 +/- 2.5), lubrication (3.3 +/- 2.6), orgasm (2.6 +/- 2.3), satisfaction (4 +/- 1.7), and pain/dyspareunia (3.2 +/- 2.6). The mean total FSFI score was 20.1 +/- 12.4 (median 24.7). In this series, the prevalence of female sexual dysfunction (FSFI score <or=26.55) was 55.7%, with women presenting difficulties across all domains of female sexual function but mostly in the dyspareunia and lubrication domains. Logistic regression analysis determined that female age (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.6-6.8), p = 0.001), postmenopausal status (OR 2.8, 95% CI 1.3-6.1, p = 0.007), partner's age (OR 2.0, 95% CI 1-4, p = 0.03), educational level (OR 2.7, 95% CI 1.5-5, p = 0.001), and the presence of erectile dysfunction (OR 3.8, 95% CI 1.3-10.9, p = 0.01) and premature ejaculation (OR 4.1, 95% CI 1.4-11.7, p = 0.0001) significantly increased the risk for female sexual dysfunction. Partner faithfulness (OR 0.2, 95% CI 0.1-0.4, p = 0.001) and menopausal HT use (OR 0.4, 95% CI 0.1-1, p = 0.04) decreased this risk. In this series, male sexual health and demographic profile and female HT use were relevant determinants for sexual functioning among middle-aged women.
    Full-text · Article · Dec 2008 · Climacteric
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    ABSTRACT: Urogenital aging and female sexual dysfunction (FSD) are significant problems following menopause. Estrogen decline is one of the key factors contributing to sexual functioning because of its crucial role for genital arousal (vasocongestion and lubrication) and other domains of the sexual response. Several common medical conditions, including cardiovascular disease (CVD), may interfere with women's sexual response across the aging process. FSD is one of the most common CVD-related quality-of-life complications with a major impact on patients' and their sexual partners' life. There is no evidence that FSD may represent an early indication of cardiovascular risk in postmenopausal women. In spite of the high prevalence, FSD remains largely under-recognized and sexual counseling is an important consideration for the proper management of postmenopausal women with CVD. Many local estrogen products are available (creams, tablets, suppositories, pessaries and rings) and are equally effective for treatment of vaginal atrophy. When a history of CVD is present, local estrogens may be safely used to treat urogenital atrophy with a significant improvement of sexual health and quality of life.
    No preview · Article · Jan 2009 · Climacteric
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