- About 40% of women of all ages reported on an anonymous survey that they'd had moderate–severe vulvovaginal symptoms in the previous month, even though potential participants with a diagnosis of vaginitis were excluded
- Contrary to expectations, the symptomatic group was younger than the asymptomatic group, and overall symptom prevalence was not associated with menopausal status
- Vulvovaginal symptoms had an adverse impact on women's interest in sexual ability and ability to have sex
- Clinicians should ask all women about the full spectrum of potential vulvovaginal symptoms
Vulvar and vaginal discomfort is common after menopause, but few studies have explored the prevalence of symptoms throughout a woman's lifespan. By providing an anonymous survey, researchers at Massachusetts General Hospital led by Caroline M. Mitchell, MD, MPH, a researcher with the Vincent Center for Reproductive Biology in the Department of Obstetrics & Gynecology, have found that about 40% of both premenopausal and postmenopausal women experienced moderate to severe vulvovaginal symptoms within the past month. The findings are reported in the Journal of Lower Genital Tract Disease.
A Comprehensive Survey
The researchers sent an anonymous survey to a random subset of 1,676 women between the ages of 18 and 84 who were seen at Mass General between October 2016 and June 2017. These women were not pregnant, had had an annual examination in the past three years and had not been diagnosed with vulvovaginitis in the preceding year, including sexually-transmitted infections. There was an oversampling of nonwhite and Spanish-speaking women. They were asked to complete the survey either on paper or using a link to a secure web portal.
The survey asked about the presence of vulvar and/or vaginal itching, burning, irritation and pain, vaginal discharge, vaginal dryness and pain with vaginal penetration in the past month. Participants who reported a symptom were asked to rate its severity from 1 (mild) to 3 (severe).
Prevalence of Symptoms
In total, 278 surveys were completed and 272 were eligible for analysis, for a 16% response rate. Exactly half of the participants were postmenopausal. Of the 272 respondents, 173 (64%) reported having at least one vulvovaginal symptom of any severity in the past month. Sixty-six of those respondents (24% of the total population) reported only mild symptoms and were termed asymptomatic. The other 107 women (39%) reported one or more moderate to severe symptoms:
- Vaginal discharge: 18%
- Vaginal dryness: 17%
- Vulvovaginal pain: 15%
- Vulvovaginal discomfort (itch, burn, irritation): 12%
Over half of the symptomatic women, 54%, reported moderate–severe symptoms in just one category, but 35% reported two moderate–severe symptoms and 12% reported three or more.
Symptomatic women were significantly more likely than asymptomatic women to report a history of asthma, eczema or seasonal allergies, or a previous diagnosis of bacterial vaginosis or yeast infection. The researchers suggest that in some women, vaginal symptoms could be a manifestation of overall atopy.
Surprising Results Related to Menopause
Contrary to expectations, the symptomatic group was significantly younger than the asymptomatic group (average age 49 vs. 54). Another surprise was that the overall prevalence of moderate–severe symptoms was not associated with menopausal status: 42% among premenopausal women vs. 37% among postmenopausal women.
Almost a third of symptomatic women said their symptoms frequently or always interfered with both their interest in sex (31%) and their ability to have sex (30%).
There was no significant difference between the symptomatic and asymptomatic groups in the number of respondents who reported either lack of desire or a wish for more sexual activity. However, the symptomatic group was significantly more likely to report:
- Pain during sex
- Not wanting sex because of embarrassment over their symptoms
- Not having as much sex as they would like because of their health
- Feeling that their partner desired more sex
Recommendations for Physicians
The researchers emphasize that a simple examination or diagnostic testing may identify treatable causes of vulvovaginal symptoms, so primary care providers should ask all women about them. Women are apt to have moderate to severe symptoms in only one category, so asking about a broad range of symptoms is necessary to elicit the full scope of potential concerns.
Learn more about the Vincent Center for Reproductive Biology