Postmenopausal women with severe symptoms of vulvovaginal atrophy (VVA) experience a worse quality of life, according to a study published in Menopause.

Researchers conducted the European Vulvovaginal Epidemiology Survey (EVES) to identify the prevalence of confirmed VVA among postmenopausal women, as well as to assess the relationship between severity of VVA symptoms and quality of life. Women included in the study were aged 45 to 75 years (mean age, 58.9 years) with absence of menses for ≥12 months (mean time since menopause, 10.1 years). Participants ranked 19 potential VVA-related complaints on a 4-point severity scale: absent, mild, moderate, and severe.

Participants also completed the EuroQol (EQ-5D-3L) and Day-to-Day Impact of Vaginal Aging (DIVA) questionnaires to measure the impact of VVA on quality of life. EQ-5D-3L assigns a score to 5 dimensions (mobility, self-care, daily activities, pain/discomfort, and anxiety/depression) and includes a visual analog scale (VAS) that rates current health status.  DIVA scores quality of life for 4 dimensions (daily activities, emotional well-being, sexual functioning, and self-concept/body image). To confirm VVA, most participants (>90%) underwent a complete pelvic examination with measurement of pH.

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Of a total of 2160 participants with at least one symptom of VVA, 66.3% experienced severe vaginal symptoms, 30.5% experienced severe vulvar symptoms, and 11.2% experienced severe urinary symptoms. Approximately 29.3% of participants did not report any severe symptoms. The prevalence of VVA confirmed by gynecologic examination was 90.5% (1954 of 2160). The prevalence of VVA in women with severe vaginal, vulvar, and urinary symptoms was 93.5%, 94.4%, and 91.4%, respectively, and 83.4% in those without severe symptoms. The most frequently reported VVA symptoms were vaginal dryness (87.6%) and dyspareunia (66.8%).

Results from the EQ-5D-3L questionnaire indicate a mean overall score of 71.7 with a mean associated VAS of 0.892. Mean overall and VAS scores were higher in women who did not experience severe symptoms (73.8 and 0.918, respectively) compared with those with severe symptoms (70.9 and 0.882, respectively), indicating a worse quality of life for the latter group.

DIVA overall score as well as scores for individual components were significantly worse for women with severe VVA symptoms compared with those women not affected by severe symptoms (P <.0001). In the DIVA questionnaire, however, the impact of severe symptoms was lower for both the sexual functioning component and the daily activities component. Emotional well-being and the self-concept/body image scores were 2- and 3-times higher for women with severe VVA symptoms vs those without severe symptoms, reflecting a greater impact of symptoms on quality of life.

The EQ-5D-SL score was lower in those who had a diagnosis of VVA confirmed via gynecologic examination compared with those without a confirmed VVA diagnosis (0.890 vs 0.913, P <.05). For women with confirmed VVA, a higher rate of problems was reported for both the mobility and pain/discomfort dimensions. The overall score for the DIVA questionnaire was significantly higher in women with a confirmed diagnosis of VVA than in those without (0.939 vs 0.769, P< .0001). The highest rate of problems was reported for self-concept/body image component (1.019 in women with a confirmed VVA diagnosis and 0.723 in women without).

“In line with previous findings, the results of this subanalysis of the EVES study show that both generic and vaginal aging-related quality of life scores showed a significant relationship with the different types of severe VVA symptoms,” the authors conclude.


Nappi RE, Palacios S, Bruyniks N, Particco M, Panay N; on behalf of the EVES Study. The burden of vulvovaginal atrophy on women’s daily living: implications on quality of life from a face-to-face real-life survey [published online November 12, 2018]. Menopause. doi: 10.1097/GME.0000000000001260