title: Vaginal symptoms in postmenopausal women: self-reported severity, natural history, and risk factors.
abstract: OBJECTIVE
  This study aimed to examine factors other than estrogen deficiency influencing the development and persistence of vaginal dryness, itching, and painful sexual intercourse after menopause.
  
  
  METHODS
  We analyzed data from a 2-year, population-based cohort of 1,017 postmenopausal women aged 55 to 75 years. Vaginal symptoms were assessed by interviewer-administered questionnaire, and vaginal swabs were performed to assess vaginal pH and microbial flora at baseline, 12 months, and 24 months. Generalized estimating equations were used to identify characteristics associated with symptoms.
  
  
  RESULTS
  Half of the women (n = 471) reported problematic vaginal dryness, a third (n = 316) reported itching, and 40% of sexually active women (n = 166) reported painful intercourse at baseline. Of women not taking estrogen, half of those reporting baseline symptoms were symptomatic after 24 months. Vaginal dryness was associated with younger age (odds ratio [OR], 0.81; 95% CI, 0.69-0.94, per 5-y increase), nonwhite race (ie, African American, Hispanic, Asian or Pacific Islander, or American Indian [OR, 1.53; 95% CI, 1.04-2.27]), diabetes (OR, 1.51; 95% CI, 1.07-2.12), lower 36-item Short-Form Health Survey physical functioning scores (OR, 0.90; 95% CI, 0.85-0.97, per 10-point increase), lower body mass index (OR, 0.81; 95% CI, 0.71-0.93, per 5 kg/m increase), recent sexual activity (OR, 1.14; 95% CI, 1.08-1.21), and vaginal colonization with enterococci (OR, 1.25; 95% CI, 1.04-1.51). Vaginal itching was also associated with lower physical functioning scores (OR, 0.86; 95% CI, 0.80-0.92, per 10-point increase). Risk factors for painful intercourse included younger age (OR, 0.72; 95% CI, 0.56-0.93, per 5-y increase), diabetes (OR, 3.48; 95% CI, 1.93-6.27), lower body mass index (OR, 0.76; 95% CI, 0.61-0.95, per 5 kg/m increase), and higher vaginal pH (OR, 1.10; 95% CI, 1.00-1.21, per 0.5 units).
  
  
  CONCLUSIONS
  Vaginal symptoms affect a large proportion of postmenopausal women, particularly those with diabetes and those with lower body mass index, but may resolve for up to half of women without estrogen therapy.
authors: Department of Medicine, University of California San Francisco, San Francisco, CA, USA. ahuang@ucsfmed.org
authors: Alison J
authors: AJ
authors: Huang
authors: Elya E
authors: EE
authors: Moore
authors: Edward J
authors: EJ
authors: Boyko
authors: Delia
authors: D
authors: Scholes
authors: Feng
authors: F
authors: Lin
authors: Eric
authors: E
authors: Vittinghoff
authors: Stephan D
authors: SD
authors: Fihn
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D003920:Diabetes Mellitus; D004414:Dyspareunia / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D016017:Odds Ratio; D017698:Postmenopause; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D014623:Vaginal Diseases / Q000453:epidemiology*; D014861:Washington / Q000453:epidemiology