title: Characteristics of post-menopausal women with genitourinary syndrome of menopause: Implications for vulvovaginal atrophy diagnosis and treatment selection.
abstract: BACKGROUND
  Vulvovaginal atrophy (VVA), also known as genitourinary syndrome of menopause, exerts a negative impact on the sexuality, health and quality of life of post-menopausal women. A better understanding of post-menopausal women's profiles as defined by their attitude and behaviours in relation to their VVA symptoms may improve public health policies and will allow appropriate targeting of public health campaigns. These improvements may help women of middle and advanced age recover and maintain their quality of life. In this study, we analysed the attitudes of post-menopausal women, aged 45-74 years, with VVA symptoms from five European countries, with the aim of identifying profile markers to improve healthcare strategies.
  
  
  METHODS
  Two consecutive cross-sectional studies were conducted in five European countries (the UK, France, Spain, Germany and Italy). An initial exploratory study (n=69) was based on interviews and then an analytical study (n=749) was based on online surveys to validate women's profiles by means of a multi-level approach.
  
  
  RESULTS
  We identified eight profiles: self-treater, pragmatic, vivacious, reserved, silent sufferer, expressive, stoic and sad. The percentage distribution varied among the countries. The 'pragmatic', 'vivacious' and 'expressive' women were the most proactive, talkative and open with their healthcare professional, whereas women with the 'reserved' and 'stoic' profiles showed less interest in searching for information about their VVA symptoms, either from their healthcare professional or from other sources.
  
  
  CONCLUSIONS
  The attitudes and behaviours of post-menopausal women in relation to their VVA allow for the clear definition of a series of profiles with varying representation across countries. This study reveals the importance of identifying post-menopausal women's profiles to develop interventions to help them overcome barriers to the diagnosis, management and treatment of VVA.
authors.affiliation: Clinical Institute for Gynecology, Obstetrics and Neonatology, Hospital Clínic, Barcelona, Spain; Faculty of Medicine, University of Barcelona, IDIBAPS, Barcelona, Spain. Electronic address: castelobranco@ub.edu.
authors.forename: Camil
authors.initials: C
authors.lastname: Castelo-Branco
authors.affiliation: Department of Obstetrics and Gynaecology, Umberto I Hospital, University of Turin, Turin, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Biglia
authors.affiliation: Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Dept of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy.
authors.forename: Rossella E
authors.initials: RE
authors.lastname: Nappi
authors.affiliation: Center for Gynecologic Endocrinology HORMONE-HAMBURG, Hamburg, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Schwenkhagen
authors.affiliation: Palacios Institute of Women's Health, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Palacios
mesh_terms: D000368:Aged; D001284:Atrophy / Q000175:diagnosis / Q000473:pathology / Q000523:psychology; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D052776:Female Urogenital Diseases / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause / Q000523:psychology*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013577:Syndrome; D014621:Vagina / Q000473:pathology*; D014844:Vulva / Q000473:pathology*
keywords: Ageing; Attitudes and women profiles; Genitourinary syndrome of menopause; Healthcare professionals; Sex; Vulvo-vaginal atrophy