title: Vulvar and vaginal atrophy in four European countries: evidence from the European REVIVE Survey.
abstract: OBJECTIVE
  The aim of the European REVIVE survey was to achieve a better understanding of vulvovaginal atrophy (VVA), a chronic and progressive condition after menopause. We investigated perceptions, experiences and needs in terms of sexual and vaginal health in a sample of European postmenopausal women.
  
  
  METHODS
  An online internet based survey was conducted in Italy, Germany, Spain and the UK with a total surveyed sample of 3768 postmenopausal women (age: 45-75 years).
  
  
  RESULTS
  The most common VVA symptom was vaginal dryness (70%). VVA has a significant impact on the ability to be intimate (62%), to enjoy sexual intercourse (72%) and to feel sexual spontaneity (66%). Postmenopausal women with VVA are sexually active (51%), but their sexual drive is reduced. Health-care professionals (HCPs) have discussed VVA with postmenopausal women (62%), but they initiated the conversation only in 10% of the cases. The most common treatments for VVA are over-the-counter, non-hormonal, local vaginal products. Thirty-two per cent of postmenopausal women were naïve to any kind of treatment, whereas discussion with the HCP was relevant to be on current treatment (60% of postmenopausal women that discussed VVA with a HCP vs. 23% who did not). The top reasons for poor compliance with vaginal treatments were: not bothersome enough symptoms (18%); vaginal changes not therapeutically reversed (18%); relief from VVA symptoms (17%). Approximately 45% were satisfied with treatment. The most frequent disliked aspects of treatment were the route of administration or the messiness. The fear of hormones was common in postmenopausal women using vaginal prescription products.
  
  
  CONCLUSIONS
  The European REVIVE survey confirmed that VVA symptoms are frequent in postmenopausal women and demonstrates a significant impact on quality of life and sexual life. However, the condition is still under-diagnosed and under-treated, with a high rate of dissatisfaction for actual available treatments in the four European countries surveyed. The discussion of symptoms with HCPs seems the most critical factor for diagnosis and treatment of VVA.
authors.affiliation: a Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS S. Matteo Foundation, Department of Clinical, Surgical, Diagnostic and Paediatric Sciences , University of Pavia , Pavia , Italy ;
authors.forename: R E
authors.initials: RE
authors.lastname: Nappi
authors.affiliation: b Palacios Institute of Women's Health , Madrid , Spain ;
authors.forename: S
authors.initials: S
authors.lastname: Palacios
authors.affiliation: c Imperial College London , London , UK ;
authors.forename: N
authors.initials: N
authors.lastname: Panay
authors.affiliation: d Shionogi Italy , Rome , Italy ;
authors.forename: M
authors.initials: M
authors.lastname: Particco
authors.affiliation: e Southern California Center for Sexual Health and Survivorship Medicine Inc. , Newport Beach , CA , USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Krychman
mesh_terms: D000368:Aged; D001284:Atrophy; D004414:Dyspareunia / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011788:Quality of Life; D012725:Sexual Behavior; D014621:Vagina / Q000473:pathology*; D014623:Vaginal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D014844:Vulva / Q000473:pathology*
keywords: Europe; REVIVE Survey; Vulvar and vaginal atrophy; dyspareunia; postmenopausal women; sexual relationships; treatment; vaginal dryness