title: Attitudes and perceptions towards vulvar and vaginal atrophy in Italian post-menopausal women: Evidence from the European REVIVE survey.
abstract: OBJECTIVE
  To achieve a deeper understanding of the attitudes and perceptions of Italian post-menopausal women (PMW) regarding vulvo-vaginal atrophy (VVA).
  
  
  METHODS
  As part of the EU REVIVE study, an online survey was conducted in four European countries; the Italian arm comprised 1000 participants from representative regions of Italy.
  
  
  METHODS
  The perceptions, experiences and needs of Italian PMW in relation to sexual and vaginal health.
  
  
  RESULTS
  The most frequent VVA symptom was vaginal dryness (78%). Usually, the severity of symptoms was similar to or worse than when they first appeared. This was particularly true for dyspareunia, the most bothersome symptom (76%). VVA symptoms had a significant impact on Italian participants' ability to achieve pleasurable relations (74%) and spontaneity (70%). Although 75% of participants were still sexually active, their sex drive had been reduced by a third because of VVA. Women expected that doctors would start a discussion of menopausal symptoms and sexual health, but this was rarely the case (11%). Most women had been treated with a vaginal over-the-counter (OTC) product. Women who had discussed their condition with a physician were more likely (68%) to be under treatment for VVA than those who had not (36%). Low compliance was associated with symptom improvement (23%), not having annoying symptoms (22%), and the impossibility if restoring the vagina to normal (14%). Common reasons for treatment dissatisfaction were related to route of administration or discomfort. Lack of efficacy and fear of a hormone effect were perceived as the main limitations for OTC and local estrogen products, respectively.
  
  
  CONCLUSIONS
  Despite the commonness of VVA and its significant impact on quality of life, the condition remains underdiagnosed in Italy. Discussion of symptoms with doctors influences the diagnosis, and patients' satisfaction with available treatments is not high.
authors.affiliation: 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. Electronic address: renappi@tin.it.
authors.forename: Rossella E
authors.initials: RE
authors.lastname: Nappi
authors.affiliation: Shionogi Italy, Rome, Italy.
authors.forename: Martire
authors.initials: M
authors.lastname: Particco
authors.affiliation: Department of Obstetrics and Gynaecology, University of Torino School of Medicine, Ospedale Mauriziano Umberto I, Torino, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Biglia
authors.affiliation: Department of Obstetrics and Gynecology, University of Modena, Modena, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Cagnacci
authors.affiliation: Department of Neurosciences and Reproductive Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Costantino
authors.initials: C
authors.lastname: Di Carlo
authors.affiliation: Obstetrics and Gynecology Unit, Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Luisi
authors.affiliation: Department of Obstetrics and Gynaecology, University of Cagliari, University Hospital of Cagliari, Cagliari, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Paoletti
mesh_terms: D000368:Aged; D001284:Atrophy; D005060:Europe; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007558:Italy; D008875:Middle Aged; D017698:Postmenopause; D011788:Quality of Life; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D014621:Vagina / Q000473:pathology*; D014623:Vaginal Diseases / Q000473:pathology / Q000523:psychology*; D014844:Vulva / Q000473:pathology*
keywords: Dyspareunia; Post-menopausal women; REVIVE survey; Sexual relationships; Vaginal dryness; Vulvar and vaginal atrophy