title: Vulvar and vaginal atrophy as viewed by the Spanish REVIVE participants: symptoms, management and treatment perceptions.
abstract: OBJECTIVE
  To gain a deeper comprehension of current vulvovaginal atrophy (VVA) knowledge among Spanish postmenopausal women.
  
  
  METHODS
  An online survey (REVIVE) was conducted in four European countries with an overall sample of 768 participants included in Spain. Perceptions, experiences and needs of Spanish postmenopausal women in terms of sexual and vaginal health were reported.
  
  
  RESULTS
  Vaginal dryness was the most common VVA symptom in Spain (81%). The severity of symptoms reported by postmenopausal women tended to be similar or worse than at onset, especially in the most troublesome symptom, dyspareunia (80%). VVA symptoms significantly impact on Spanish participants' ability to achieve sexual enjoyment (75%), relationship with partner (67%) and sexual spontaneity (66%). Although 71% of participants with partners (83%) were sexually active, their sex drive was reduced by one-third as a consequence of VVA. Despite the fact that women expected doctors to start asking them about menopausal symptoms, this rarely occurred. Treatments were administered mainly vaginally without prescription (62% were using over-the-counter products at the time). Postmenopausal women who had discussed their symptoms with physicians were twice as likely to be treated (66% vs. 33%) than those who had not. Low compliance with treatment was justified by Spanish participants with not bothersome enough symptoms (22%), relief (21%), inability to reverse vaginal changes (15%) and treatment price (13%). Almost half of the participants with a current local estrogen prescription showed satisfaction. The acknowledged main limitation for all treatments was the inability to restore the natural conditions of the vagina. The price of over-the-counter products was also reported as an important concern in Spanish postmenopausal women.
  
  
  CONCLUSIONS
  VVA remains underdiagnosed and undertreated in Spain, despite its high frequency and significant impact on quality of life. Since patient satisfaction with available treatments remains compromised, an effective discussion of symptoms and therapies with doctors would improve its management.
authors.affiliation: a Instituto Palacios de Salud y Medicina de la Mujer , Madrid , Spain.
authors.forename: S
authors.initials: S
authors.lastname: Palacios
authors.affiliation: b Department of Obstetrics and Gynecology , Hospital Universitario de Guadalajara , Guadalajara , Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Cancelo
authors.affiliation: c Clinic Institute of Gynecology, Obstetrics and Neonatology , Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona , Barcelona , Spain.
authors.forename: C
authors.initials: C
authors.lastname: Castelo Branco
authors.affiliation: d Department of Obstetrics and Gynecology , Hospital Universitario Central de Asturias , Oviedo , Spain.
authors.forename: P
authors.initials: P
authors.lastname: Llaneza
authors.affiliation: e Institut de Sexologia de Barcelona , Barcelona , Spain.
authors.forename: F
authors.initials: F
authors.lastname: Molero
authors.affiliation: f DIATROS Diagnósticos y Tratamientos Avanzados S.L.P , Barcelona , Spain.
authors.forename: R Sanchez
authors.initials: RS
authors.lastname: Borrego
mesh_terms: D001284:Atrophy / Q000523:psychology; D003075:Coitus / Q000523:psychology*; D004414:Dyspareunia / Q000209:etiology / Q000523:psychology; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010465:Perception; D010817:Physician-Patient Relations; D017698:Postmenopause / Q000523:psychology*; D011788:Quality of Life; D013030:Spain; D011795:Surveys and Questionnaires; D014621:Vagina / Q000473:pathology*; D014844:Vulva / Q000473:pathology*
keywords: REVIVE survey; Spain; Vulvar and vaginal atrophy; dyspareunia; postmenopausal women; sexual relationships; treatment; vaginal dryness