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Vulvovaginal atrophy is strongly associated with female sexual dysfunction among sexually active postmenopausal women

Levine, Kristen B. MSPH1; Williams, Rachel E. PhD, MS2; Hartmann, Katherine E. MD, PhD3

doi: 10.1097/gme.0b013e31815a5168
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Objective: The relationship between vulvovaginal atrophy and female sexual dysfunction is unclear. We investigated this association among sexually active postmenopausal women.

Design: The Menopause Epidemiology Study is a cross-sectional, population-based study of women 40 to 65 years old in the United States chosen from a source population selected by random digit dialing and probability sampling. We focused on sexually active postmenopausal women (N = 1,480) for our analyses. Vulvovaginal atrophy was defined as one or more of the following: vaginal dryness, itching, irritation; pain on urination; or pain or bleeding on intercourse. The Arizona Sexual Experience Survey was used to define female sexual dysfunction. Sexual dysfunction subtypes for desire, arousal, and orgasm difficulties were individually scored. We evaluated demographic, behavioral, reproductive history, and medication covariates for effect modification and confounding. Multivariate logistic regression was used to assess the relationship between vulvovaginal atrophy and female sexual dysfunction.

Results: The prevalence of vulvovaginal atrophy (57%) and female sexual dysfunction (55%) was high. Women with female sexual dysfunction were 3.84 times more likely to have vulvovaginal atrophy than women without female sexual dysfunction (95% CI: 2.99-4.94). Hot flashes modified the association between vulvovaginal atrophy and desire difficulty. Educational level modified the association between vulvovaginal atrophy and arousal difficulty. Parity modified the association between vulvovaginal atrophy and orgasm difficulty.

Conclusions: This large population-based study provides evidence of an association between vulvovaginal atrophy and overall female sexual dysfunction and its subtypes. Therapies aiming to reduce symptoms of one condition may also relieve symptoms of the other.

In this large population-based study, the prevalence of vulvovaginal atrophy (57%) and female sexual dysfunction (55%) was high. Women with female sexual dysfunction were 3.84 times more likely to have vulvovaginal atrophy than women without female sexual dysfunction (95% CI, 2.99-4.94).

Received August 6, 2007; revised and accepted September 5, 2007.

From the 1Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; 2Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park; 3Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN.

Funding/support: This research was funded by GlaxoSmithKline.

Financial disclosure: K.B.L. received an unrestricted educational grant from GlaxoSmithKline and is a recipient of a Merck Foundation Pre-Doctoral Fellowship in Pharmacoepidemiology. R.E.W. is an employee of GlaxoSmithKline and has equity interest in GlaxoSmithKline.

Address correspondence to: Kristen Levine, MSPH, Department of Epidemiology, CB #7435, University of North Carolina at Chapel Hill, Chapel Hill, NC. E-mail: kristen.levine@unc.edu

©2008The North American Menopause Society