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Factors associated with developing vaginal dryness symptoms in women transitioning through menopause

a longitudinal study

Waetjen, L. Elaine MD1; Crawford, Sybil L. PhD2; Chang, Po-Yin PhD1; Reed, Barbara D. MD3; Hess, Rachel MD, MS4; Avis, Nancy E. PhD5; Harlow, Sioban D. PhD6; Greendale, Gail A. MD7; Dugan, Sheila A. MD8; Gold, Ellen B. PhD1 for the Study of Women's Health Across the Nation (SWAN)

doi: 10.1097/GME.0000000000001130
Original Articles

Objective: To evaluate factors associated with incident self-reported vaginal dryness and the consequences of this symptom across the menopausal transition in a multiracial/ethnic cohort of community-dwelling women.

Methods: We analyzed questionnaire and biomarker data from baseline and 13 approximately annual visits over 17 years (1996-2013) from 2,435 participants in the Study of Women's Health Across the Nation, a prospective cohort study. We used discrete-time Cox proportional-hazards regression to identify predictors of incident vaginal dryness and to evaluate vaginal dryness as a predictor of pain during intercourse and changes in sexual intercourse frequency.

Results: The prevalence of vaginal dryness increased from 19.4% among all women at baseline (ages 42-53 years) to 34.0% at the 13th visit (ages 57-69 years). Advancing menopausal stage, surgical menopause, anxiety, and being married were positively associated with developing vaginal dryness, regardless of partnered sexual activity. For women not using hormone therapy, higher concurrent levels of endogenous estradiol were inversely associated (multivariable-adjusted hazard ratio: 0.94 per 0.5 standard deviation increase, 95% confidence interval: 0.91-0.98). Concurrent testosterone levels, concurrent dehydroepiandrosterone sulfate levels, and longitudinal change in any reproductive hormone were not associated with developing vaginal dryness. Both vaginal dryness and lubricant use were associated with subsequent reporting of pain during intercourse, but not with a decline in intercourse frequency.

Conclusion: In these longitudinal analyses, our data support many clinical observations about the relationship between vaginal dryness, menopause, and pain during intercourse, and suggest that reporting of vaginal dryness is not related to androgen level or sexual intercourse frequency.

1School of Medicine, University of California Davis, Sacramento, CA

2Department of Statistics, University of Massachusetts, Worcester, MA

3School of Medicine, University of Michigan, Ann Arbor, MI

4School of Medicine, University of Utah, Salt Lake City, UT

5Wake Forest School of Medicine, Winston-Salem, NC

6School of Public Health, University of Michigan, Ann Arbor, MI

7David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA

8Rush University, Chicago, IL.

Address correspondence to: L. Elaine Waetjen, MD, Department of Obstetrics and Gynecology, School of Medicine, University of California, Davis, 4860 Y St, Suite 2500, Sacramento, CA 95817. E-mail:

Received 12 January, 2018

Revised 30 March, 2018

Accepted 30 March, 2018

Funding/support: The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women's Health (ORWH) (Grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH, or the NIH.

Financial disclosure/conflicts of interest: None reported.

Steering Committee: Susan Johnson, Current Chair.

Chris Gallagher, Former Chair.

© 2018 by The North American Menopause Society.