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Clinician knowledge, attitudes, and barriers to management of vulvovaginal atrophy

variations in primary care and gynecology

Vesco, Kimberly K., MD, MPH1,2; Beadle, Kate, NP, NCMP1,2; Stoneburner, Ashley, MPH1; Bulkley, Joanna, PhD1; Leo, Michael C., PhD1; Clark, Amanda L., MD, MCR, NCMP1,2

doi: 10.1097/GME.0000000000001198
Original Articles

Objective: Vulvovaginal atrophy is a common, but under-recognized condition affecting postmenopausal women. To guide development of an intervention to boost its detection and treatment, we surveyed primary care and gynecology clinicians practicing in an integrated healthcare system.

Methods: We constructed a three-part survey that contained (1) eight multiple-choice knowledge questions; (2) three Likert-scale questions regarding clinicians’ likelihood of assessing for vulvovaginal atrophy symptoms at a routine (well) visit, confidence in advising patients about symptoms and counseling about therapy; and (3) a 12-item check list of potential barriers to diagnosis and treatment. Analyses were performed using multiple regression.

Results: Of the 360 clinicians who were sent an e-mail request, 119 (90 primary care, 29 gynecology) completed the survey (33%). Responders and nonresponders did not differ by age, specialty, or clinician type. The proportion with correct responses to knowledge questions differed between primary care (63%) and gynecology (77%) (adjusted mean difference [AMD] =16, 95% CI [10-22]). Primary care clinicians were less likely than gynecology clinicians to assess for symptoms (AMD = 1.04, 95% CI [0.55-1.52]), and were less confident about their ability to advise on symptoms (AMD = 0.66, 95% CI [0.33-0.99]) and to counsel patients about treatment (AMD = 0.76, 95% CI [0.42-1.10]). Lack of time (71%) and educational materials (44%) were the most common barriers to diagnosis and treatment.

Conclusions: Primary care and gynecology clinicians differ in their knowledge and confidence in managing vulvovaginal atrophy but report similar practice barriers. Addressing identified knowledge deficits and practice barriers may lead to improved management of vulvovaginal atrophy.

1Center for Health Research, Kaiser Permanente, Portland, OR

2Department of Obstetrics and Gynecology, Kaiser Permanente Northwest, Portland, OR.

Address correspondence to: Kimberly K. Vesco, MD, MPH, Amanda L. Clark, MD, MCR, NCMP, Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR 97227. E-mails:,

Received 8 May, 2018

Revised 23 July, 2018

Accepted 23 July, 2018

Funding/support: This work was supported by an Independent Grant for Learning and Change, #10319749, funded by Pfizer Inc. in collaboration with The North American Menopause Society.

Financial disclosure/conflicts of interest: None reported.

Prior presentation of data: Dr. Vesco presented preliminary data from this study as an oral abstract presentation at the 21st HCSRN Annual Meeting, Long Beach, CA, March 11-13, 2015 and the 26th North American Menopause Society Annual Meeting, Las Vegas, NV, September 30-October 3, 2015.

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© 2019 by The North American Menopause Society.