No Time for 'Taboos'

A call for improvements to postmenopausal vaginal care

/ Author:  / Reviewed by: Joseph V. Madia, MD

To mark World Menopause Day on 18th October 2010, the International Menopause Society (IMS) is launching new Recommendations for the management of postmenopausal vaginal atrophy.

Vaginal atrophy is a distressing condition that will affect up to half of women after menopause. This new guidance is essential as, according to new research, one in two women with vaginal atrophy (VA) will live with their condition unnecessarily for over three years, despite effective treatments being available. The data suggests that this is largely due to poor awareness and understanding of the condition among women, and because VA is a “taboo” subject - even between a doctor and patient.

VA is characterised by symptoms including vaginal dryness, itching, increased tendency of infection and pain during sex. It occurs when the vaginal walls become thin, fragile and inflamed due to a reduction of oestrogen in the body. While VA has an obvious impact on sexual intimacy, it also has negative consequences for a woman’s personal relationships, self-esteem and overall quality of life. If left untreated, VA can lead to serious long-term urogenital problems, including incontinence. However, despite these negative implications, just one in four women will actually speak to her doctor about VA.1

Dr David Sturdee, President of the IMS and lead author of the Recommendations, said, “It is unacceptable that women are living with VA for so long, when various safe and effective treatments are available. So, to mark World Menopause Day, the IMS is launching the new Recommendations and is calling upon doctors to proactively raise the topic of vaginal health with postmenopausal patients. Women with VA are also encouraged to seek medical advice, as there is absolutely no need for them to continue suffering in silence.”

The Recommendations note that many women may not report VA symptoms to their doctor because of concerns about taking hormone replacement therapy (HRT). Some of this reluctance is due to the adverse publicity for HRT over recent years, but, regardless of whether these concerns are justified, local oestrogen therapy for VA, which delivers a low dose of hormone directly to the vagina, is not associated with the possible risks of systemic (oral) HRT. Doctors need to ensure patients fully understand this, so that they can benefit from VA treatment.

In addition, women with VA may have cultural or religious reasons for not talking to their doctor about their symptoms, and women in general may be understandably reluctant to discuss such private matters, particularly with a male doctor. The Recommendations offer advice and guidance to healthcare professionals, to enable them to initiate a successful dialogue with their patient. Most women express relief and respond positively when a doctor initiates the conversation about this topic.

Survey highlights challenges in awareness and communication about VA

Results from the VIVA (Vaginal Health: Insights, Views & Attitudes) Survey, an international study involving over 3,500 postmenopausal women, show that 96% of postmenopausal women are incorrectly attributing VA symptoms to other conditions such as thrush or a bladder infection. The data also show that women do not understand that VA is a chronic condition, and are resorting to short-term symptom relief using lubricants and moisturisers, when treatment for the underlying cause is available from the doctor.

The VIVA Survey also found that half of women would not discuss VA symptoms with their physician. In addition, only two in five women would talk to their spouse or partner about VA and two-thirds reported that their mother never spoke to them about menopause, suggesting that VA is still very much a taboo subject.

Dr Rossella Nappi, Associate Professor of Obstetrics and Gynecology, Research Center for Reproductive Medicine and Director of the Gynecological Endocrinology & Menopause Unit, University of Pavia (Italy), said, “It is so sad that women are suffering in silence with this condition; many believe that VA is just an inevitable part of menopause and that they have no choice but to live with the consequences. However, this is not the case, so it is vital that a dialogue about vaginal health is initiated with postmenopausal patients as part of routine.”

Reviewed by: 
Review Date: 
October 11, 2010
Last Updated:
October 11, 2010