VVA... Do you know what it is?

VVA affects many women yet, most women still don't know what it is. Today, we uncover the mystery of VVA...

Vaginal dryness is common among women of all ages, but is particularly common during and after menopause. In menopause, dryness is usually one of many symptoms of vaginal or vulvovaginal atrophy (VVA). Another term is ‘genitourinary syndrome of menopause (GSM)’ because the bladder is affected by the low estrogen status related to menopause.

The prevalence rates of vaginal dryness due to VVA or GSM are estimated at approximately 15% of premenopausal and up to 57% of postmenopausal women.

The causes of decreased vaginal lubrication are advancing age, hormonal changes of menopause, breastfeeding, stress, conditions such as diabetes, inflammatory bowel disease, chronic heart failure, and multiple sclerosis. Medical induced causes are radiation, chemotherapy, and antidepressant use.

There is an association between vaginal dryness and painful intercourse, called dyspareunia, which is estimated to affect around half of all women at some point in their lives. Inadequate lubrication is a common cause of dyspareunia which is defined as recurrent or persistent pain with sexual activity that causes marked distress.

The female sexual response is affected by neurotransmitters that can affect the blood supply and the smooth muscle relaxation of the genital, resulting in increased pelvic blood flow, vaginal lubrication, and clitoral and labial engorgement. During the reproductive years, estrogen plays a key role in maintaining the normal vaginal environment. As estrogen levels fall during menopause, vaginal atrophy, or thinning and inflammation of the vaginal walls and vulval tissues occur, which can result in decreased vaginal lubrication.

The Real Women's Views of Treatment Options for Menopausal Vaginal Changes (REVIVE) study consisted of a survey in 3046 postmenopausal women with VVA symptoms in the US. It  found the most common symptoms to be dryness (55% of participants), dyspareunia (44%), and irritation (37%), and these symptoms affected enjoyment of sex in over half (59%) of participants.

The symptoms of VVA may be successfully managed by a variety of prescription and over-the-counter (OTC) treatments. The choice of therapy depends on symptom severity, the effectiveness and safety of the therapy for the individual patient, and patient preference. Estrogen is able reverse VVA, but only after many months and sustained use.

Available treatments include personal lubricants and moisturizers, topical vaginal estrogen, hormone therapy, and the selective estrogen receptor modulator, ospemifene (indicated for dyspareunia).

For women who prefer not to or cannot use estrogen, personal moisturizers and lubricants are often recommended. Lubricants can relieve vaginal dryness and discomfort during sexual activity, providing short-term relief from dyspareunia. Vaginal moisturizers are intended to be used primarily for the relief of vaginal dryness on a day-to-day basis, to provide comfort and offer long-term benefits.

Despite the availability of various treatment options, many women to not seek care or advice, and if they do, they often wait over a year. Lack of awareness among women about the physical changes associated with menopause and the availability of effective and well-tolerated treatments, reluctance to discuss symptoms with their healthcare professionals, safety concerns, inconvenience, and inadequate symptom relief from available treatments are potential barriers to seeking relief.

pH and osmolality values of tested products (1).

Results are presented as the mean ± SD (n = 2–3). pH goal 3.5 to 4.5

Osmolality best between 380 and 1200

Read part three of Dr. Kim series on Menopause :
Painful Relations Past Menopause. Is it all related to Hormonal Imbalance?

1. Cunha, A. R., Machado, R. M., Palmeira-de-Oliveira, A., Martinez-de-Oliveira, J., das Neves, J., & Palmeira-de-Oliveira, R. (2014). Characterization of commercially available vaginal lubricants: a safety perspective. Pharmaceutics, 6(3), 530–542. https://doi.org/10.3390/pharmaceutics6030530