Elsevier

Maturitas

Volume 91, September 2016, Pages 81-90
Maturitas

The REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey in Europe: Country-specific comparisons of postmenopausal women’s perceptions, experiences and needs

https://doi.org/10.1016/j.maturitas.2016.06.010Get rights and content

Highlights

  • An analysis of the variability across Europe of vaginal health perception is reported.

  • The opportunity for improving quality of sexual life varied among European countries.

  • ‘Healthcare system’ was one of the main factors influencing the management of vulvar and vaginal atrophy.

  • Interaction with physicians and socio-cultural elements impacted women perceptions.

Abstract

Objectives

To achieve a better comprehension of the variability of perceptions, experiences and needs in terms of sexual and vaginal health in postmenopausal women (PMW) from four different European countries.

Methods

An internet-based survey was conducted in Italy, Germany, Spain and the United Kingdom with a total surveyed population of 3768 PMW aged between 45 and 75 years.

Results

The UK sample was significantly older, with almost a quarter of participants over 65 years of age, and had the highest proportion of women experiencing recent vulvar and vaginal atrophy (52.8%). The majority of Italian and Spanish participants were receiving VVA treatment, whereas in the UK only 28% of PMW were on medication. The most common menopausal symptom was vaginal/vulvar dryness, with almost 80% of participants reporting it in all the countries except the UK (48%). On the other hand, vaginal/vulvar irritation was more frequently reported in the UK (41%). The percentage of participants with a partner was lower in the UK (71%), as was the monthly rate of sexual activity (49%). In the UK, the proportion of participants who had seen a healthcare professional for gynaecological reasons in the last year was lower than in other countries (27% vs. ≥50%), as was the proportion who has discussed their VVA symptoms with them (45% vs. ∼67%). In this sense, UK PMW waited for a longer before asking for help (especially for pain with intercourse and dryness). The main issues relating to VVA treatment difficulties expressed by participants were administration route in the UK, efficacy in Germany, and side-effects in Italy.

Conclusions

Although all European women shared the same expectation of improving the quality of their sex lives, the opportunity for that varied among different countries in relation to the healthcare system and to the effective communication achieved with healthcare professionals when managing VVA.

Introduction

One of the main consequences of reduced estrogen levels after menopause is vulvar and vaginal atrophy (VVA), which affects almost 40–60% of postmenopausal women [1], [2], [3], [4], [5], [6] and is part of the more general genitourinary syndrome of menopause [7], [8]. Women who suffer from this medical condition often have a combination of symptoms that include loss of vaginal elasticity, dryness, decreased lubrication, irritation, and dyspareunia which significantly impact daily and sexual life in aging populations [3], [9]. Despite the social impact of VVA and the availability of therapeutic agents, many women do not report their symptoms to healthcare professionals (HCP) and thus their clinical status remains underdiagnosed and untreated [10].

Many HCPs and patients report difficulty in broaching the subject during consultations due to the embarrassment in acknowledging symptomatology [11], [12], [13], [14]. Therefore, underreported symptoms are usually followed by significant disease progression in many women and a considerable period of chronic suffering [15]. Moreover, the frequently-observed late diagnosis combined with concerns expressed both by patients and HCPs regarding the long-term safety of estrogen-containing product application, and the inconvenience of topical product application can compromise the therapeutic approach of VVA and the treatment adherence [16], [17]. Currently available treatments include topical over-the-counter (OTC) non-hormonal moisturizers and lubricants, as well as prescribed systemic hormonal and local vaginal estrogen treatments [3].

Results from several cross-cultural surveys have found that VVA has a global, general negative impact on sexual health, behavior and satisfaction of postmenopausal women, beyond the possible confounding factors due to population heterogeneity and limited diagnostic criteria [10], [14], [18], [19], [20]. Recently, a large study based on an online questionnaire was published with the aim of characterizing the experience and perception of VVA symptoms by postmenopausal women and to further elucidate the state of the current interactions with HCPs in Europe: the REVIVE-EU (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs—Europe) [21].

The objective of the present analysis, based on the REVIVE-EU survey, was to better understand the inter-country variation (in Europe) of women’s perceptions, experiences and needs in relation to sexual and vaginal health, highlighting common and socio-culturally specific aspects of the four European countries studied (Germany, Italy, Spain and United Kingdom). The aim of this analysis was to gain information on the four countries women’s awareness of VVA, its impact on women’s lives as well as to collect data on HCP relationships and attitudes towards VVA treatments together with information seeking behavior.

Section snippets

Population

The European REVIVE included a total cohort of 3768 postmenopausal women with VVA symptoms from four European countries (1000 from Germany, 1000 from Italy, 1000 from the United Kingdom, and 768 from Spain). The inclusion criteria were: natural or surgically induced menopausal women, residence in one of the four study countries, aged between 45–75 years old, experience of one or more vulvar and/or vaginal atrophy symptoms (dryness, pain with sex, irritation, tenderness, pain with exercise

Survey population distribution

The baseline demographics and clinical characteristics of the survey participants from the four countries are summarized in Table 1. The average age of the Spanish sample was the lowest with 55.3% belonging to the 45–55 age group and only 3.6% of participants being older than 65 years old. In contrast, the UK sample was significantly older (25.0% in the 45–55 years age group and 23.5% over 65 years old). Among the cohort of surveyed participants (Fig. 1), around 44% of the participants in Spain

Discussion

The European REVIVE survey of 3768 postmenopausal women with diagnosed VVA was the largest cohort of participants included in a study of this nature to date [21]. The REVIVE study highlighted several limitations in diagnosis, clinical management and treatment approaches for this chronic condition in Europe, as well as considerable lack of awareness of VVA underlying causes in postmenopausal sufferers. For the first time, this analysis aimed to investigate the population and country variation

Conclusions

Regardless of cultural differences and the role of different health systems, postmenopausal women shared the expectation that a treatment should improve the quality of their sex lives and promote a return of the body and genital organs to a pre-menopause state. Nevertheless, the method to achieve this was varied among different European countries, most influenced by the nature of their health care system, the involvement of patients in treatment decisions and the effective communication

Contributors

REN, SP and NP designed the study.

REN, SP, MP and NP developed the methodology.

REN, SP and NP collected the data.

MP performed the analysis.

REN wrote the manuscript.

SP, MP and NP critically revised the manuscript.

All authors gave final approval of the version to be published.

Conflict of interest

Rossella E. Nappi had a financial relationship (lecturer, member of advisory boards and/or consultant) with Bayer HealthCare AG, Boehringer Ingelheim, Ely Lilly, Endoceutics, Gedeon Richter, HRA Pharma, Merck Sharpe & Dohme, Novo Nordisk, Pfizer Inc, Procter & Gamble Co, Shionogi Limited and TEVA Women’s Health Inc.

Santiago Palacios has been a symposium speaker or advisory board member for Servier, Pfizer, GSK, Abbott, Ferrer, Bioiberica, Shionogi, Amgen, Novo Nordisk and Teva. He has also

Funding

Financial support for the REVIVE Survey was provided by Shionogi Limited.

Ethical approval

The comprehensive online questionnaire was approved by the corresponding accredited institutional review boards at the respective institutions (University of Pavia, Palacios Institute of Women‘s Health, Imperial College London). All survey participants were appropriately informed of the nature of the study and gave informed consent to participate before completing the online questionnaire.

Provenance and peer review

This article has undergone peer review.

Acknowledgements

The authors would like to thank Emili González-Pérez (TFS Develop), Scientific Advisor and Medical Writer, for his assistance with manuscript preparation. Sponsorship and article processing charges for this study were funded by Shionogi, Inc.

References (30)

  • S.A. Kingsberg et al.

    Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey

    J. Sex. Med.

    (2013)
  • K.S. Sutton et al.

    To lube or not to lube: experiences and perceptions of lubricant use in women with and without dyspareunia

    J. Sex. Med.

    (2012)
  • D.J. Portman et al.

    Vulvovaginal atrophy terminology consensus conference panel, genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the international society for the study of women’s sexual health and the north american menopause society

    Menopause

    (2014)
  • 2011 EU Census

    Eurostat, the Statistical Office of the European Union

    (2012)
  • R.E. Nappi et al.

    Vaginal health: insights, views & attitudes (VIVA)—results from an international survey

    Climacteric

    (2012)
  • Cited by (44)

    • The role of hormone therapy in urogenital health after menopause

      2021, Best Practice and Research: Clinical Endocrinology and Metabolism
    • Intravaginal 6.5 mg prasterone administration in postmenopausal women with overactive bladder syndrome: A pilot study

      2021, European Journal of Obstetrics and Gynecology and Reproductive Biology
      Citation Excerpt :

      Epithelial mucosa appeared less fragile and not bloody. Two large studies, VVIVA (Vaginal Health: Insights, Views, & Attitudes)[43] and REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) [44], evidenced the negative impact of GSM on women QoL. Furthermore, several authors demonstrated that intravaginal administration of prasterone has beneficial effects on QoL in women affected by VVA, by analyzing dyspareunia and QoL related to sexual function.[40,45]

    • The Gynogram: A Multicentric Validation of a New Psychometric Tool to Assess Coital Pain Associated With VVA and Its Impact on Sexual Quality of Life in Menopausal Women

      2021, Journal of Sexual Medicine
      Citation Excerpt :

      If menopause itself embodies a great symbolic, existential and cultural significance,4 on the other hand the coital pain due to hormonal changes occurring in this period appears to be a crucial issue.5,6 In this regard, a frequent condition bearing on the general well-being of elderly females and couples is the Vulvo-Vaginal Atrophy (VVA),7,8 affecting about fifty per cent of post-menopausal women.9 The primary cause of this multi-factorial symptom is the decrease of estrogen levels, typical of the menopause, inducing the reduction of vaginal blood flow, loss of vaginal elasticity, proliferation of connective tissue of poor quality, loss of lubrication, pain during sexual intercourse, and, finally, impairment of sexual intimacy.

    View all citing articles on Scopus
    View full text