Are women with urogenital atrophy symptomatic?

Abstract

Objective: To correlate the physical findings of urogenital atrophy, an inevitable consequence of menopause, with symptoms suggestive of atrophic vaginitis. Methods: Women presenting for routine outpatient gynecologic care were asked to complete a five-item questionnaire regarding the presence and severity (0–3) of vaginal atrophy symptoms. They underwent a pelvic examination recording vaginal mucosal changes and severity (0–3), including pH. Symptoms and physical findings were averaged for an overall score of 0–3. A vaginal sidewall cytologic maturation index (MI) was performed (range 0–100). Symptoms were correlated with mucosal changes, pH, and MI, using Spearman rank correlation. Results: Sixty-nine women, mean age 66 (range 23–89) were enrolled. Symptom scores were surprisingly low, mean 0.36 (range 0–2.6). Symptom scores were poorly correlated with age (0.35) and physical findings (0.35) but not with MI (–0.04). There was a moderate correlation between physical examination and MI (–0.49). Low pH correlated well with high MI. Women on estrogen therapy had higher symptom ( P = 0.0097) and physical finding ( P = 0.0311) scores. Conclusions: Although urogenital atrophy occurs universally after menopause, most elderly women are minimally symptomatic. Symptoms alone should not guide initiation of therapy.