Vaginal Atrophy and Sexual Dysfunction in Current Users of Systemic Postmenopausal Hormone Therapy
Suchada Indhavivadhana MD*, Pichai Leerasiri MD*, Manee Rattanachaiyanont MD*, Somsak Laiwejpithaya MD**, Prasong Tanmahasamut MD*, Kitirat Techatraisak MD*, Surasak Angsuwathana MD*
Affiliation : * Gynecologic Endocrinology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Gynecologic Cytology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To determine the prevalence of vaginal atrophy and sexual dysfunction in current users of systemic postmenopausal
hormone therapy (pHT).
Material and Method: A cross-sectional study was conducted in 97 current users of pHT at Siriraj Menopause Clinic from
2005 to 2007. Subjective symptoms of vaginal atrophy and sexual dysfunction were assessed by interviewing. Objective signs
of vaginal atrophy were assessed using pelvic examination, vaginal pH, and maturation value (MV).
Results : The prevalence of vaginal atrophy in current users of systemic pHT determining from patient’s symptoms, pelvic
examination, vaginal pH, and MV were 44.3%, 15.5%, 21.6% and 8.8%, respectively. The prevalence of sexual dysfunction
varied from 48.7% to 71.6% depending on types of dysfunction. There was poor association between the subjective symptoms
and signs, and the objective indicators of vaginal atrophy. Among various regimens of pHT, tibolone had the lowest
prevalence of subjective atrophic symptoms; estrogen-only pHT had the lowest prevalence of objective atrophic signs; and
raloxifene had the highest prevalence of atrophic symptoms and signs, and sexual dysfunction. There was statistically
significant association between regimens of pHT and objective indicators for vaginal atrophy (p = 0.004 for pH, and 0.000
for MV).
Conclusion : Current users of systemic pHT still have vaginal atrophy and sexual dysfunction which relates to regimens of
pHT. The prevalence of vaginal atrophy varies depending on the assessment methods. The subjective method gives higher
prevalence than the objective one does. Since the subjective symptoms of vaginal atrophy would have more adverse effect on
quality of life than the objective signs do, the authors suggest that patients’ complaints be used to assess factors affecting
vaginal atrophy in further research.
Keywords : Vaginal atrophy, Sexual dysfunction, Current users, Postmenopausal hormone therapy
