New data, published today in Menopause International, suggests that post-menopausal women in Britain are experiencing less sex, and less satisfying sex compared to their European and North American counterparts1, because they are considerably less likely to access appropriate treatment for a common, taboo condition called vaginal atrophy1.
The first-of-its-kind study, called the CLarifying vaginal atrophy's impact On SEx and Relationships (CLOSER) study, showed that British post-menopausal women with vaginal atrophy are more likely to experience less sex1, and less satisfying sex, compared to other women in Europe and North America (67% and 61% vs 58% and 49% overall, respectively)1. Fear of painful sex was one of the main reasons women avoided intimacy (63%)1, with almost one third of women (30%) and male partners (29%) saying that vaginal discomfort had caused a "big problem" for their sex lives1.
Despite over one and a half million women across the UK potentially experiencing this problem2,4, British women in CLOSER were 50% less likely (21% versus 41% overall) to receive local oestrogen treatment, compared to women from other countries1.
"Given the obvious impact of vaginal atrophy on women in the UK, and their partners, it is very sad to learn that we are lagging behind other Western countries in terms of ensuring appropriate access to treatment," commented Dr Heather Currie, co-author of the study and Associate Specialist Gynaecologist at the Dumfries and Galloway Royal Infirmary, founder of menopausematters.co.uk and Honorary Secretary of the British Menopause Society. "It is our hope that the CLOSER study will encourage our fellow medical professionals, and women themselves, to routinely raise the topic of post-menopausal vaginal health, thereby facilitating appropriate diagnosis and treatment."
Vaginal atrophy is a chronic condition caused by a drop in oestrogen levels, with symptoms including vaginal dryness, itching and painful intercourse5. The condition can have a significant emotional impact, as well as on quality of life, and can lead to serious long-term urogenital problems if left untreated (e.g. incontinence)6.
Local oestrogen, the preferred treatment for vaginal atrophy according to The British Menopause Society7, is applied directly to the vagina while, in systemic hormone therapy, the hormones travel around the entire body7. As vaginal atrophy is a chronic condition, treatment needs to be continued to maintain the benefits7.
"More than two-thirds (68%) of British women in CLOSER used lubricants and moisturisers to treat their vaginal symptoms, but these are not as effective as oestrogen therapy as they do not treat the underlying cause," explained Dr Nick Panay, co-author and Consultant Gynaecologist, Queen Charlotte's & Chelsea and Chelsea & Westminster Hospitals, London, and Immediate Past Chair of the British Menopause Society. "Local oestrogen offers women a well-tolerated and effective solution to vaginal atrophy which, as the CLOSER study illustrates, can significantly disrupt many relationships."
British women who had tried local oestrogen treatment for vaginal atrophy reported beneficial effects such as less painful sex (58%)8, more satisfying sex for their partner (42%)8 and themselves (40%)8, feeling closer and less isolated from their partner (33%)8, having sex more often (27%)8, and saying that they now look forward to having sex (26%)8.
Explore further: Long-term consequences of vaginal delivery
More information: References
1. Domoney C, Currie H, Panay N, Maamari R, Nappi RE. The CLOSER survey: impact of postmenopausal vaginal discomfort on women and male partners in the UK. Menopause International. June 2013; 19(2):69-76.
2. Nappi RE, Kokot-Kierepa M. Vaginal health: Insights, Views and Attitudes (VIVA) – results from an international survey. Climacteric. February 2012;15:36-44.
3. Cardozo L, Bachmann G, McClish D, Fonda D, Birgerson L. Meta-analysis of estrogen therapy in the management of urogenital atrophy in postmenopausal women: second report of the Hormones and Urogenital Therapy Committee. Obstet Gynecol 1998;92:722-7.
4. Office for National Statistics. Table 1 2011 Census: Usual resident population by five-year age group and sex, United Kingdom and constituent countries. Last accessed: May 2013.
5. Simon J, et al. Effective Treatment of Vaginal Atrophy With an ultra-Low-Dose Estradiol Vaginal Tablet. Obstetrics & Gynecology. 2008; 112(5):1053-1060.
6. Hextall A. Oestrogens and lower urinary tract function. Maturitas. 2000;36:83-92
7.Panay N, Hamoda H, Arya R and Savvas M on behalf of The British Menopause Society. The 2013 British Menopause Society & Women's Health Concern recommendations on hormone replacement therapy. Menopause International. Published online before print May 2013;Accessble at: http://min.sagepub.com/content/early/2013/05/23/1754045313489645; doi: 10.1177/1754045313489645.
8. Domoney C, et al. Vaginal Health: When intimacy matters! British Menopause Society (BMS) Annual Congress, 2012.