About VVA

The first oral prescription treatment that does not contain hormones, for post-menopausal women with moderate to severe symptomatic vulvovaginal atrophy (VVA) ^4-6

The impact of VVA

The symptoms of vulvovaginal atrophy (VVA) can have a significant impact on a woman’s life¹

Over 60% of post-menopausal women suffer from the symptoms of VVA, such as vaginal dryness and dyspareunia^1-3

What is VVA?

Healthy pre-menopausal vaginal epithelium

Vaginal epithelium following low oestrogen levels

Well lubricated and thick vaginal epithelium

- Stratified squamous epithelium²

- Thickened rugated surface^2-4

- Moist²

- pH ≤ 4.5²

Thinning of vaginal epithelium and loss of lubrication

- Thinner epithelium^2-4

- Flattening of rugae and reduced elasticity^2-4

- Increased connective tissue in relation to epithelium^2-4

- Decrease in blood flow and vaginal lubrication^2-4

- Increased pH (≥4.6)²

This leads to vulvovaginal atrophy (VVA), which is associated with a number of symptoms, such as dyspareunia (pain with intercourse), vaginal dryness, and irritation.¹

Symptoms, including dyspareunia, may affect sexual activities, relationships, daily activities, and quality of life.¹

There are an estimated 13 million women in the post-menopausal age group in the UK⁵

Over 60% of post-menopausal women suffer from the symptoms of VVA, such as vaginal dryness and dyspareunia^6-8

Half of post-menopausal women, aged 45-75 years, are sexually active⁹

Symptoms of VVA can impair everyday life, sexual relationships and physical intimacy of post-menopausal women and their partners^{6, 10, 11}

60% of women with postmenopausal vaginal discomfort will avoid physical intimacy¹¹

Symptoms of VVA:

Impair the quality of a woman’s sex life and relationship, causing significant emotional distress, reduced self-esteem and well-being¹¹
Impact on everyday life, including her sleep, enjoyment of life and temperament^6,10

More than half of women with vaginal discomfort are untreated¹²

63% of post-menopausal women do not know that vaginal discomfort is a chronic condition⁶, the underlying cause of which can usually be treated.

Dissatisfaction with current treatment options is high^10,13

Only 45% of women are satisfied with the treatments available for vulvovaginal atrophy¹⁴

Some women receiving OTC treatment have concerns over efficacy¹⁰
Some women have a fear of using hormones¹³
Vaginal oestrogens are contraindicated in women with a history of breast cancer^15-17
Some women dislike the route of administration and messiness of available treatments¹³
39% of women find local therapies uncomfortable to apply¹⁰
Some women are physically not able to apply local oestrogens¹³

Women may be too embarrassed or uncomfortable to discuss their symptoms, but they need your help in managing their VVA¹

Just over half of post-menopausal women with VVA have discussed symptoms with their healthcare professional¹⁰

Without help from someone knowledgeable, a lot of women with VVA could be…

…Afraid to speak and suffering in silence without knowing how to bring up the subject

…Unaware their symptoms are treatable

…Dissatisfied with using treatments they don’t like

Diagnosing VVA

Validated tools such as the Vaginal Health Index (VHI), which includes vaginal pH measure, and the Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire can be useful in evaluating VVA^{19, 22}

Patient symptoms²

Signs on visual examination²⁰

Laboratory findings²

Vaginal health index (VHI)^19,21

Vaginal dryness

Vaginal pain associated with sexual activity (dyspareunia)

Vaginal and/or vulvar irritation or itching

Dysuria

Vaginal bleeding associated with sexual activity

Pallor

Redness

Petechiae

Dryness

Friability

<5% superficial cells on VMI

Vaginal pH of ≥4.6

Lower score corresponds to greater urogenital atrophy

Vaginal Health Index (VHI)¹³

Score	Overall elasticity*	Fluid secretion type and consistency	pH	Epithelial mucosa	Moisture
1	None	None	6.1	Petechiae noted before contact	None, mucosa inflamed
2	Poor	Scant, thin yellow	5.6-6.0	Bleeds with light contact	None, mucosa not inflamed
3	Fair	Superficial, thin white	5.1-5.5	Bleeds with scraping	Minimal
4	Good	Moderate, thin white	4.7-5.0	Not friable, thin mucosa	Moderate
5	Excellent	Normal (white flocculent)	≤4.6	Not friable, normal mucosa	Normal

*Lower score corresponds to greater urogenital atrophy

The Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire

The DIVA questionnaire is designed to evaluate the impact of vaginal symptoms on women’s activities of daily living, emotional well-being, sexual functioning, and self-concept and body image²²

References:

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