Application of the 21-item Vulvovaginal Symptoms Questionnaire in postmenopausal Spanish women

Development and psychometric properties of a measurement to ascertain the impact of genitourinary symptoms on health-related quality of life in menopausal women: the Cervantes-GSM questionnaire

OBJECTIVE

The Cervantes-GSM questionnaire is a novel tool currently being developed to examine the impact of genitourinary symptoms on health-related quality of life in adult women with genitourinary syndrome of menopause (GSM).

METHODS

A literature review and cognitive debriefing were conducted in women with GSM, which provided the basis for creating a draft questionnaire. This draft version was pilot-tested to check participant comprehension and ease of completion. The initial draft was then refined to obtain a 15-item version with five domains whose initial psychometric properties were analyzed in 130 adult women with GSM. The psychometric properties tested in this study were factorial structure, feasibility, reliability, and construct validity.

RESULTS

The Cervantes-GSM 15-item questionnaire consists of five domains: vulvovaginal symptoms, urinary symptoms, psychological (emotions), interference with daily activities, and sexuality. The instrument was shown to be feasible and easy to complete, regardless of age or educational level. Internal consistency was high (Cronbach α = 0.88). Construct validity was supported by convergent-divergent validity showing higher correlation coefficients between items in their own domain (>0.70) than with the other items and domains in the questionnaire. Cervantes-GSM also showed known group validity with significant differences in total score and most domains (13-20 points, P < 0.01) regardless of whether women chose local treatment of their genitourinary symptoms.

CONCLUSION

This study presents a novel questionnaire capable of assessing health-related quality of life in menopausal women with GSM. The tool has shown acceptable preliminary psychometric properties, including feasibility, factor structure, construct validity, and internal consistency.

Psychometric properties of a Persian version of the Vulvovaginal Symptoms Questionnaire for measuring vulvovaginal symptoms in postmenopausal women

OBJECTIVE

Vulvovaginal symptoms are common in postmenopausal women and can affect their quality of life and sexual function. Using a sample of postmenopausal Iranian women, we evaluated a Persian translation of the Vulvovaginal Symptoms Questionnaire (VSQ).

METHODS

This study included 201 postmenopausal Iranian women referred to dermatology and gynecology clinics affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. We translated the VSQ to the Persian language using the forward-backward method. We examined the questionnaire's internal consistency using Cronbach α coefficient and evaluated its construct validity using exploratory and confirmatory factor analyses.

RESULTS

A Cronbach α coefficient of 0.763 confirmed the overall internal consistency of the Persian VSQ. Exploratory factor analysis indicated that except for three items in the symptoms subscale, others had sufficient α coefficients, although some did not load on the expected subscales. Confirmatory factor analysis confirmed the appropriate allocation of all but two items to the expected subscales. An intraclass correlation coefficient of 0.89 confirmed the reliability of the questionnaire.

CONCLUSIONS

Although some parts of the Persian VSQ were unsatisfactory, most were appropriate for assessing vulvovaginal symptoms in postmenopausal Iranian women. We recommend further cultural adaptations.

Cross-cultural adaptation and psychometric evaluation of the Brazilian Portuguese version of the Vulvovaginal Symptoms Questionnaire

OBJECTIVE

The aims of this study were to perform a cross-cultural adaptation of the Vulvovaginal Symptoms Questionnaire (VSQ) into Brazilian Portuguese (VSQ-Br) and evaluate its measurement properties (structural validity, construct validity, internal consistency, and reliability).

METHODS

Cross-cultural adaptation was conducted through the translation, synthesis, and back-translation of the VSQ-Br. Subsequently, 314 women completed the Pelvic Floor Impact Questionnaire, Pelvic Floor Disorders Inventory, Medical Outcomes Study 36-Item Short-Form Health Survey, and VSQ-Br. Seven to 10 days later, participants completed the VSQ-Br for the second time. Data were submitted for confirmatory factor analysis. Cronbach α was used to verify internal consistency, and construct validity was assessed using Pearson correlation coefficient ( r ). Reliability was calculated using the intraclass correlation coefficient.

RESULTS

Confirmatory factor analysis showed that the questions were grouped into four domains (symptoms, emotions, life impact, and sexual impact). The model showed good fit (>0.95). The Cronbach α in this study was 0.85, reflecting adequate internal consistency. Adequate reliability was confirmed, with an intraclass correlation coefficient total score of 0.80. The VSQ-Br had a weak correlation with the pelvic domain of the Pelvic Floor Disorders Inventory, the pelvic organ prolapse domain of the Pelvic Floor Impact Questionnaire, and pain, vitality, and the social aspect domains of the Medical Outcomes Study 36-Item Short-Form Health Survey.

CONCLUSIONS

The VSQ-Br was validated and had acceptable measurement properties for assessing vulvovaginal symptoms in Brazilian women.

Vulvovaginal atrophy management with a laser: the placebo effect or the conditioning Pavlov reflex

Postmenopausal vulvovaginal pain and atrophy require appropriate and sensitive outcomes that correlate with the genital discomfort, symptoms and expected changes. In some studies, hormone and laser treatments do not detect benefits due to the fact that appropriate measuring tools were not used. While some studies have demonstrated placebo effects for both therapeutic approaches, others support that sham-intervention could be a therapeutic by creating a conditioning reflex. However, obtained results are directly related with the quality of outcomes: you get what you measure. It is imperative to follow the Core Outcomes in Menopause global initiative.

Vaginal collagen I and III changes after carbon dioxide laser application in postmenopausal women with the genitourinary syndrome: a pilot study

OBJECTIVE

The aim of the study was to evaluate the clinical response and collagen remodeling in the vaginal wall after three sessions of carbon dioxide (CO₂) laser application.

METHODS

Fourteen postmenopausal women with vulvovaginal atrophy, aged 45-65 years and sexually active, were evaluated with clinical questionnaires, gynecological examinations and histological techniques before and after 20 weeks of treatment (ClinicalTrials.gov NCT03939078). Treatment consisted of 3-monthly sessions of the CO₂ laser. Clinical questionnaires included the Vaginal Health Index, the Female Sexual Function Index and the International Consultation on Incontinence Questionnaires Short Form. Biopsies were taken from the lateral vaginal wall at week 0 (left wall) and week 20 (right wall). Tissue samples were stained with hematoxylin and eosin, Periodic Acid-Schiff, Picrosirius Red Stain and Orcein dyes. Immunohistochemical study was used to quantify collagens I and III in the samples.

RESULTS

The mean age was 54.4 ± 4.5 years, and the average time of amenorrhea was 7.6 ± 5.1 years. The Female Sexual Function Index and the Vaginal Health Index Score values increased while the International Consultation on Incontinence Questionnaire Short Form score decreased after the programmed treatment. There was no significant change in vaginal pH. Histological studies showed increases in the total and superficial epithelial cell layers, and type III collagen fibers (from 10.86 ± 7.66 to 16.87 ± 3.96, p < 0.05), and immunohistochemical studies confirmed the significant increase in collagen III.

CONCLUSION

Histological findings revealed epithelial atrophy reversal and collagen remodeling of the vaginal wall. Immunohistochemical analysis showed an increase in collagen type III fibers.

A Qualitative Exploration of Women's Experiences of Living With Chronic Vulvar Dermatoses

BACKGROUND

Many vulvar dermatoses (VDs) are chronic and cannot be "cured," thus affected women must learn to live with the impact of the disease, and its treatment, on their quality of life.

AIM

To qualitatively investigate the impact of VDs on women's quality of life through firsthand accounts.

METHODS

12 women, 7 with lichen sclerosus and 5 with erosive vulvovaginal lichen planus recruited from a vulvar disease clinic participated in in-depth, exploratory interviews. Scripts were analyzed by applying a thematic network. The following steps were used: (1) coding the text, (2) development of descriptive themes, and (3) generation of thematic networks.

OUTCOMES

The main outcome explored was the narrative experiences of women living with VDs.

RESULTS

A global theme of suffering emerged. Themes associated with this suffering were organized under the themes of isolation, interference, and grieving. Women felt isolated because they felt unable to talk about their suffering; experienced a lack of external validation and support; and felt different as individuals, women, and sexual beings. Most women expressed negative views of their genitalia. Women spoke of the VDs, and its management, as interfering with thoughts, activities, and sex life. Symptoms were described as all-encompassing. Women spoke about limiting and/or avoiding daily activities and, in particular, sexual activities. Women described diminished sexual pleasure and experienced loss in their intimate relationships. Women described an ongoing grieving process; anger and sadness over the loss of their former healthy self; the burden of ongoing treatment; and attempts to cope and accept their current condition.

CLINICAL IMPLICATIONS

The findings suggest that assessment of women with VDs should include a detailed history of the impact of the VDs on women's psychological and sexual health.

STRENGTHS AND LIMITATIONS

A strength of this study is that we openly explored the lived experiences of women who had been clinically diagnosed with vulvar lichen sclerosus and erosive vulvovaginal lichen planus. A limitation is that the findings may not represent the experience of women living with VDs who do not wish to discuss their VDs or who are undiagnosed, untreated, and/or treated by other health-care providers.

CONCLUSIONS

Women described profound impact of VDs on psychological and sexual health. Sadownik LA, Koert E, Maher C, et al. A Qualitative Exploration of Women's Experiences of Living With Chronic Vulvar Dermatoses. J Sex Med 2020;17:1740-1750.

Association between depressed mood and sexual function among mid-aged Paraguayan women

BACKGROUND

Depressive symptoms may affect female mid-life sexuality, whereas sexual problems tend to aggravate depression. Despite this, data assessing this association drawn from mid-aged Paraguayan women are scarce.

OBJECTIVE

This study aimed to assess the association between depressed mood and the risk of sexual dysfunction during female mid-life.

METHODS

Sexually active urban-living women from Asunción, Paraguay (n = 193, aged 40-60 years) were surveyed with the 6-item Female Sexual Function Index (FSFI-6), the 10-item Center for Epidemiological Studies Depression Scale (CESD-10), and a general questionnaire containing personal and partner information. Depressed mood was defined as a total CESD-10 score of 10 or more, and an increased risk for sexual dysfunction as an FSFI-6 total score of 19 or less. The association of depressed mood and an increased risk of sexual dysfunction was evaluated with multivariable Poisson regression.

RESULTS

The mean age (±standard deviation) of surveyed woman was 48.3 ± 6.0 years and 61.1% (n = 118) were perimenopausal and postmenopausal. A total of 21.8% (n = 42) had depressed mood and 28.5% (n = 55) had an increased risk of sexual dysfunction. The final adjusted regression model determined that women with depressed mood were twice as likely to have an increased risk of sexual dysfunction, compared to women with normal mood (adjusted prevalence ratio = 2.14, 95% confidence interval 1.26-3.60). On the other hand, depressed mood was associated with a mean total FSFI-6 score that was 20% lower than that observed among women with normal mood (adjusted incidence rate ratio = 0.80, 95% confidence interval 0.68-0.93).

CONCLUSION

In this mid-aged Paraguayan female sample there was a significant association between depressed mood and an increased risk of sexual dysfunction.

Measurement properties of patient-reported outcome measures (PROMs) for women with genitourinary syndrome of menopause: a systematic review

OBJECTIVE

Genitourinary syndrome of menopause affects up to 50% of postmenopausal women and has negative impacts on the women's quality of life. In this systematic review, we aimed to identify and assess the measurement properties of all existing patient-reported outcome measures (PROMs) specific for genitourinary symptoms that were developed and/or validated for measuring patient-reported outcomes in postmenopausal women.

METHODS

Studies which evaluated, described, or compared measurement properties of PROMs were considered as eligible. We performed a systematic literature search in MEDLINE, EMBASE, and Web of Science. The methodological quality of each study was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) Risk of Bias checklist. Furthermore, predefined quality criteria for good measurement properties were applied and the quality of the evidence was graded.

RESULTS

Nine articles reporting on four PROMs were included. Two instruments, the Vulvovaginal Symptoms Questionnaire and the Day-to-Day Impact of Vaginal Aging Questionnaire, can be further recommended for use. Both showed moderate to high quality of evidence for sufficient structural validity, internal consistency, and construct validity. The two other instruments, urogenital atrophy quality of life (UGAQoL) and the Urogenital Symptom Scale, cannot be recommended for use, whereby the UGAQoL still has the opportunity to be recommended if the authors gave access to the instrument and further validation studies were conducted.

CONCLUSIONS

Both Vulvovaginal Symptoms Questionnaire and Day-to-Day Impact of Vaginal Aging Questionnaire can be recommended for use and results obtained with these two instruments can be seen as trustworthy. Future validation studies should focus on those two instruments.