The Humanistic and Economic Impact of Vaginal Dryness in Premenopausal,Perimenopausal,and Postmenopausal Women

Abstract

Background:

Vaginal dryness is a highly prevalent condition. Much of previous research has focused on postmenopausal women. The aim of this study was to evaluate the impact of vaginal dryness on a predominantly premenopausal sample of women.

Methods:

The study was conducted online. Participants with self-reported vaginal dryness completed the Work Productivity and Activity Impairment (WPAI) scale, and a generic quality-of-life instrument, the assessment of quality of life instrument (AQoL)-4D. Information regarding sociodemographics was also collected. National (United Kingdom) median age-specific weekly wages were used to derive the economic cost of vaginal dryness.

Results:

A total of 524 women completed the study. The average age was 40.18 years (range 18–70 years) and just under 62% of the sample was premenopausal. Around 40% of women reported severe or very severe vaginal dryness. The average AQoL-4D score was 0.584 (standard deviation [SD]: 0.286) and decreased in line with level of severity (p = 0.014). Quality of life was not related to either age (p = 0.14) or menopausal status (p = 0.055). Of those women in employment (n = 369), 16.5% (SD: 24.3%) of their working hours were lost due to vaginal dryness; work impairment level was 34.4% (SD: 31.8%). The average lost weekly wage was £67.82 (SD: £130.88). The estimated average loss to employers was £82.56 (SD: £109.38) with a total weekly loss of £31,622.

Conclusions:

This study has shown the significant impact vaginal dryness has on premenopausal and postmenopausal women in terms of quality of life and economic burden, as well as the potential cost of this condition to society.

Introduction

Vaginal dryness is a suboptimal health condition that can cause an array of physical symptoms such as skin irritation, burning, itching, and discomfort.^1
–3 Psychological symptoms are also reported such as lost sexual desire and anxiety, which have been shown to negatively impact on the life quality and sexual intimacy of the affected individuals and couples.^1,4 Vaginal dryness has also been shown to influence daily life with individuals reporting discomfort or pain while sitting, standing, and exercising.⁵

It is a common condition affecting both premenopausal and postmenopausal women. The condition is largely recognized within the latter population, with estimates of greater than 50% of postmenopausal women older than 51 years reporting symptoms of vaginal dryness.⁶ This is mainly attributed to hormonal downregulation and decreasing level of estrogen that occur during the climacteric period. However, it is also true that around 17% of premenopausal women 17–50 years of age experience problems as a consequence of vaginal dryness.⁵

Previous studies in the literature have tended to focus on the impact of vaginal dryness on postmenopausal women. One study⁷ investigated the effect of vaginal dryness and found no relationship between work productivity and severity of the condition. However, this study focused on postmenopausal women with an average age of 59 years. Less is known about the impact of this condition in premenopausal and perimenopausal women and whether there may be a potential greater impact on work productivity.

This study aimed to understand the impact on health-related quality of life (HRQoL) and work productivity in individuals who suffer from vaginal dryness. Moreover, to understand how the severity of vaginal dryness can impact on HRQoL and also how vaginal dryness impacts on work productivity. In addition, this study aimed to determine whether a difference exists between premenopausal and postmenopausal women, the former a population that has largely been overlooked in previous research.

Methods

This was an observational survey to determine the humanistic and economic impact of vaginal dryness. The target population was self-reporting individuals residing in the United Kingdom, who were suffering from vaginal dryness either as a long-term or transient condition. The sample size was calculated as follows: (z-score)² × p × (1 − p)/(margin of error),² where z-score = 1.96 (for confidence interval [95% CI]), p = 0.50 (50% of the population, i.e., an estimate number of women in the population), and a 5% margin of error. This resulted in a sample size of 384. As this study did not involve intervention, an estimated sample size of 500 participants was felt sufficient to provide reliable results and be representative of the wider U.K. female population. Included in this study were women older than 18 years, who self-declared that they were suffering from symptoms of vaginal dryness. Excluded from the study were males, nonsufferers of vaginal dryness, and participants that were non-English speaking or unable to read English. Participants were drawn from an online panel and were identified and recruited by a third-party online data collection and analytics provider (Qualtrics LLC).

Ethical considerations

Ethical considerations outlined in the “Good practice in research: Internet-mediated research guidance document” (UKRIO, V1.0 2016)⁸ were applied to this study. Informed consent was obtained from each respondent within the survey. Respondent confidentiality and anonymity were maintained, and all data collected were anonymized. Due to the nature of the study, it did not require national research ethics approval; however, it was approved by Reckitt Benckiser's (RB Healthcare Ltd.) internal independent scientific review committee. The data were provided to RB Healthcare Ltd. completely anonymized by the third-party provider, that is, all personally identifiable variables, including name and IP addresses, were removed by Qualtrics LLC before being sent to RB Healthcare Ltd.

Data collection

The survey was developed into four sections, including screening to determine eligibility, sociodemographic details, and two validated instruments detailed below. Participants were presented with an initial background to the survey on the online platform explaining the purpose of the study, the nature of the questions, and the sponsor (RB Healthcare Ltd). Having read the introduction, participants were then asked to provide their consent to participate. Having consented, participants were then directed to the survey. The participants were first presented with screening questions to determine whether they were currently experiencing vaginal dryness. Participants who passed the screening questions were then presented with a number of sociodemographic and health-related questions, before completing a number of self-reported questions. The self-reported questions included severity of vaginal dryness (1 = “A little dry” to 5 = “Extremely dry”); whether sexually active and the impact of vaginal dryness on sexual relationships (1 = strongly affect; 2 = somewhat affected; 3 = neither affected, nor unaffected; and 4 = unaffected); and general health (0 = very poor health to 100 = very good health). Menopausal status was also captured using the following definitions: postmenopausal, defined as the time following the last menstrual period, specifically the last 12 months with no periods in someone who still has their ovaries or immediately following surgery if ovaries has been removed; perimenopausal, experiencing the signs and symptoms of menopause (but not postmenopausal, i.e., still having periods); and premenopausal, no symptoms or signs of menopause experienced (https://www.nichd.nih.gov/health/topics/menopause/conditioninfo/default). Participants then completed the work productivity and activity impairment questionnaire (WPAI)⁹ and the assessment of quality of life instrument (AQoL-4D).¹⁰

Work productivity and activity impairment questionnaire

The work productivity and activity impairment questionnaire (WPAI)⁹ is a six-item instrument measuring the impact of a specific health condition (i.e., vaginal dryness) on respondents. The questions cover the number of hours worked, the number of working hours missed due to the specific health problem, the number of hours missed due to other reasons (e.g., holidays), as well as the impact on productivity and other daily activities. The responses are scored to produce the percentage work time missed due to the problem (absenteeism), the percentage impairment due to the problem (presenteeism), percentage activity impairment, and percentage overall impairment.

Assessment of quality of life instrument

The AQoL-4D is a generic HRQoL instrument.¹⁰ The instrument comprised 12 questions. Each question has four response categories specific to each item ranging from 1 (no impairment) to 4 (total impairment). Responses to the questions are converted into four domain scores: independent living, relationships, mental health, and the senses, as well as an overall HRQoL score. The scores produced by this conversion are utilities, that is, weighted preference for a particular health state. Utilities may range from 0—death to 1—perfect health. Scores less than 0 represent health states considered to be worse than dead.

Data analysis

On completion of the survey, all data were exported into MS Excel from the Qualtrics platform where it was organized and coded (comma-separated variables), ready for entry and analysis in SAS (version 9.4). Statistical significance was set at p < 0.05. Descriptive statistics were derived from the participants' responses (mean and standard deviation [SD] for quantitative data and medians and range for qualitative data). One-way analysis of variance with Tukey's honestly significant difference (HSD) test was used to explore differences between groups of variables. Linear regression was applied to determine the impact of vaginal dryness on HRQoL (AQoL-4D) controlling for age, menopausal status, and general health. Working hours lost due to vaginal dryness (as derived from the WPAI) were converted to age-specific estimates of lost wages using published data for the United Kingdom, for the entire female working population,¹¹ by multiplying hours lost work (absenteeism) with median hourly wage. Median hourly pay for women in the United Kingdom is £11.18; based on a typical working week of 37.5 hours, total weekly wage would amount to £419.25. The estimated potential loss to employers was calculated by multiplying hours lost due to presenteeism by median hourly wage. AQoL-4D scores were compared to published norms.¹² Chi-squared tests were applied to test for statistically significant associations between the qualitative variables.

Results

Demographic details

At the time the survey was closed, a total of 524 responses were received. Of these, no responses were omitted for incompleteness or ineligibility. The social-demographic details for the participants are shown in Table 1. The average age of the participants was 40.18 years (SD 13.19, range 18–70). Average age by menopausal status was as follows: 33.29 years for premenopausal women (SD 9.80); 46.18 years for perimenopausal women (SD 8.69), and 56.71 years for postmenopausal women (SD 8.15). Over 40% of participants rated their vaginal dryness as severe or very severe (categories 4 and 5). Vaginal dryness increased with age of participants (p < 0.0001). The majority of participants were married, in a civil partnership or cohabiting (73.09%), and premenopausal (61.83%). A total of 85.7% of participants were sexually active (N = 449). Of those sexually active, 12.5% (N = 56) and 18.9% (N = 85) reported vaginal dryness strongly or somewhat affecting their sexual relationships. There did not appear to be an obvious relationship between severity of vaginal dryness and impact on sexual relationships. For instance, of those participants who were sexually active, reporting a strong impact of vaginal dryness on their sexual relationship, 54.6% and 27.3% reported low to moderate levels of vaginal dryness (1 or 2, respectively). A significant number of participants had used treatment for vaginal dryness (58.02%), the most common of which being a lubricant (N = 170, 55.92%) or lubricant in combination with hormone-replacement therapy, moisturizer or vaginal estrogen (N = 31, 10.2%). Only 4 (1.35%) women were using hormone-replacement therapy alone and 26 (8.55%) were using vaginal estrogen; 2 (0.66%) women were using both treatments. Around one third of the sample were current smokers; there was no relationship observed between vaginal dryness and smoking status. Of the women who reported having experienced a urinary tract infection (38% of the sample), over 62% had experienced this at least once and 26.5% twice; 40% of women had experienced candidiasis and 61% had experienced this at least once. Just under 60% of women had children, of whom 42% had one child.

Table 1.

Sociodemographic Details by Vaginal Dryness

Vaginal dryness (severity, least to most severe)	Total	1	2	3	4	5	p
N (%)	524	13 (2.48)	78 (14.89)	215 (41.03)	178 (33.97)	40 (7.63)
Age, mean (SD)	40.18 (13.19)	33.39 (13.11)	36.32 (12.53)	39.17 (12.47)	42.23 (13.36)	46.25 (14.14)	<0.0001
General health, mean (SD)	68.9 (19.89)	77.85 (14.63)	71.37 (20.87)	67.73 (20.39)	68.29 (18.62)	70.2 (21.82)	0.30
Married/civil partnership/cohabiting, N (%)	383 (73.09)	6 (46.15)	52 (66.67)	160 (74.42)	132 (74.16)	33 (82.5)
Sexually active, yes	449 (85.69)	66 (84.62)	188 (87.44)	152 (85.39)	32 (80)	11 (84.62)	0.79
Sexually active, no	75 (14.31)	12 (2.29)	27 (5.15)	26 (4.96)	8 (1.53)	2 (0.38)	0.79
Current smoker, no, N (%)	355 (67.75)	9 (69.23)	59 (75.64)	144 (66.98)	117 (65.73)	26 (65)	0.60
Current smoker, yes, N (%)	169 (32.25)	4 (30.77)	19 (24.36)	71 (33.02)	61 (34.27)	14 (35)	0.60
Current smoker 1–10 cigarettes/day, N (%)	84 (49.7)	2 (50)	11 (57.89)	33 (46.48)	32 (52.46)	6 (42.86)	0.33
Current smoker 11–19 cigarettes/day, N (%)	62 (36.69)	1 (25)	6 (31.58)	31 (43.66)	21 (34.43)	3 (21.43)
Current smoker 20+ cigarettes/day, N (%)	23 (13.61)	1 (25)	2 (10.53)	7 (9.86)	8 (13.11)	5 (35.71)
Treatment for vaginal dryness, no, N (%)	220 (41.98)	11 (84.62)	43 (55.13)	103 (47.91)	58 (32.58)	5 (12.5)	0.0001
Treatment for vaginal dryness, yes, N (%)	304 (58.02)	2 (15.38)	35 (44.87)	112 (52.09)	120 (67.42)	35 (87.5)	0.0001
Premenopausal, N (%)	324 (61.83)	11 (84.62)	54 (69.23)	137 (63.72)	103 (57.87)	19 (47.5)	0.033
Perimenopausal, N (%)	102 (19.47)	1 (7.69)	14 (17.95)	47 (21.86)	30 (16.85)	10 (25)
Postmenopausal, N (%)	98 (18.7)	1 (7.69)	10 (12.82)	31 (14.42)	45 (25.28)	11 (27.5)

SD, standard deviation.

Quality of life (AQoL-4D) results

Dryness

The mean AQoL-4D score was 0.584 (SD = 0.286). The mean female population norm for the AQoL-4D is 0.82 (SD = 0.22).¹¹ This suggests that vaginal dryness has a significant impact on women's HRQoL.

Table 2 shows the distribution of mean AQoL-4D scores by severity of vaginal dryness. HRQoL decreased as the severity of the condition increased. There was a statistically significant difference [F(4, 519) = 3.18, p = 0.014] between these mean scores. The post hoc Tukey's Studentized Range (HSD) test revealed statistically significant differences between the least category of severity (category 1) and categories 3 (mean difference [MD] = 0.25, p < 0.05), 4 (MD = 0.26, p < 0.05), and 5 (MD = 0.27, p < 0.05).

Table 2.

AQoL-4D and Severity of Vaginal Dryness

Dryness	N	Mean	Median	SD	Minimum	Maximum
1	13	0.828	0.839	0.123	0.609	1.000
2	78	0.626	0.694	0.280	−0.013	1.000
3	215	0.576	0.624	0.286	−0.040	1.000
4	178	0.564	0.596	0.287	−0.035	1.000
5	40	0.557	0.625	0.305	−0.017	1.000

AQoL-4D, assessment of quality of life instrument.

Again, it should be noted that with the exception of the least severe category, the mean HRQoL scores for all other categories fell significantly below population norms. The results of the regression analysis [F(3, 520) = 41.61, p < 0.0001; R ² = 0.19] showed that vaginal dryness continued to have a significant negative impact on HRQoL [beta = −0.034, standard error, SE = 0.013, t(1) = −2.66, p = 0.0082] when age, was controlled for [age, beta = 0.0013, SE = 0.001, t(1) = 1.49, p = 0.14]. General health was a statistically significant predictor of quality of life [beta = 0.006, SE = 0.001, t(1) = 10.62, p < 0.0001].

Menopause status

HRQoL was reduced for those women who were perimenopausal and was better for those premenopausal and postmenopausal women, however, there were no statistically significant MDs for the AQoL-4D by menopause status [F(2, 521) = 0.34, p = 0.71] (Table 3). There was a greater proportion of premenopausal women reporting the two most severe categories of vaginal dryness (122, 23.3%) compared to both perimenopausal (40, 7.3%) and postmenopausal women (56, 10.7%). Conversely, there was also a greater proportion of premenopausal women reporting the least severe two categories of vaginal dryness (65, 12.4%) compared to perimenopausal (15, 2.9%) and postmenopausal women (11, 10.7%). These differences were statistically significant [χ ² ₍₈₎ = 16.76, p = 0.033]. Post hoc analyses showed that all of these differences were between the postmenopausal women and the other two categories and not between premenopausal and perimenopausal women (p < 0.05).

Table 3.

AQoL4D and Menopausal Status

Menopause status	N	Mean	Median	SD	Minimum	Maximum
Premenopausal	324	0.586	0.637	0.280	−0.033	1.000
Menopausal	102	0.566	0.641	0.315	−0.040	1.000
Postmenopausal	98	0.599	0.676	0.276	−0.035	1.000

Work productivity results

Table 4 shows the results from the WPAI. A total of 383 participants reported (73.1%) that they were currently employed. The mean number of working hours missed in the past 7 days due to vaginal dryness (for those employed) was just under 6. The standard working day in the United Kingdom is 7.5 hours; this, therefore, represents 0.80 of a working day. The mean impact scores (on a scale from 0 to 10) were around 3, reflecting a low to moderate impact of vaginal dryness on work productivity and daily activities. Table 5 shows the impact of menopausal status on work productivity for those women who were in paid employment (N = 383). Work productivity and overall activities were least affected for postmenopausal women. Although there were differences between levels of absenteeism and the three categories, these were not statistically significant [F(2, 366) = 1.90, p = 0.15]. There were statistically significant differences between the categories for presenteeism [F(2, 380) = 12.01, p < 0.0001], overall work impairment [F(2, 380) = 8.64, p = 0.0002], and activity [F(2, 380) = 10.38, p < 0.0001].

Table 4.

Items from the Work Productivity and Activity Impairment Questionnaire from Employed Participants (N = 383)

Items	Mean	Median	SD	Maximum
WPAI2—Work hours missed due to vaginal dryness	5.922	0.00	11.291	60.000
WPAI3—Work hours missed due to other reasons	7.102	1.00	11.754	60.000
WPAI4—Actual hours worked	26.577	30.00	14.475	60.000
WPAI5—To what extent vaginal dryness impacted on productivity (0–10 scale)	2.480	2.00	2.474	10.000
WPAI6—To what extent vaginal dryness impacted on daily activities (0–10 scale)	2.619	2.00	2.611	10.000

WPAI, Work productivity and activity impairment questionnaire.

Table 5.

Menopausal Status and Productivity

Menopause status	N	Variable	N	Mean	SD	Maximum
Premenopausal	256	Absenteeism	245	0.175	0.246	1
		Presenteeism	256	0.282	0.249	1
		Overall work impairment	256	0.38	0.312	1
		Activity impairment	256	0.297	0.268	1
Perimenopausal	76	Absenteeism	75	0.174	0.241	0.8
		Presenteeism	76	0.229	0.238	1
		Overall work impairment	76	0.331	0.329	1
		Activity impairment	76	0.236	0.241	1
Postmenopausal	51	Absenteeism	49	0.102	0.23	1
		Presenteeism	51	0.104	0.195	0.8
		Overall work impairment	51	0.183	0.283	1
		Activity impairment	51	0.124	0.2	0.8

For those in employment, the amount of time at work missed over the last 7 days (absenteeism) due to vaginal dryness was 16.5% (N = 369, SD 24.3%). This figure differs from the hours missed (reported above) as it takes the actual hours worked into account. The percentage impairment experienced at work (presenteeism) was 24.8% (N = 383, SD = 24.7%); the overall work impairment was 34.4% (SD = 31.8%) and activity impairment due to vaginal dryness was 26.2% (SD = 26.1%).

The average age-adjusted (estimated) lost weekly wage was £67.82 (SD = £130.88, range £0–£683.20) for those in employment. The average age-adjusted weekly wage lost by severity of vaginal dryness is shown in Table 6.

Table 6.

Weekly Average Estimated Age-Adjusted Lost Wage by Severity of Vaginal Dryness

Dryness	N	Mean (£)	Median (£)	SD	Maximum (£)
1	10	12.08	0.00	27.74	89.81
2	60	17.58	0.00	45.12	295.09
3	150	67.12	0.00	121.23	628.67
4	133	69.72	11.50	127.45	577.35
5	30	181.93	46.80	228.11	683.20

Mean weekly wages lost increased in line with severity of vaginal dryness. This increase was statistically significant [F(4, 378) = 9.08, p < 0.0001]. The post hoc Tukey's Studentized Range (HSD) test revealed significant differences (p < 0.05) between severity levels 1 and 5 (MD = £169.86, 95% CI £44.08–£295.64), 2 and 5 (MD = £164.36, 95% CI £87.34–£241.39); 3 and 5 (MD = £114.82, 95% CI £45.93–£181.84); and 4 and 5 (MD = £112.21, 95% CI £42.59–£181.84).

The degree of presenteeism was multiplied by the self-reported number of hours worked over the last 7 days. This figure was then multiplied by the age-specific median weekly wage to produce an estimate of costs to the employer. The average weekly cost to the employer across all degrees of severity of vaginal dryness was £82.56 (SD £109.38, range £0–£732). The estimated total weekly wages lost to the employer was £31,622. These represent the estimated potential lost weekly costs to the employers of women in this study. Table 7 shows a breakdown of these costs of severity; the estimated costs to the employer due to presenteeism increased in line with severity of vaginal dryness. This increase was statistically significant [F(4, 378) = 8.99, p < 0.0001].

Table 7.

Weekly Estimated Average Cost to Employer Resulting from Presenteeism

Severity of vaginal dryness	N	Mean (£)	Median (£)	Std dev (£)	Maximum (£)
1	10	17.37	0.00	49.60	157.81
2	60	40.14	15.73	58.79	255.84
3	150	79.53	43.07	106.18	732.00
4	133	89.95	56.45	102.41	542.71
5	30	171.58	123.50	174.47	609.60

There were statistically significant differences between level 5 and levels 1, 2, 3, and 4, as well as between 2 and 4, and 3 and 5 (Tukey's HSD, p < 0.05). HSD, Honestly Significant Difference.

Discussion

This study aimed to evaluate the impact of vaginal dryness on women's HRQoL and work productivity. The participants in the study were relatively young and predominantly premenopausal women, the majority of whom rated vaginal dryness as severe or very severe, compared to either perimenopausal or postmenopausal women. Vaginal dryness was shown to have a significant negative impact on these women's HRQoL. For example, the overall mean QoL score was considerably less than the population norms and comparable to individuals who had experienced a stroke (0.57, SD 0.27) or those with multiple comorbidities (0.57, SD 0.30).¹¹ These results are in line with previous research,^1,4 which has shown a negative impact of vaginal dryness on women's HRQoL. However, the degree of impairment on HRQoL found in this study contrasts starkly with that of one other study, which to our knowledge, is the only other to include a generic quality-of-life measure.⁷ When considering this difference in severity of vaginal dryness and impact on quality of life between premenopausal women and perimenopausal or postmenopausal women, it is important to also consider how vaginal dryness may occur in these groups. It is well known that estrogen loss is one of the most common causes of vaginal dryness, with natural menopause being one of the usual causes of decreasing estrogen concentrations.¹³ However, estrogen levels can fall due to a variety of conditions that affect its release at any age such as oophorectomy, postpartum loss of placental estrogen, radiation therapy, chemotherapy, and increased prolactin concentration.¹³ In addition, stress and the use of certain medications can also lead to vaginal dryness. The hormonal changes that occur as a result of some surgeries and chemotherapy can be abrupt and dramatic, particularly in women of reproductive age, leading to a loss of self-confidence as well as sexual confidence as a result of changes to the body, as well as pain and discomfort caused by vaginal dryness. This could go some way to explain the difference in impact of quality of life between premenopausal women and perimenopausal/postmenopausal women. Of course, this may simply be a result of differences between the differing generic HRQoL instruments used in this (AQoL-4D) and previous study (EQ-5D). However, it should be noted that research in other medical conditions has suggested the EQ-5D may overestimate HRQoL scores.¹⁴ Furthermore, in this study, there was a clearer separation in HRQoL scores between levels of vaginal dryness, particularly between the most and least severe states, compared to previous published research with the EQ-5D, where there was a much narrower separation between levels of severity. This suggests the AQoL-4D may be more sensitive to severity of dryness in comparison to the EQ-5D.

In addition to the HRQoL scores, this study also found a marked effect of vaginal dryness on work productivity, particularly in terms of the level of absenteeism and presenteeism. Again, this contrasts with previous research reporting no effect of vaginal or vulvo-vaginal atrophy (VVA) on work productivity.⁷ A possible explanation for this could be that in this study, the sample largely comprised premenopausal women with an average age of 40 years, whereas participants in other studies have been older, postmenopausal women. For instance, the average age of women in the previous study investigating work productivity and vaginal dryness⁷ was just below 60 years. It may very well be that vaginal dryness had less or no impact on work productivity in those studies as older participants are potentially less likely to be in employment or may be working fewer hours per week, a point that was also underlined by the fact that productivity was least affected in postmenopausal women. To investigate this further, a post hoc regression analysis was undertaken, which included absenteeism and presenteeism in the model, along with vaginal dryness. When absenteeism [beta −0.20, SE 0.052, t(1) = −3.82, p < 0.0002] and presenteeism [beta −0.23, SE 0.058, t(1) = −3.94, p < 0.0001] are included as predictors, vaginal dryness was no longer a statistically significant predictor of HRQoL [beta −0.029, SE 0.015, t(1) = −1.95, p = 0.052].* This suggests that the relationship between vaginal dryness and HRQoL is mediated by work productivity; in other words, vaginal dryness impacts on women's ability to work or perform well at work, which in turn negatively impacts on quality of life. The results demonstrate that premenopausal and perimenopausal women in particular are disproportionately affected by this compared to postmenopausal women. Because of this impact on work productivity, it was also shown that vaginal dryness has a significant economic impact on both women, as well as employers. On average, £67.82 was estimated to have been lost in wages over the preceding week, representing around 16% of average weekly earnings. Presenteeism due to vaginal dryness was also shown to have a potentially significant impact on employers (of the women participating in this study).

There were several potential limitations to this study. The study had potential selection bias enrolling women from an online panel, who had previously registered with the survey platform. Furthermore, these women had to be experiencing (or have recently experienced) vaginal dryness an entrance criterion for the study. The study may therefore not be fully representative of all U.K. women, that is, it was restricted to only those women with self-reported vaginal dryness, who had agreed to participate in the survey. Others will, by definition, have been excluded, including respondents with no access to the internet, limited internet skills, or less education or income, and so on. It is, therefore, not known how many women in the United Kingdom are affected by vaginal dryness, thereby potentially restricting the generalizability of the results. There are inherent issues with participants self-reporting, including rating vaginal dryness, as well as menopausal status in the absence of verification by healthcare practitioners. These self-reports may introduce potential bias and therefore limit the generalizability of the results. Furthermore, responders self-reporting vaginal dryness creates a risk of response bias in this study as the women completing the survey may have an innate interest in their condition. However, this study has demonstrated that internet-mediated research can yield effective results, which can quickly obtain a large target population, who can provide complete responses and allow quick data compilation.

Conclusion

This study demonstrated that vaginal dryness has a significant impact on women's HRQoL. Furthermore, it is, to our knowledge, the first study to demonstrate a link between vaginal dryness and work productivity, in particular for those women with significant vaginal dryness. It also demonstrated a potential mediating effect between vaginal dryness, productivity at work, and HRQoL. Given the incidence of vaginal dryness in the population,^5,15,16 the condition represents a significant humanistic and economic burden to both individual women as well as to society.

Footnotes

Author Disclosure Statement

A.B.S., S.H., and N.F. are current employees of Reckitt Benckiser Health Care (UK) Ltd. (RB) N.K. is a former employee of RB. RB manufactures vaginal moisturizers and lubricants.

Funding Information

No funding was received for this article.

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