The Impact of Genitourinary Syndrome of Menopause on Well-being, Functioning, and Quality of Life in Postmenopausal Women

Eloy Moral, MD, PhD; Juan L. Delgado, MD, PhD; Francisco Carmona, MD, PhD; Borja Caballero, MD; Cristina Guillán, MD; Paula M. González, MD; Javier Suárez-Almarza, Pharm, BSND; Syra Velasco-Ortega, Pharm; Concepción Nieto Magro, MD, PhD; for the writing group of GENISSE study


Menopause. 2018;25(12):1418-1423. 

In This Article

Abstract and Introduction


Objective: Symptoms of genitourinary syndrome of menopause (GSM) are bothersome to middle-aged and older women, and affect their quality of life (QoL), sexuality, and daily activities. The objective of the study was to evaluate the impact of vaginal symptoms and GSM on the well-being, functioning, and QoL of postmenopausal women from Spain.

Methods: This study involved 423 postmenopausal women participating in the GENISSE study (a multicenter, cross-sectional, descriptive, observational study) who presented at least 1 vaginal symptom. All women completed the "day-to-day impact of vaginal aging" (DIVA) questionnaire. Analysis of total scores and subdomains of the questionnaire were performed in women diagnosed with GSM and those without the condition.

Results: In these women, the highest mean scores on the DIVA questionnaire were found in the sexual functioning domain long version (mean 1.8; SD 1.0), followed by the sexual functioning domain short version (mean 1.7; SD 1.1), self-perception and body image (mean 1.4; SD 1.1), activities of daily living (mean 0.7; SD 0.8), and emotional well-being (mean 0.7; SD 0.8) scales. A total of 299 women (70.7%) had vaginal symptoms with a diagnosis of GSM, whereas 124 (29.3%) had no GSM diagnosis. Scores on the DIVA questionnaire were significantly higher in women with a diagnosis of GSM than in those without this condition.

Conclusions: Vaginal symptoms impact the well-being, functioning, and QoL of postmenopausal women, especially sexual function, self-perception, and body image. This impact is significantly higher in women with GSM. Identifying and treating patients affected by vaginal symptoms and GSM may be beneficial for improving their QoL.


Genitourinary syndrome of menopause (GSM) is defined as a collection of signs and symptoms that are mainly associated with the decrease in estrogen production during menopause.[1] It involves changes in the labia, clitoris, introitus, vagina, urethra, and bladder. Approximately 50% of menopausal and postmenopausal women develop signs and symptoms of GSM.[2–4] Symptoms of GSM include vaginal dryness; irritation/burning/itching of the vulva or vagina; diminished lubrication, dyspareunia, or discomfort with sexual activity; postcoital bleeding; reduced arousal, orgasm, and desire; dysuria; and urinary frequency and urgency.[5,6] Vaginal dryness is one of the most prevalent symptoms, affecting up to 60% of postmenopausal women.[7,8] GSM is also characterized by the following signs: decreased moisture, decreased elasticity, labia minora resorption, pallor/erythema, loss of vaginal rugae, tissue fragility/fissures/petechiae, urethral eversion or prolapse, loss of hymenal remnants, prominence of urethral meatus, introital retraction, and recurrent urinary tract infections.[1] Decreased moisture is the most prevalent sign.[1] The symptoms of GSM are bothersome and usually require intervention.[9,10] They cause discomfort and distress in middle-aged and older women, impacting their quality of life (QoL), sexual functioning, and daily living activities.[11–15] Despite the valuable information about the prevalence of GSM and its impact on sexual activity, little is known about its impact on multiple dimensions of well-being or functioning in the daily lives of postmenopausal women. The GENISSE study was a multicenter, cross-sectional, descriptive, observational study that involved 430 postmenopausal women who consulted a gynecologist in Spain for any reason between September and October 2015.[16] It found the prevalence of GSM to be approximately 70%. In that study, the diagnosis of GSM was based on the presence of at least 2 symptoms, or 1 sign and 1 symptom (bothersome to the woman), and not otherwise explained by any other pathology.[1,16] At the time of diagnosis, only 40% of women reported a prior history of vulvovaginal atrophy (VVA) or GSM. Furthermore, GSM was undetected in 60% of cases, as diagnosed when visiting the gynecologist for a routine visit (with no previous gynecological pathology). Given the importance of well-being and functioning in postmenopausal women, one of the objectives of the GENISSE study was to evaluate the impact of signs and symptoms of GSM on the QoL.[17]