Postmenopausal Women With Depression or Urinary Incontinence Experience Vaginal Symptoms Affecting Daily Life

UCSF Researchers Recommend Special Efforts Be Made for Identification, Treatment

By Scott Maier

Special efforts should be made to identify and treat depression and urinary incontinence in postmenopausal women with vaginal symptoms, according to UC San Francisco researchers, as these two common conditions not only tend to co-exist with vaginal symptoms but also may complicate the impact of these symptoms on women’s daily activities and quality of life.

The study appears online on July 15, 2015, in Menopause and will be featured in the January 2016 print edition.

“Our findings suggest that depression and urinary incontinence may magnify the effects of vaginal symptoms on women’s activities, feelings and relationships, and postmenopausal women experiencing these comorbid problems may be in special need of evaluation and treatment,” said lead author Mary Hunter, MN, physiological nursing doctoral candidate in the School of Nursing at UCSF.

Up to a third of postmenopausal women experience vaginal dryness, soreness, itching, irritation, pain during sexual activity and other issues, according to the study. However, the significance of these symptoms in relation to functionality and well-being is not well understood.

Hunter and her colleagues conducted this research as an ancillary study to the Reproductive Risks of Incontinence Study at Kaiser (RRISK), a multiethnic cohort study of risk factors for urinary tract dysfunction in community-dwelling middle-aged and older women. RRISK participants were female enrollees in Kaiser Permanente Northern California, which serves approximately 25-30 percent of the northern California population.

The initial study data was collected from November 2008 to April 2012 through visits with 2,016 women in their homes as part of the third wave of RRISK. Of that total, 745 participants who reported being postmenopausal and having at least one vaginal symptom then were asked to complete a Day-to-day Impact of Vaginal Aging (DIVA) questionnaire, and received an assessment of multiple sociodemographic and clinical factors that have potential to influence the impact of these symptoms.

The research team used the DIVA questionnaire responses to assess symptom impact on daily living, emotional well-being, self-concept and body image, and sexual functioning. Approximately 21 percent of the participants were African American, 25 percent Latina and 20 percent Asian. Higher scores on the DIVA questionnaire indicate greater negative impact.

In their analysis, the researchers found that women with comorbid depression reported an 11-22 percent greater impact of vaginal symptoms on all dimensions of functioning and well-being. Women with urinary incontinence reported a 27-37 percent greater impact of vaginal symptoms on daily living, emotional well-being, and self-concept and body image.

Women sexually active on at least a weekly basis reported lower impact of their vaginal symptoms with regards to self-concept and body image and sexual function. This association aligns with the observation of William H. Masters and Virginia E. Johnson, among others, that more frequent sexual activity may be protective of sexual function and well-being.

Interestingly, among the ethic groups, the researchers found that Latina women tended to have lower impact scores for the DIVA self-concept and body image and sexual function domains compared to white women, though the reasons for this are unknown.

Other UCSF contributors to the Menopause study were senior author Alison Huang, MD, associate professor of medicine; Sanae Nakagawa, MA, programmer analyst; and Miriam Kuppermann, PhD, MPH, professor of obstetrics, gynecology and reproductive sciences and epidemiology and biostatistics. Stephen Van Den Eeden, PhD, of Kaiser Permanente Northern California, was a co-author responsible for data collection.

Funding was provided by the National Institute on Aging; National Institutes of Diabetes, Digestive, and Kidney Diseases; Office of Research on Women’s Health; Paul Beeson Career Development Award in Aging Research; and the American Federation on Aging Research.

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco.