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.

Help-seeking for genitourinary symptoms: a mixed methods study from Britain's Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

OBJECTIVES

Quantify non-attendance at sexual health clinics and explore help-seeking strategies for genitourinary symptoms.

DESIGN

Sequential mixed methods using survey data and semistructured interviews.

SETTING

General population in Britain.

PARTICIPANTS

1403 participants (1182 women) from Britain's Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3; undertaken 2010-2012), aged 16-44 years who experienced specific genitourinary symptoms (past 4 weeks), of whom 27 (16 women) who reported they had never attended a sexual health clinic also participated in semistructured interviews, conducted May 2014-March 2015.

PRIMARY AND SECONDARY OUTCOME MEASURES

From survey data, non-attendance at sexual health clinic (past year) and preferred service for STI care; semistructured interview domains were STI social representations, symptom experiences, help-seeking responses and STI stigma.

RESULTS

Most women (85.9% (95% CI 83.7 to 87.9)) and men (87.6% (95% CI 82.3 to 91.5)) who reported genitourinary symptoms in Natsal-3 had not attended a sexual health clinic in the past year. Around half of these participants cited general practice (GP) as their preferred hypothetical service for STI care (women: 58.5% (95% CI 55.2% to 61.6%); men: 54.3% (95% CI 47.1% to 61.3%)). Semistructured interviews elucidated four main responses to symptoms: not seeking healthcare, seeking information to self-diagnose and self-treat, seeking care at non-specialist services and seeking care at sexual health clinics. Collectively, responses suggested individuals sought to gain control over their symptoms, and they prioritised emotional reassurance over accessing medical expertise. Integrating survey and interview data strengthened the evidence that participants preferred their general practitioner for STI care and extended understanding of help-seeking strategies.

CONCLUSIONS

Help-seeking is important to access appropriate healthcare for genitourinary symptoms. Most participants did not attend a sexual health clinic but sought help from other sources. This study supports current service provision options in Britain, facilitating individual autonomy about where to seek help.

Attitude towards active surveillance: a cross-sectional survey among patients with uroandrological disorders

OBJECTIVES

We looked at subjective attitude towards active surveillance (AS) as the first option for cancer management in a cohort of patients seeking first medical help for uroandrological disorders prior to a formal discussion with a caregiver.

DESIGN

Cross-sectional observational study.

SETTING

Uroandrological outpatient clinic of a European academic centre.

PARTICIPANTS

Data of 1059 patients at their first access for uroandrological purposes from January 2014 to December 2016 were analysed.

INTERVENTION

Patients were invited to complete a survey with closed questions investigating their attitude towards AS, prior to any clinical evaluation. Likewise, patients were invited to score the importance given to different aspects of personal life in the case of a cancer diagnosis, using a 10-point Likert scale.

PRIMARY AND SECONDARY OUTCOMES MEASURES

The reported opinion towards AS management for cancer was assessed. Logistic regression analyses tested participants' sociodemographic characteristics associated with a positive opinion on AS.

RESULTS

Positive, negative and doubtful attitudes towards AS were observed in 347 (33%), 331 (31%) and 381 (36%) patients, respectively. Female patients were more likely to report a negative attitude towards AS (38.7% vs 29.6%, p=0.04) while patients with previous parenthood more frequently reported a positive opinion on AS (37.2% vs 29.9%, p=0.005). Patient age emerged as the only predictor of a positive attitude towards AS (OR 1.03; 95% CI 1.01 to 1.04, p<0.001), with a 46% and 33% probability of being pro-AS for a patient aged 65 and 45 years, respectively.

CONCLUSIONS

One out of three patients would express positive feedbacks on AS in the unfortunate case of tumour diagnosis, only according to his/her baseline personal opinion and prior to any discussion with a cancer caregiver. The older the patient, the higher the probability of being compliant with a conservative management for cancer.

Deployed women's illness behaviors while managing genitourinary symptoms: An exploratory theoretical synthesis of two qualitative studies

BACKGROUND

The recent removal of United States military combat exclusion rules resulted in more women serving in forward deployed austere conditions. In the deployed setting, women were diagnosed with genitourinary (GU) conditions five times greater than men.

PURPOSE

Describe deployed military women's GU illness behaviors.

METHOD

Two qualitative descriptive studies interviewing military women and enlisted medics were synthesized using the Illness Behavior Model.

DISCUSSION

Similar and divergent views on the impact of the military culture of the illness behaviors were described by women and medics. Both agreed appropriate attention on managing GU symptoms must continue; however differing strategies were appraised. One agreed option was to offer a health care mentor.

CONCLUSION

The Illness Behavior Model provided an excellent framework for evaluation of military women's illness behaviors exposing areas for comparing and contrasting the perspectives provided. While significant changes have been made, additional strategies will continue to improve the women's deployed health care quality.

The uptake of HIV testing among patients with chlamydial or gonococcal infections attending a genitourinary medicine clinic

Bacterial sexually transmitted infections (STIs) may be markers of high-risk sexual activity. Counselling for these infections provides an opportunity for promoting HIV testing.

The aim of the present study was to compare the uptake of HIV testing between patients with gonorrhoea or chlamydial infections and those without a bacterial STI. A study on patients screened for chlamydial or gonococcal infections in the Department of Genitourinary (GU) Medicine, Edinburgh between 1 July 2002 and 30 June 2003. The overall uptake of HIV testing among patients screened for chlamydial and gonococcal infections was 2263 (37%) of 6184 and 2012 (44%) of 4583, respectively ( P < 0.0002). Uptake of HIV testing was significantly higher among uninfected patients: for chlamydial infection, 17% of 1857 infected patients versus 45% of 4327 uninfected patients ( P < 0.0002); and for gonococcal infection, 24% of 256 infected patients versus 45% of 4327 uninfected patients ( P < 0.0002).

The policy of pre-test counselling needs to be redesigned in order to improve the uptake of HIV testing among patients with high-risk sexual activity.

Urogenitale Symptome und urologische Interventionsmöglichkeiten in der palliativen Situation

During the course of malignancies of nearly all tumor entities the urogenital organs are frequently influenced. The resulting disorders are subsumed under the term"urogenital symptoms". Especially with the goal of improving quality of life these symptoms have to be treated with respect. In addition further therapeutic measures, e.g. the application of a palliative chemotherapy, makes an unobstructed urinary excretion necessary. This article gives an overview of the indications for treating urogenital symptoms and contrasts different therapy concepts.

Rates and previous disease history in old age suicide

OBJECTIVE

Suicide rates in persons over 65 have been reported to be higher than those of younger age groups. Since the absolute number of suicides in the elderly is expected to rise, more precise ways to identify potential risk factors for elderly suicides are needed.

METHODS

On the basis of forensic examinations suicide rates and methods in elderly Finns of northern Finland were compared with those of adults aged 18-64 years. Data from earlier illnesses of the suicide victims were scrutinized for records of multiple physical disorders.

RESULTS

Over the 15-year period the mean annual suicide rate per population of 100,000 was significantly lower in the elderly (22.5) than adults aged 18-64 years (38.4). A decrease in suicide rates over time occurred in both groups. Suicide methods among elderly were more often violent, and they were seldom under the influence of alcohol. They also had a high prevalence of previous hospital-treated depressive episodes and hospital-treated physical illnesses. A lifetime history of hospital-treated depression was more common among elderly victims who had received hospital treatment for genitourinary diseases, injuries or poisonings after their 50th birthday.

CONCLUSIONS

Our results from elderly suicide victims suggest an association between multiple physical illnesses and a history of depression. Especially, genitourinary diseases as well as hospital treatment due to injuries or poisonings were shown to associate with depression. Elderly Northern Finns showed lower suicide rates, and they decreased during the study period suggesting that active preventive measures against suicide are also feasible in the elderly.

"It feels good to be told that I'm all clear": patients' accounts of retesting following genital chlamydial infection

OBJECTIVE

To examine the meaning that people with genital chlamydial infection attribute to retesting as part of their treatment management.

METHODS

Unstructured interviews with 50 heterosexual patients (40 female and 10 male) who had or had had genital chlamydia infection. Recruitment was via a genitourinary medicine clinic and a contraceptive clinic.

RESULTS

The return visit was understood in terms of the retest. The retest occupied a pivotal position in the infection experience and was invested with symbolic significance because it provided a means by which to deal with feelings of bodily pollution. It marked the end of dirtiness that was important for the restoration of identity. It also marked the beginning of cleanness that was important in relation to sexual relationships.

CONCLUSION

The sociocultural construction of sexually transmitted infections shapes the individual experience of having chlamydial infection. This perspective sheds light on the meaning that individuals invest in aspects of infection management. It is important for some people to know rather than assume that their infection has been eliminated, a function that is fulfilled by the retest. When retesting is not available, individuals may use increasingly available opportunistic chlamydia testing for this purpose with consequent cost and resource implications.

Gender differences in sexual behaviours in response to genitourinary symptoms

OBJECTIVE

To understand gender differences in sexual behaviours in response to genitourinary symptoms.

METHODS

473 (239 female and 234 male) subjects were enrolled at an STD clinic regardless of symptoms or infection status. Subjects completed a 30 day calendar recall interview of genitourinary symptoms, coital activity, sexual partners, and condom use.

RESULTS

Of the total of 473 participants, 261 (55%) reported symptoms (61% women and 39% men). STI prevalence was 73% and 75% for symptomatic women and men, respectively. For black women the probability of coitus was decreased in the presence of vaginal discharge (OR 0.64, 95% CI 0.47 to 0.89). No change in coital activity was seen in non-black women in the presence of vaginal discharge. Having vaginal discharge did increase the likelihood of condom use by their partners (OR 2.48, 95% CI 1.05 to 5.88), if coitus occurred. Urethral discharge was not associated with coitus or condom use in men. However, in men, dysuria was associated with increased likelihood of condom use (OR 4.25, 95% CI 1.57 to 11.56) if coitus occurred.

CONCLUSION

Black women altered both coital activity and condom use behaviours in response to vaginal discharge. In contrast, non-black women did not modify coital activity. Men increased condom use when having dysuria but did not alter coital activity. Changes in sexual behaviours may alter the risk of STI transmission independent of interactions with the healthcare system. STI education and prevention programmes need to better understand these gender and racial differences in developing effective strategies to reduce STI transmission.

Struktur- und Prozessqualität der stationären urologischen Rehabilitation

Inpatient rehabilitation and "Anschlussheilbehandlung" (rehabilitation soon after operation or acute intervention) are effective and economic for long-term improvement of urologic patients. Only therapy guided by urologic specialists during rehabilitation and afterwards guarantees the possibility of excellent results. Especially QOL and functional deficits are improved markedly by urologic rehabilitation. Therefore, inpatient urologic rehabilitation should be initiated more often in the future.

The Menopause Rating Scale (MRS) as outcome measure for hormone treatment? A validation study

Background

The Menopause Rating Scale is a health-related Quality of Life scale developed in the early 1990s and step-by-step validated since then. No methodologically detailed work on the utility of the scale to assess health-related changes after treatment was published before.

Method

We analysed an open, uncontrolled post-marketing study with over 9000 women with pre- and post-treatment data of the MRS scale to critically evaluate the capacity of the scale to measure the health-related effects of hormone treatment independent from the severity of complaints at baseline.

Results

The improvement of complaints during treatment relative to the baseline score was 36% in average. Patients with little/no complaints before therapy improved by 11%, those with mild complaints at entry by 32%, with moderate by 44%, and with severe symptoms by 55% – compared with the baseline score. We showed that the distribution of complaints in women before therapy returned to norm values after 6 months of hormone treatment. We also provided weak evidence that the MRS results may well predict the assessment of the treating physician. Limitations of the study, however, may have lead to overestimating the utility of the MRS scale as outcome measure.

Conclusion

The MRS scale showed some evidence for its ability to measure treatment effects on quality of life across the full range of severity of complaints in aging women. This however needs confirmation in other and better-designed clinical/outcome studies.

[Urology and Psychosomatics. A historical summary]

The investigation and description of psychosomatic interrelationships has a long tradition in the field of urology. At the beginning of last century, psychosomatic theories and therapies involving urologic questions were developed, some of which are still part of current therapeutic strategies. Numerous studies accentuated the need for a psychosomatic diagnostics and therapy of urologic diseases. The appreciation of psychosomatic urology is growing, a fact which is reflected in current urological teaching curricula.

The use of Visual Analog Scale in urogynecologic research: a psychometric evaluation

OBJECTIVE

The purpose of this study was to assess the validity of Visual Analog Scales in urogynecologic research.

STUDY DESIGN

In phase I, 35 women completed short forms of the urogenital distress inventory, incontinence impact questionnaire, and Beck depression inventory fast screen using the Likert-type scale and Visual Analog Scale formats. Reliability was estimated with Spearman's correlations and Cronbach's alpha; construct validity was assessed with the use of factor analyses. In phase II, 101 women were recruited for the test-retest reliability assessment of the Visual Analog Scale formats of the urogenital distress inventory and incontinence impact questionnaire short forms. Reproducibility was analyzed with intraclass correlations.

RESULTS

In phase I, correlations between the Likert-type scale and the Visual Analog Scale were good: urogenital distress inventory (0.748), incontinence impact questionnaire (0.787), and Beck depression inventory fast screen (0.852; P <.05). In phase II, intraclass correlations were 0.898 and 0.938 for the urogenital distress inventory and incontinence impact questionnaire scores, respectively ( P <.001).

CONCLUSION

The Visual Analog Scale is a simple, reliable, and reproducible method for the assessment of quality of life in urogynecologic research.

Psychoonkologie

Cancer and psychiatric symptoms commonly co-occur. The frequency is about 50%, and those most important for urology are depression, anxiety, and probably post-traumatic stress disorder. There is a strong relationship between psychological distress and cancer pain. This review provides information on diagnostic and therapeutic strategies for psychiatric diseases, which are important for oncology patients in urology. Special advice is given for the doctor-patient relationship and communication.

Urologische Funktionsst�rungen nach sexuellem Missbrauch und Gewalt

Criminal statistics say that 300,000 children are sexually abused in the Federal Republic of Germany every year: 70-75% are abused by their own fathers or another psychological parent. Most victims are girls aged 7-12 years. Sexual abuse during childhood can lead to severe psychosomatic dysfunctions both in children and adults. Possible long-term results are depression, anxiety, emotional and cognitive problems, personal dysfunction, eating and sleeping disorders, alcohol or drug abuse, relationship problems, social maladaptation, and somatizations. Many urological dysfunctions without organic findings can be caused by sexual abuse. Among others, chronic pelvic pain (CPPS), enuresis, incontinence, and sexual dysfunction can occur. When children or adults see the urologist because of their symptoms there is always the danger of reproducing the abusive event by invasive diagnostic methods.Sometimes harming themselves the patients bring this situation about unconsciously. With the following article we want to heighten the awareness among urologists.

Measuring health-related quality of life in women with urogenital dysfunction: the urogenital distress inventory and incontinence impact questionnaire revisited

AIMS

Symptoms of urogenital dysfunction are known to negatively affect health-related quality of life in women. To assess effectiveness of treatment, it is currently recommended to include measurements of quality of life in outcome analysis. One of the questionnaires that is commonly used is the combination of the Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ). Unfortunately, the validity of the UDI and IIQ has only been tested in highly selected subgroups of female patients. Therefore, it is unclear whether this questionnaire is suitable for use in populations with different characteristics.

METHODS

We analyzed the scale construction and validity of the UDI and IIQ in a random sample of 2,042 women, aged 20-70 years old and a clinical sample of 196 women.

RESULTS

Our results show that the UDI can be divided into five subscales, namely discomfort/pain, urinary incontinence, overactive bladder, genital prolapse, and obstructive micturition. The internal consistency (Cronbach's alpha) ranged between 0.74 and 0.82. In addition to the original four subscales of the IIQ (mobility, physical, social, and emotional functioning), we identified a fifth subscale with four items about embarrassment. Internal consistency of these subscales ranged between 0.83 and 0.93. In addition to the internal consistency, we tested the criterion and construct validity of these new subscale division.

CONCLUSIONS

We found these subscales to be reliable and of clinical use. It is recommended to use the revised UDI and IIQ in outcome analysis of treatments for urogenital symptoms in women.

[Somatization disorders of the urogenital tract]

Diffuse symptoms in the urogenital region can frequently be explained by somatization disorders. Since they cannot be proven either by laboratory tests or with common technical diagnostic methods, somatization disorders should always be taken into consideration. Somatization disorders are to be considered functional disorders. Since somatization disorders due to muscular tension prevail in the urogenital region, the functional disturbance can be explained by the muscular tension. Subsequently, muscular tension causes the pathophysiological development of symptoms. As a rule they appear as myofascial pain or disorder. Muscular tension can have a psychic origin. The absence of urological findings is typical. Males and females between the ages of 16 and 75 can be affected by somatization disorders in the urogenital region. Somatization disorders due to muscular tension belong to the large group of symptoms due to tension. Diagnostic and therapeutic procedures as well as the pathophysiology of somatization disorders due to muscular tension are illustrated by two detailed case-reports.

What do patients attending HIV and GUM outpatient clinics want from service providers? Results from a large-scale consultation exercise in west London

Our objectives were to understand patient demographic profiles, experiences of care and opinions about services. A questionnaire survey of 202 HIV patients and 389 genitourinary medicine (GUM) outpatients attending clinics during one week in 1999 was undertaken at a clinical directorate of HIV/GUM in west London. HIV and GUM patients differed by age (over 30: 84% vs 39%), sex (male: 88% vs 51%), and attendance (attended 6+ times: 55% vs 14%). Most indicated that they were satisfied with the general standard of care (97% HIV patients vs 95% GUM patients). Several clinic features were rated essential. When indicating reasons they might leave in the future, HIV patients were more likely to select leading edge care factors, such as lack of up-to-date treatment (54%). More GUM patients selected factors relating to convenience, such as waiting times (58%). In conclusion, most HIV and GUM patients were satisfied with their care, but differing experiences and opinions need to be addressed when planning services.

How much interest is the Internet to patients?

OBJECTIVES

To assess the accessibility of the internet, the level of interest from patients attending genitourinary (GU) medicine clinics, and explore potential concerns about confidentiality.

METHODS

Questionnaire based survey of patients attending five GU medicine clinics in England.

RESULTS

41% of GU medicine clinic patients in 1999 had access to the internet (range 31%-52%) with access more common in younger age groups, and less common in women and black Caribbean patients. One in 10 patients (with internet access) had used the internet to find out more about the problem with which they had come to the clinic. 60% of patients replied that information on sexual health on the internet was of interest to them and a high proportion of patients said they would use the internet to access information about GU clinics (64%), book an appointment (64%) or get test results (63%). Almost a quarter of patients who made additional suggestions wanted an interactive website.

CONCLUSIONS

A high proportion of patients attending GU clinics have access to the internet with potential uses for health education and service delivery.

The development of a quality of life instrument for use with post-menopausal women with urogenital atrophy in the UK and Sweden

Many post-menopausal women suffer from oestrogen deficiency. This can cause urogenital atrophy which leads to symptoms such as dyspareunia, dysuria, vaginal dryness and urge incontinence. Even though urogenital atrophy is a common condition, little attempt has been made to investigate the impact that the condition has on the quality of life of the women concerned. A quality of life instrument specifically for use with women with urogenital atrophy was developed. The needs-based approach to quality of life was adopted, which states that quality of life is the extent to which an individual is able to satisfy her needs. The development work was undertaken simultaneously in the UK and Sweden. The measure was found to be acceptable and relevant to women in both countries and to have good levels of test-retest reliability (0.92 in the UK and 0.85 in Sweden), internal consistency (alpha coefficients 0.90 in both countries) and construct validity. It is suitable for use in clinical trials and for monitoring the progress of patients in clinical practice.

Women's attitudes to urodynamics: a questionnaire survey

OBJECTIVE

To obtain a measure of how well women tolerate urodynamic investigations and to determine how well they thought the test was explained.

DESIGN

Prospective questionnaire survey.

SETTING

A teaching hospital tertiary referral centre urodynamic laboratory.

PARTICIPANTS

Three hundred and twenty-four women attending for urodynamic investigations on 331 occasions. Questionnaires were returned from 297 women (91.7%) with six women returning two questionnaires.

RESULTS

Urodynamic investigations were well tolerated by most women, with 45% feeling that the procedure was not as bad as they expected. Moderate or severe anxiety about the test was experienced by 42% and 40% felt moderately or severely embarrassed. Pain was noted by 27% of women during investigation, and by 13% after investigation. Overall distress from the procedure was less in older women and in those who had been referred from a specialist urogynaecology clinic. Distress was higher when difficulties were encountered during the investigation and in women who had investigations other than a standard cystometrogram. Women were likely to find the test less distressing when they felt they had been given adequate information about the test.

CONCLUSIONS

Although urodynamic investigations are generally well tolerated, there is a significant minority of women who find the test embarrassing, painful and distressing.

An exploration into occupational stress experienced by HIV health care professionals who work within genitourinary medicine settings

The present study investigates the occupational stress of health care workers involved with HIV care in genitourinary medicine (GUM) outpatient departments. Sixteen nursing and 14 medical staff completed the P. Gray-Toft and J. G. Anderson (1981) occupational stress inventory. This assesses 7 potential sources of stress (death and dying, uncertainty regarding treatment, inadequate preparation, lack of support, conflict with others, conflict with physicians, and workload). The mean scores obtained revealed a preponderance of low-stress scores for both medical and nursing staff. Analyses of variance and covariance further demonstrated that, in general, levels of stress did not differ within or between the occupational groups. However, sources and characteristics of stress were different between nurses and doctors. In this group of health care professionals, their work with HIV-positive patients within the GUM outpatient setting may be instrumental in limiting levels of stress.

A study of European womens' experience of the problems of urogenital ageing and its management

OBJECTIVES

A six country Pan-European study of aspects of urogenital ageing (UGA).

METHODS

The study was carried out using a stratified random sample of 3000 women between the ages of 55 and 75 years.

RESULTS

A total of 30% suffered from UGA symptoms, of whom 60% made efforts to alleviate their UGA problems, most commonly using HRT. There were some international differences regarding womens' perceptions of HRT, sexual relationships, prevalence and treatment of UGA problems and their attitudes to them across the six European States.

CONCLUSIONS

Despite some international differences there was a generally similar experience of UGA problems across the six European populations studied, with a minority of women suffering significantly, however the distress of that subgroup highlighted the need for health professionals to appreciate the impact of UGA on those affected and to understand that many of these older women may be reticent in seeking help.

[Urogenital symptoms and their resulting discomfort in non-institutionalized 50-to-75-year-old Dutch women]

OBJECTIVE

To determine the prevalence of urogenital symptoms in non-institutionalized Dutch women, aged 50 to 75 years, and the degree of discomfort.

DESIGN

Cross-sectional study.

SETTING

Nationwide investigation.

METHOD

A questionnaire was sent to 2157 non-institutionalized Dutch women aged 50 to 75 years. The survey sample was representative of the female population aged 50 to 75 years with respect to age, marital status, level of education and menopausal age.

RESULTS

The usable response was 81.6% (n = 1761). The overall prevalence of vaginal dryness, soreness and dyspareunia was 27%. The prevalence of micturition symptoms, urinary incontinence and recurrent urinary tract infections was 36%. The prevalence estimates for vaginal dryness and urinary incontinence showed a linear decrease with increasing age. Almost half of the symptomatic women reported moderate to severe discomfort. One-third of those affected received medical care. Previous hysterectomy had no effect on the reported prevalence estimates. Hysterectomized women reported moderate to severe complaints more often than non-hysterectomized ones.

CONCLUSION

The prevalence of urogenital symptoms in non-institutionalized Dutch women aged 50 to 75 years, was high: 47%. Of these women, 40% to 60% experienced discomfort, but only one-third had sought medical advice. These urogenital problems will probably increase in the coming decades.