Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: a longitudinal study

Menopause. 2018 Oct;25(10):1094-1104. doi: 10.1097/GME.0000000000001130.


Objective: To evaluate factors associated with incident self-reported vaginal dryness and the consequences of this symptom across the menopausal transition in a multiracial/ethnic cohort of community-dwelling women.

Methods: We analyzed questionnaire and biomarker data from baseline and 13 approximately annual visits over 17 years (1996-2013) from 2,435 participants in the Study of Women's Health Across the Nation, a prospective cohort study. We used discrete-time Cox proportional-hazards regression to identify predictors of incident vaginal dryness and to evaluate vaginal dryness as a predictor of pain during intercourse and changes in sexual intercourse frequency.

Results: The prevalence of vaginal dryness increased from 19.4% among all women at baseline (ages 42-53 years) to 34.0% at the 13th visit (ages 57-69 years). Advancing menopausal stage, surgical menopause, anxiety, and being married were positively associated with developing vaginal dryness, regardless of partnered sexual activity. For women not using hormone therapy, higher concurrent levels of endogenous estradiol were inversely associated (multivariable-adjusted hazard ratio: 0.94 per 0.5 standard deviation increase, 95% confidence interval: 0.91-0.98). Concurrent testosterone levels, concurrent dehydroepiandrosterone sulfate levels, and longitudinal change in any reproductive hormone were not associated with developing vaginal dryness. Both vaginal dryness and lubricant use were associated with subsequent reporting of pain during intercourse, but not with a decline in intercourse frequency.

Conclusion: In these longitudinal analyses, our data support many clinical observations about the relationship between vaginal dryness, menopause, and pain during intercourse, and suggest that reporting of vaginal dryness is not related to androgen level or sexual intercourse frequency.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Age Factors
  • Analysis of Variance
  • Anxiety
  • Chi-Square Distribution
  • Coitus / physiology
  • Cross-Sectional Studies
  • Dehydroepiandrosterone Sulfate / blood
  • Dyspareunia / enzymology*
  • Dyspareunia / epidemiology*
  • Estradiol / blood
  • Ethnic Groups
  • Female
  • Follow-Up Studies
  • Hormone Replacement Therapy
  • Humans
  • Hysterectomy / adverse effects
  • Incidence
  • Longitudinal Studies
  • Marital Status
  • Menopause / physiology*
  • Middle Aged
  • Multivariate Analysis
  • Proportional Hazards Models
  • Prospective Studies
  • Self Report
  • Surveys and Questionnaires
  • Testosterone / blood
  • Vaginal Diseases / epidemiology*
  • Vaginal Diseases / ethnology*


  • Testosterone
  • Estradiol
  • Dehydroepiandrosterone Sulfate