Understanding Vaginal Health Research Abstract

Vaginal Health Across the Lifespan: Prevalence, Impact, and Awareness Gaps - Findings from a Cross-Sectional Survey of 1,202 Women

July 2024

Key Findings

1. 55.1% of respondents reported vaginal dryness or atrophy, the most prevalent vaginal health issue in this sample, with 49.5% of those affected experiencing it daily or near-daily. The mean age of onset was 47.5 years.
2. 32.6% experienced at least one vaginal infection (UTIs: 19.0%, thrush: 17.1%, BV: 7.4%). For most sufferers, these are recurrent: 61.3% of UTI sufferers experience episodes a few times a year or more, and 11.6% of BV sufferers experience it all the time.
   
3. 39.7% of sexually active respondents reported pain during sex due to dryness, irritation, or infections; 57.8% reported their vaginal health impacted their sex life.
   
4. 66.3% of respondents identified at least one external worsening factor; the menopausal transition was the consistent inflection point across all condition types.
   
5. Cranberry juice: the most popular non-prescription remedy (used by 33.6%), is also the least effective (combined positive: 59.3%; extremely effective: just 7.4%). Creams and pessaries and dietary changes achieve the strongest effectiveness profiles (86.0% and 86.2% respectively).
   
6. 94.7% of respondents felt that vaginal health was not adequately covered in sex education, and 38.0% felt unable to discuss their vaginal health with partners or family.

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Background

Vaginal health encompasses a spectrum of conditions, including infections, dryness, atrophy, dyspareunia, and pH imbalance - that significantly affect quality of life, sexual wellbeing, and self-confidence. Despite their prevalence, these conditions remain under-discussed in clinical settings and are frequently reported as a source of embarrassment by affected women. The menopausal transition in particular is associated with pronounced changes in vaginal health, yet awareness of these changes and available interventions remains limited. This study aimed to characterise the prevalence, severity, and impact of vaginal health issues across a large sample of adult women and to assess current management approaches and their effectiveness. The survey was conducted by DR.VEGAN^®, July 2024.

Methods

A cross-sectional online survey was administered to 1,202 women. Individual-level response data were available for all analyses. The survey captured the following: dietary profile; age; reproductive and hormonal status; clinical history of PCOS and endometriosis; experience of vaginal infections (UTIs, thrush, BV); vaginal dryness and atrophy; pain during sex; menstrual cycle-related vaginal changes; age-related progression; worsening factors; self-reported knowledge and communication about vaginal health; and emotional and relational impact. Use of management strategies and their rated effectiveness were also assessed.

Results

Sample characteristics

Of 1,202 respondents, 86.5% were in or approaching the menopausal transition: 32.4% (n=389) perimenopausal, 34.8% (n=418) menopausal, and 19.4% (n=233) postmenopausal. A further 10.7% (n=129) reported suffering from PMS. The largest age group was 45–54 years (51.9%, n=624), followed by 55–64 years (27.0%, n=325). PCOS was reported by 6.3% and endometriosis by 10.0%. See Figure 1.

Vaginal infections.

Of 1,179 respondents, 32.6% (n=384) reported at least one vaginal infection. For most sufferers, these are recurrent rather than isolated events. See Figure 2 for prevalence and frequency data.

Vaginal dryness and atrophy.

Of 1,175 respondents, 55.1% (n=647) reported vaginal dryness or atrophy - the most prevalent vaginal health issue in this sample. Among those affected, 49.5% experienced dryness daily or near-daily. The mean age at onset was 47.5 years (median 50), consistent with the perimenopausal transition as the primary trigger. Among the 1,016 peri/meno/postmenopausal respondents, 58.6% reported any dryness or atrophy. See Figure 3.

Pain during sex

Of 977 women for whom sex was applicable, 39.7% (n=388) reported pain during sex due to dryness, irritation, or infections. The mean age at which this became a problem was 46.0 years (median 49), reflecting the menopausal transition as a key inflection point. Free-text comments highlighted the relational and emotional impact: “I have only had sex once since beginning menopause over 4 years ago; it was extremely uncomfortable, painful and distressing”; “just feel my sex life is over.”

Age-related progression

Of 1,116 respondents, 48.7% (n=543) reported more vaginal health issues as they had aged, while only 13.1% reported fewer. Vaginal health predominantly worsens over the life course for this population, consistent with the progressive physiological changes associated with declining oestrogen.

Worsening factors

Of 1,113 respondents, 66.3% identified at least one external factor worsening their vaginal health. See Figure 4 for the full worsening factor profile.

Emotional and relational impact

Vaginal health conditions carried a substantial emotional and relational burden. Of 1,087 respondents, 57.8% (n=628) reported their sex life was impacted, 47.0% (n=512) said it affected their confidence, and 50.8% (n=553 of 1,088) reported feeling embarrassed about their vaginal health issues. See Figure 5.

Awareness, communication and education

While 65.1% of respondents felt knowledgeable about how to care for their vaginal health, 94.7% (n=1,025 of 1,082) felt vaginal health was not adequately covered in sex education. Communication barriers were also evident: 38.0% felt unable to discuss their vaginal health with partners or family, and 20.4% felt unable to discuss it with their doctor. Free-text responses reinforced the broader cultural taboo: “As a nurse of 30 years, I found women didn’t want to talk about it - it was a taboo subject; they were embarrassed and felt they’d done something wrong.”

Treatment strategies and effectiveness. Of 1,067 respondents, 71.4% had tried at least one treatment or management strategy. See Figure 6 for the full effectiveness comparison.

Conclusions

This large survey of 1,202 women demonstrates that vaginal health conditions are highly prevalent, predominantly chronic, and significantly under-addressed. Vaginal dryness or atrophy affects over half of respondents, with nearly half of those affected experiencing it daily or near-daily. Infections, particularly UTIs and thrush, are recurrent for most sufferers. Dyspareunia affects two in five sexually active respondents, and the menopausal transition consistently emerges as the primary inflection point across all condition types. The emotional and relational burden is substantial, with over half reporting impacts on their sex life and confidence. Despite reasonably good personal knowledge, 94.7% feel sex education is inadequate, and significant barriers to discussion with both social and clinical contacts persist. Cranberry juice, the most commonly used non-prescription remedy, is also the least effective. These findings point to a clear need for better-informed, evidence-based supplementary interventions and significantly improved public education and clinical communication around vaginal health.

Keywords: vaginal health, UTIs, thrush, BV, vaginal dryness, atrophy, dyspareunia, menopause, perimenopause, women’s health, sexual wellbeing, pH balance

Survey date: July 2024  |  Sample size: N = 1,202  |  Data: Individual-level responses   

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