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The European Vulvovaginal Epidemiological Survey (EVES) in Italy. Impact of vulvovaginal atrophy on the quality of life and sexual function in breast cancer survivors

  • Rossella E. Nappi1,*,
  • Nicoletta Biglia2
  • Ettore Cicinelli3
  • Tiziana Di Paolantonio4
  • Stefano Luisi5
  • Massimo Stomati6
  • Paola Villa7,8
  • on behalf of the EVES study investigators§

1Research Centre for Reproductive Medicine, Gynecological Endocrinology and Menopause, IRCCS Policlinico San Matteo Foundation, University of Pavia, 27100 Pavia, Italy

2University of Turin, Department of Surgical Sciences, Mauriziano Umberto I Hospital, 10128 Turin, Italy

32nd Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70121 Bari, Italy

4Shionogi srl, 00193 Rome, Italy

5Department of Molecular and Developmental Medicine, Division of Obstetrics and Gynecology, University of Siena, 53100 Siena, Italy

6Division of Obstetrics and Gynecology, Department of Gynecology and Obstetrics, "D. Camberlingo" Hospital, Francavilla Fontana, ASL Brindisi, 72100 Brindisi, Italy

7Department of Women, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy

8Catholic University of Sacred Heart, Rome, 00168 Rome, Italy

DOI: 10.31083/j.ejgo.2021.01.2119 Vol.42,Issue 1,February 2021 pp.38-44

Submitted: 30 April 2020 Accepted: 27 October 2020

Published: 15 February 2021

*Corresponding Author(s): Rossella E. Nappi E-mail:

§ The author’s own special request.

About author: § The complete list of the EVES Study investigators participating from Italian sites is as follows: A. M. Becorpi (Florence, Italy), P. Benedetti Panici (Rome, Italy), C. Benedetto (Turin, Italy), N. Biglia (Turin, Italy), M. Busacca (Milan, Italy), A. Cagnacci (Modena, Italy), A. Cianci (Catania, Italy), E. Cicinelli (Bari, Italy), F. De Seta (Trieste, Italy), C. Di Carlo (Naples, Italy), M. Gambacciani (Pisa, Italy), M. Guida (Salerno, Italy), S. Luisi (Siena, Italy), D. Marchesoni (Udine, Italy), R.E. Nappi (Pavia, Italy), A. M. Paoletti (Cagliari, Italy), S. Palacios (Madrid, Spain), A. Pellegrino (Lecco, Italy), V. Remorgida (Genoa, Italy), S. Salvatore (Milan, Italy), R. Seracchioli (Bologna, Italy), M. Stomati (Brindisi, Italy), N. Surico (Novara, Italy), P. Villa (Rome, Italy).


The European Vulvovaginal Epidemiology Survey (EVES) sub-analysis assesses the impact of history of breast cancer (HBC) on vulvovaginal atrophy (VVA), sexual function and quality of life in a sample of postmenopausal women. Women aged 45-75 years with at least one symptom of VVA attending Italian menopause centers were included; subgroup data were described according to the absence (N = 967) or presence (N = 78) of HBC. VVA confirmed by gynecological examination and Vaginal Health Index < 15 was more prevalent in women with HBC (93.6% vs. 86.0% and 78.2% vs. 65.9%, respectively). Self-reported vaginal discharge, itching and urinary frequency were more prevalent in women without HBC compared to different HBC subgroups. Day-to-Day Impact of Vaginal Aging (DIVA) and sexual function scores were similar between women with or without HBC, but women who have completed breast cancer (BC) therapy showed lower sexual distress. Women with HBC had a higher vaginal prevalence and severity of signs of VVA, while self-reported VVA symptoms were generally less disruptive in women with HBC. These exploratory findings warrant confirmation in larger studies.


Breast cancer; Menopause; Gynecological examination; Quality of life; Sexual dysfunction; Vulvovaginal atrophy; Genitourinary syndrome of menopause

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Rossella E. Nappi,Nicoletta Biglia,Ettore Cicinelli,Tiziana Di Paolantonio,Stefano Luisi,Massimo Stomati,Paola Villa,on behalf of the EVES study investigators. The European Vulvovaginal Epidemiological Survey (EVES) in Italy. Impact of vulvovaginal atrophy on the quality of life and sexual function in breast cancer survivors. European Journal of Gynaecological Oncology. 2021. 42(1);38-44.


[1] Portman DJ, Gass MLS. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and the North American Menopause Society. Maturitas. 2014; 79: 349-354.

[2] Nappi RE, Palacios S. Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause. Climacteric. 2014; 17: 3- 9.

[3] Kingsberg SA, Wysocki S, Magnus L, Krychman ML. Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (REal Women’s VIews of Treatment Options for Menopausal Vaginal ChangEs) survey. The Journal of Sexual Medicine. 2013; 10: 1790-1799.

[4] Nappi RE, Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA)-results from an international survey. Climacteric. 2012; 15: 36-44.

[5] Gandhi J, Chen A, Dagur G, Suh Y, Smith N, Cali B, et al. Genitourinary syndrome of menopause: an overview of clinical manifestations, pathophysiology, etiology, evaluation, and manage-ment. American Journal of Obstetrics and Gynecology. 2016; 215: 704-711.

[6] Biglia N, Bounous VE, Sgro LG, D’Alonzo M, Pecchio S, Nappi RE. Genitourinary syndrome of menopause in breast cancer survivors: are we facing new and safe hopes? Clinical Breast Cancer. 2015; 15: 413-420.

[7] Crandall C, Petersen L, Ganz PA, Greendale GA. Association of breast cancer and its therapy with menopause-related symptoms. Menopause. 2004; 11: 519-530.

[8] Arraras JI, Illarramendi JJ, de la Cruz S, Asin G, Manterola A, Ibanez B, et al. Erratum: quality of life in long-term premenopausal early-stage breast cancer survivors from Spain. Effects of surgery and time since surgery. Journal of Balkan Union of Oncology. 2016; 21: 1573.

[9] Joly F, Espié M, Marty M, Héron J, Henry-Amar M. Long-term quality of life in premenopausal women with node-negative localized breast cancer treated with or without adjuvant chemotherapy. British Journal of Cancer. 2000; 83: 577-582.

[10] Lindley C, Vasa S, Sawyer WT, Winer EP. Quality of life and preferences for treatment following systemic adjuvant therapy for early-stage breast cancer. Journal of Clinical Oncology. 1998; 16: 1380-1387.

[11] Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE. Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. Journal of Clinical Oncol-ogy. 1998; 16: 501-514.

[12] Biglia N, Cozzarella M, Cacciari F, Ponzone R, Roagna R, Mag-giorotto F, et al. Menopause after breast cancer: a survey on breast cancer survivors. Maturitas. 2003; 45: 29-38.

[13] Palacios S, Nappi RE, Bruyniks N, Particco M, Panay N. The European Vulvovaginal Epidemiological Survey (EVES): prevalence, symptoms and impact of vulvovaginal atrophy of menopause. Climacteric. 2018; 21: 286-291.

[14] Nappi RE, Palacios S, Bruyniks N, Particco M, Panay N, On Behalf of the EVES Study Investigators. The European Vulvovaginal Epidemiological Survey (EVES). Impact of history of breast cancer on prevalence, symptoms, sexual function and quality of life related to vulvovaginal atrophy. Gynecological Endocrinology. 2021; 37: 78-82.

[15] EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16: 199-208.

[16] Groenvold M. Health-related quality of life in early breast cancer. Danish Medical Bulletin. 2010; 57: B4184.

[17] Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. Journal of Sex & Marital Therapy. 2005; 31: 1-20.

[18] DeRogatis L, Clayton A, Lewis-D’Agostino D, Wunderlich G, Fu Y. Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder. The Journal of Sexual Medicine. 2008; 5: 357-364.

[19] Bachmann G. Urogenital ageing: an old problem newly recognized. Maturitas. 1995; 22: S1-S5.

[20] Biglia N, Bounous VE, D’Alonzo M, Ottino L, Tuninetti V, Robba E, et al. Vaginal atrophy in breast cancer survivors: attitude and approaches among oncologists. Clinical Breast Cancer. 2017; 17: 611-617.

[21] Lester J, Pahouja G, Andersen B, Lustberg M. Atrophic vaginitis in breast cancer survivors: a difficult survivorship issue. Journal of Personalized Medicine. 2015; 5: 50-66.

[22] Gibson CJ, Huang AJ, Larson JC, Mitchell C, Diem S, LaCroix A, et al. Patient-centered change in the day-to-day impact of post-menopausal vaginal symptoms: results from a multicenter randomized trial. American Journal of Obstetrics and Gynecology. 2020; 223: 99.e1-99.e9.

[23] Friedrich M, Zenger M, Hinz A. Response shift effects of quality of life assessments in breast cancer survivors. European Journal of Cancer Care. 2019; 28: e12979.

[24] Sprangers MAG, Schwartz CE. Integrating response shift into health-related quality of life research: a theoretical model. Social Science & Medicine. 1999; 48: 1507-1515.

[25] Huang AJ, Gregorich SE, Kuppermann M, Nakagawa S, Van Den Eeden SK, Brown JS, et al. Day-to-day impact of vaginal aging questionnaire. Menopause. 2015; 22: 144-154.

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