Hypothesis / aims of study
There is a lack of published research specifically addressing Genito Urinary Syndrome of the Menopause ( GSM ) among the Egyptian women. study aimed to:
Estimate the rate of GSM among perimenopausal and menopausal women in Ain shams university outpatients clinics, by using the validated DIVA questionnaire.
Identify the most bothersome symptom(s) of GSM and evaluate their impact on quality of life (QoL), within the context of cultural attitudes that may influence symptom reporting and health-seeking behavior. and, to identify the most important affected domains.
To compare the quality of life affected domains scores in Postmenopausal women, who experienced symptoms of GSM compared to those who do not report such symptoms.
To Validate the Arabic translated questionnaire for use in an Arabic speaking countries context, specifically in Egypt. The DIVA questionnaire validation and adaptation is crucial to develop a sensitive tool.
Source: ashasexualhealth.org/pdfs/DIVA.pdf
Study design, materials and methods
1- validation of the Arabic translated version of the Day-to-Day Impact of Vaginal Aging (DIVA) questionnaire and cross-sectional, descriptive study for assessment of the GSM in post menopausal women.
Validation of the DIVA Questionnaire
Translated , back-translated and Cultural Adapted.
Face Validation: pilot-tested with 30 postmenopausal women.
Psychometric Evaluation of DIVA was done by using:
• Confirmatory Factor Analysis (CFA)
• Internal Consistency: by Cronbach’s alpha coefficient
• Divergent Validity: Assessed by measuring the correlation between DIVA scores and unrelated constructs using Pearson’s correlation coefficient.
• Test-Retest Reliability: the questionnaire was re administered to the same group of women after a minimum of 10 days . score consistency assessed by Pearson’s correlation.
Study Sample for DIVA Validation
A simple random sample of 150 postmenopausal women attended the gynecology clinic in Ain shams maternity hospital.
2- Assessment of GSM and Impact on Quality of Life:
Sampling Calculation
Using an estimated GSM prevalence of 50%, a 5% margin of error, and a 95% confidence level.
A total of 385 postmenopausal women reported at least one vaginal symptom who attended the gynecology clinic in Ain shams maternity hospital. selected by simple random sampling, completed the self-administered Arabic version of the DIVA questionnaire. Then clinically assessed and categorized based on the diagnosis of GSM.
Data Analysis
• Quantitative variables were presented as mean ± standard deviation (SD) if normally distributed, or as median and interquartile range (IQR) if not normally distributed.
• Group comparisons between women diagnosed with GSM and those without were performed using Chi-square tests for categorical variables and t-tests for continuous variables.
• All statistical analyses Jamovi software, version 2.3 for Windows.
Results
The Arabic version of the DIVA questionnaire was confirmed to be a valid tool. CFI value was 0.96, indicating a good model fit. Cronbach’s alpha was 0.89 for the entire scale, showing internal consistency. A correlation coefficient of 0.70 indicated acceptable test–retest reliability.
Prevalence of the GSM found to be 64%. Only 30% of them self reported the symptoms. The highest mean scores on the DIVA questionnaire were in the sexual functioning domain long version (mean 1.9; SD 1.0), followed by the sexual functioning domain short version (mean 1.8; SD 1.1), self-perception and body image (mean 1.3; SD 1.1), activities of daily living (mean 0.8; SD 0.8), and emotional well-being (mean 0.8; SD 0.7).
Scores on the DIVA questionnaire were significantly higher in women with a GSM
Interpretation of results
Vaginal symptoms impact the well-being, functioning, and QoL of postmenopausal women, especially sexual function, self-perception, and body image. This impact is significantly higher in women with GSM.