Introduction
Vulvovaginal symptoms, including dryness, irritation, burning, and pain, commonly affect postmenopausal women and contribute to reduced quality of life. These symptoms often stem from genitourinary syndrome of menopause (GSM) and influence emotional well-being, daily activities, and sexual function. Consequently, validated tools that capture both symptom presence and broader impacts have become essential in menopausal research and gynecology.
The Vulvovaginal Symptoms Questionnaire (VSQ) addresses this need effectively. Developed by Elisabeth A. Erekson and colleagues, the VSQ emerged as a multidimensional instrument specifically tailored for postmenopausal women. Published in 2013, the tool has garnered over 160 citations and demonstrates strong psychometric properties. For instance, the original validation confirmed internal consistency with Cronbach’s alpha values ranging from 0.76 (Symptoms) to 0.87 (Emotions). Therefore, researchers and clinicians rely on the VSQ to quantify symptom burden and evaluate treatment outcomes in this population.
This article provides a detailed overview of the VSQ’s purpose, structure, scoring, psychometric evidence, clinical utility, and limitations, helping researchers and clinicians apply the instrument responsibly and accurately.
Key Features of the Vulvovaginal Symptoms Questionnaire (VSQ)
Purpose and Use
The primary goal of the VSQ is to measure vulvovaginal symptoms and their multidimensional impact on a woman’s life. Specifically, it assesses how these symptoms affect emotional well-being and sexual health. Consequently, clinicians can use the data to inform treatment planning and monitor patient progress over time.
Target Population
The VSQ is exclusively validated for postmenopausal women, typically covering the following age groups:
- Older Adults (45–64 years)
- Seniors (65+ years)
Clinicians and investigators apply it in populations experiencing menopausal vulvovaginal changes.
Structure
The VSQ contains 21 dichotomous items (Yes/No) organized into four scales:
- Symptoms Scale (7 items): evaluates core symptoms like itching, burning, hurting, irritation, dryness, discharge, and odor.
- Emotions Scale (4 items): captures emotional responses, such as worry, embarrassment, and frustration.
- Life-Impact Scale (4 items): measures effects on daily activities and social interactions.
- Sexual-Impact Scale (5 items): examines influences on sexual activity and relationships (completed only by sexually active women).
Additionally, one screening item determines sexual activity status but does not contribute to scoring.
Scoring Method
Each “Yes” is scored as 1 point; “No” is scored as 0:
- Women not sexually active complete the first 16 items (score range: 0–16).
- Sexually active women complete all 21 items (score range: 0–20).
Higher scores indicate greater symptom burden and impact. This dichotomous scoring enhances simplicity and ease of interpretation in large studies and clinical use.
Administration Format
The VSQ is self-administered and requires 5–10 minutes to complete. It supports multiple formats, including:
- Paper-based
- Digital (online)
- In-person interview
- Phone/video call
Furthermore, an introductory paragraph and anatomical illustration standardize patient understanding of vulva and vagina terminology.
Applications of the Food Consumption Score (FCS)
Researchers and clinicians apply the VSQ across several domains:
- Monitoring: tracks symptom changes over time or during interventions.
- Treatment Planning: informs individualized management strategies, such as hormonal or non-hormonal therapies.
- Research Endpoint: serves as an outcome measure in observational studies and clinical trials evaluating GSM prevalence, risk factors, and intervention efficacy.
The VSQ’s disease-specific focus fills a critical gap in gynecologic symptom assessment, especially in studies involving hormone therapy, pelvic floor disorders, or quality-of-life research.
Languages and availability
The VSQ remains freely available for non-commercial research and clinical use. Validated translations include:
- English
- Mandarin Chinese
- Portuguese
- Indonesian
- Turkish
- Spanish
This linguistic diversity supports multicultural studies and global clinical applications.
Reliability and Validity
The VSQ is recognized as a highly reliable and valid instrument. Internal consistency (Cronbach’s alpha) is strong across its subscales: Emotions (0.87), Life-impact (0.83), Sexual-impact (0.82), and Symptoms (0.76). Furthermore, researchers supported its construct validity through confirmatory factor analysis and rigorous hypothesis testing.
Various studies have further supported its convergent and discriminant validity:
Limitations and Considerations
Despite its strengths as a validated tool, the VSQ has a few limitations that researchers and clinicians should consider:
- Self-report measure: As a self-report questionnaire, the results are heavily dependent on a patient’s subjective interpretation and personal memory.
- Cultural bias: There is a potential for cultural bias, which can affect how different populations interpret and respond to questions about gynecological health.
- Language barriers: although translations exist, further validation may be needed in some regions.
- Limited validation studies: fewer cross-cultural adaptations compared to broader instruments.
- Lack of sensitivity to change: The VSQ has not been formally evaluated for its responsiveness to treatment-related changes over time.
- Age restrictions: The instrument is specifically designed for postmenopausal women and is not suitable for use in younger populations or other age groups.
- Social Desirability Bias: Respondents may be influenced by a desire to present themselves in a favorable light or may feel uncomfortable disclosing the full extent of their symptoms.
Other Versions And Related Questionnaires
Researchers often use the VSQ alongside complementary tools such as:
- International Consultation on Incontinence Questionnaire – Vaginal Symptoms (ICIQ-VS)
- Female Sexual Function Index (FSFI)
- Day-to-Day Impact of Vaginal Aging (DIVA) Questionnaire
These instruments can provide broader insights into pelvic floor and sexual health.
Additional Resources
- The original validation study link
- You can access the questionnaire as a PDF through this link
- For inquiries, contact the corresponding author: elisabeth.erekson@yale.edu
Frequently Asked Questions (FAQ)
1.Who can use the VSQ?
Clinicians, researchers, and healthcare providers administer the VSQ to postmenopausal women experiencing vulvovaginal symptoms.
2. How long does it take to complete the VSQ?
Patients typically finish the VSQ in 5–10 minutes, which supports efficient use in busy clinical and research environments.
3. How is the VSQ administered?
Healthcare teams deliver the questionnaire through paper, digital platforms, in-person interviews, or phone/video calls—providing flexible options.
4. Is there any cost to using the VSQ?
The VSQ is free for non-commercial research and clinical purposes. For commercial applications or funded projects, users should seek permission from the corresponding author.
A Word From ResRef about the Vulvovaginal Symptoms Questionnaire (VSQ)
The VSQ is a structured and focused patient-reported outcome measure developed to assess vulvovaginal symptoms and their multidimensional impact in postmenopausal women. Its brief dichotomous format supports ease of administration in clinical and research settings. While not intended for diagnostic purposes, it provides a standardized method for quantifying symptom burden within its defined target population.
References
- Erekson, E. A., Yip, S. O., Wedderburn, T. S., et al. (2013). The Vulvovaginal Symptoms Questionnaire: A questionnaire for measuring vulvovaginal symptoms in postmenopausal women. Menopause, 20(9), 973–979. link
- Alem, M. E. R., Chaves, T. C., de Figueiredo, V. B., et al. (2022). Cross-cultural adaptation and psychometric evaluation of the Brazilian Portuguese version of the Vulvovaginal Symptoms Questionnaire. Menopause, 29(9), 1055–1061. link
- Tekin, A. B., Yassa, M., Kalkan, U., Sargin, M. A., Keskin, I., Usta, S., … Buran, A. M. (2022). Validation of the Vulvovaginal Symptom Questionnaire in Turkish women with genitourinary syndrome of menopause. Menopause, 29(3), 327–334. link
- Zhu, J., Wang, Y., & Chen, L. (2025). Psychometric properties of the Chinese version of the Vulvovaginal Symptoms Questionnaire in postmenopausal women. Journal of Advanced Nursing. Advance online publication. link
- Fernández-Alonso, A. M., Alcaide-Torres, J., Fernández-Alonso, I. M., Chedraui, P., & Pérez-López, F. R. (2017). Application of the 21-item Vulvovaginal Symptoms Questionnaire in postmenopausal Spanish women. Menopause, 24(11), 1295–1301. link
- Kurniawati, W., Lim Abdullah, K., Afiyanti, Y., et al. (2025). Validation of the Vulvovaginal Symptom Questionnaire in Indonesian women with postmenopausal syndrome using confirmatory factor analysis (Version 1). F1000Research, 14, 815. link
