*Article* **"Modified Schirmer Test" as an Objective Measurement for Vaginal Dryness: A Prospective Cohort Study**

**Dana Gabrieli 1,\* ,†, Yael Suissa-Cohen 2,†, Sireen Jaber <sup>2</sup> and Ahinoam Lev-Sagie 1,2**


**Abstract:** None of the currently available parameters allow for a direct and objective measurement of vaginal moisture. We used a calibrated filter paper strip as a measurement tool for the quantification of vaginal fluid, in a similar manner as the ophthalmic "Schirmer test" (used for eye moisture measurement). The study aimed to evaluate the validity of this new, objective tool, to measure vaginal moisture. We compared vaginal moisture measurements using the "modified Schirmer test" in symptomatic women with genitourinary syndrome of menopause to those of women without vaginal dryness. The mean "modified Schirmer test" measurement in the control group was 21.7 mm compared to 3.3 mm in the study group, yielding a statistically significant difference (*p* < 0.001). Strong correlations were found between "modified Schirmer test" measurements and pH (correlation coefficient −0.714), Vaginal Health Index [VHI (0.775)], and Visual Analogue Score (VAS) of dryness during intercourse (−0.821). Our findings suggest that the "modified Schirmer test" can be used as an objective measurement for the assessment of vaginal fluid level. This test may also prove useful for evaluation of non-hormonal treatments aimed to treat vaginal dryness.

**Keywords:** genitourinary syndrome of menopause (GSM); vaginal dryness; vaginal atrophy; vaginal health index (VHI); estrogen; vaginal maturation index (VMI); fractional CO<sup>2</sup> laser
