**3. Results**

Sixty women were enrolled, and their characteristics are detailed in Table 2. Out of the 30 women who were enrolled in the control group, two were excluded from the final analysis because they did not meet the inclusion criteria, as despite verbally denying any vaginal complaints, their VAS during intercourse score was 4 or higher.


**Table 2.** Patients' characteristics.

GSM = genitourinary syndrome of menopause, IUD = intra-uterine device, BTL = bilateral tubal ligation, HCs = hormonal contraceptives.

In the GSM group, 28 women were previously diagnosed with breast cancer, and 23 of them were treated with aromatase inhibitors.

"Modified Schirmer test" measurements, pH levels, VHI, and VAS are presented in Table 3. Comparison of "modified Schirmer test" measurements between the two study groups is presented in Table 3 and Figure 3. The differences between the measurements in the study group and the control group were statistically significant.


**Table 3.** Measurements of parameters evaluating vaginal atrophy.

**Figure 3.** Modified Schirmer measurements in control and study groups. The figure graphically presents the differences between "modified Schirmer test" measurements in the control and the GSM groups. The horizontal line within the box indicates the median, boundaries of the box indicate the 1st and 3rd quartile, and whiskers indicate the minimum and maximum values. **Figure 3.** Modified Schirmer measurements in control and study groups. The figure graphically presents the differences between "modified Schirmer test" measurements in the control and the GSM groups. The horizontal line within the box indicates the median, boundaries of the box indicate the 1st and 3rd quartile, and whiskers indicate the minimum and maximum values.

A statistically significant difference was observed between the two groups regarding the number of vaginal deliveries. We therefore performed a covariate analysis, correcting for vaginal deliveries, to establish that the distinction in the "modified Schirmer test" measurements was not a result of the difference in vaginal deliveries alone. The analysis yielded a statistically significant difference after the correction as well. A statistically significant difference was observed between the two groups regarding the number of vaginal deliveries. We therefore performed a covariate analysis, correcting for vaginal deliveries, to establish that the distinction in the "modified Schirmer test" measurements was not a result of the difference in vaginal deliveries alone. The analysis yielded a statistically significant difference after the correction as well.

Correlations between all measured parameters of the entire study population, expressed by Pearson's correlation coefficient, are shown in Table 4. The modified Schirmer measurements showed strong correlations to pH, VHI, and intercourse-VAS. All correlations were statistically significant (*p* < 0.001). Correlations between all measured parameters of the entire study population, expressed by Pearson's correlation coefficient, are shown in Table 4. The modified Schirmer measurements showed strong correlations to pH, VHI, and intercourse-VAS. All correlations were statistically significant (*p* < 0.001).

**Table 4.** Correlations between the different measures**.** Pearson's correlation coefficient is a measure of the linear correlation between these parameters. Correlation coefficients of 1 or −1 represent per-

**pH VHI VAS Daily** 

**Dryness** 

**Modified Schirmer (mm)** 

VHI 0.775 (0.0) −0.901 (0.0)

VAS daily dryness −0.544 (0.0) 0.711 (0.0) −0.709 (0.0)

The purpose of this study was to test a new, objective measurement modality for vaginal moisture/dryness and to evaluate its validity. To achieve this, we used a calibrated filter-paper test strip, similar to the one used for the ophthalmic Schirmer test, in a standardized manner comparing symptomatic women suffering from GSM-associated vaginal

dryness −0.821 (0.0) 0.885 (0.0) −0.936 (0.0) 0.731 (0.0)

pH −0.714 (0.0)

1 or −1 the value of the coefficient is, the stronger the correlation.

VAS intercourse

**Correlation Coefficient (Significance)** 

**4. Discussion** 

**Table 4.** Correlations between the different measures. Pearson's correlation coefficient is a measure of the linear correlation between these parameters. Correlation coefficients of 1 or −1 represent perfect correlations, whereas a correlation coefficient of 0 represents no correlation. Thus, the closer to 1 or −1 the value of the coefficient is, the stronger the correlation.

