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The aim of this study was to assess US postmenopausal women’s knowledge of and attitudes toward vaginal atrophy, using the Vaginal Health: Insights, Views & Attitudes survey.Data were obtained from 3,520 postmenopausal women (aged 55-65 y) in the United States, Canada, and Europe using a structured Internet-based questionnaire. Results for US women (n = 500) are presented.Eighty percent of women had finished their menses more than 5 years previously, and 93% had experienced at least one menopausal symptom, although only 63% associated vaginal symptoms with menopause. Of those who had experienced “vaginal discomfort” (48%), vaginal dryness (85%) and pain during intercourse (52%) were most commonly reported. Eighty-two percent of women had experienced vaginal discomfort for 1 year or more. Most women (80%) considered vaginal discomfort to negatively impact their lives, particularly with regard to sexual intimacy (75%), ability to have a loving relationship (33%), and overall quality of life (25%); women also felt that it made them feel old (36%) and affected their self-esteem (26%). Of those with symptoms, 37% did not consult any healthcare professional, and 40% waited 1 year or more before doing so. Although 78% of those with vaginal discomfort used some form of treatment, this consisted mainly of lubricating gels and creams (65%); only 34% of women had used any form of hormone therapy.Vaginal atrophy negatively impacts women’s lives, but women lack knowledge of the subject and are hesitant to consult healthcare professionals, who should proactively initiate discussions regarding appropriate treatment options.