Key takeaways:
- The incidence of clinically diagnosed vulvar atrophy or hypertrophy in non-diabetic women on GLP-1RAs is exceedingly low, at approximately 0.06%.
- There was no statistically significant difference in risk (P = 0.97) between the GLP-1RA cohort and the control group, suggesting "Ozempic vulva" may not be a widespread clinical phenomenon.
- Clinicians should maintain open dialogue with patients regarding vulvar and sexual health changes, as subclinical or aesthetic concerns may not be captured by standard ICD-10 coding.
Jessica Yih, MD, Board-certified urologist, field of sexual medicine, University of California, Irvine, presented findings at the 2026 International Society for the Study of Women’s Sexual Health (ISSWSH) annual meeting regarding the impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on vulvar anatomy. The study addressed emerging anecdotal concerns regarding "Ozempic vulva," a term used in patient forums to describe perceived soft-tissue deflation or sagging following rapid weight loss.
“I think that’s primarily where our interest was ignited with this topic, because through my conversations with other clinicians—and there was a big article on Healthline, I think, about ‘Ozempic vulva’—that’s kind of where we got this idea to take a look at TriNetX using the big database to see if we could find anything significant,” Yih said.
The retrospective cohort analysis utilized the TriNetX Global Collaborative Network, involving data from 162 health care organizations. Investigators identified 618,362 non-diabetic women prescribed GLP-1RAs, such as semaglutide, and compared them to a control group of over 84 million non-diabetic women with no GLP-1RA exposure. The primary outcomes were new-onset ICD-10 diagnoses of vulvar atrophy (N90.5) or hypertrophy (N90.6, N90.68, N90.69).
After excluding patients with pre-existing conditions, the final analysis included 617,407 GLP-1RA users with a mean follow-up of 680 days. Vulvar atrophy or hypertrophy was diagnosed in 0.061% of GLP-1RA users compared to 0.060% of non-users. The absolute risk difference was 0.001% (95% CI –0.02 to 0.02; P = 0.97), representing no statistically significant difference between the cohorts.
“Basically, with the propensity score matching, looking at patients who were on the medication and patients who were not on the medication, matching for demographics and all other medical conditions, there was basically no significant increase in those diagnoses—hypertrophy or atrophy of the vulva—with or without the medication,” Yih noted. “I think that is an interesting finding, just that there’s not a significant amount of either atrophy or hypertrophy, despite some reports of it, like clinical reports of it or anecdotal evidence of it, that it’s not a significantly increased risk.”
Yih acknowledged limitations inherent in database research, including whether prescribing providers are actively screening for these conditions. “Is the provider who’s prescribing these medications screening or diagnosing patients with those diagnoses? Or is it really only when those patients have significant concerns that they’re coming forward and being evaluated for that?” she asked.
Despite these gaps, the study provides a baseline for clinical counseling. “I think that this data is helpful to just kind of address the general concern that there’s not really a significant change in vulvar appearance across the board. It’s not really something that everybody has to worry about,” Yih concluded. “As a provider—a urologist or gynecologist or any other provider in this space—just being open to initiating the conversation, asking if there are any concerns about vulvar or pelvic health, any changes to vulvar appearance, or even to their pelvic floor function... those can be things that patients would want to talk with their providers about.”
Reference:
Hammad MA, Nakamura HS, Yih J. Vulvar Tissue Changes in Non-Diabetic Women Receiving GLP-1 Receptor Agonists: A Global Federated Cohort Analysis. Abstract. Presented at: ISSWSH. February 12-15, 2026. Long Beach, California.
