OBJECTIVE:: The aim of the study was to evaluate the prevalence and association of subjective symptoms and objective signs of vaginal atrophy (VA). METHODS:: A cross-sectional multicenter study was performed on 913 postmenopausal women consulting 22 gynecological outpatient services. The prevalence of subjective symptoms and objective signs of VA was stratified by years since menopause and related to each other. RESULTS:: In women a year after menopause the prevalence of vaginal dryness was 62% to 67%, of dyspareunia 67.5%, of itching 40%, of burning 48%, and of dysuria 15%. In women years after menopause the prevalence of vaginal dryness and dysuria was higher (85% and 30%, respectively) and that of itching and burning did not exceed 50% and 52%, respectively. The prevalence of dyspareunia was 75% in postmenopausal women after 6 years, but the rate decreased to about 41% years later. The prevalence of objective signs was also different. In women 1 year after menopause the prevalence of basic pH was 78%; of mucosal pallor, rugae thinning, and objective vaginal dryness about 60% to 62%; of mucosal fragility 35%; and of the presence of petechiae 15% to 20%. The prevalence of all objective signs was progressively higher with time since menopause reaching a value of 90% for pH?>?5, mucosal pallor, and rugae thinning; of 80% for mucosal fragility; and of 51% for petechiae. There was no strict association between signs and symptoms, apart from subjective and objective vaginal dryness (k index?=?0.820; sensitivity 0.96; specificity 0.82). CONCLUSIONS:: The results show that objective signs and subjective symptoms of VA have a different prevalence distribution in the years after menopause and are not strictly associated.