Genitourinary Syndrome of Menopause: New Terminology for Vulvovaginal Atrophy from the International Society for the Study of Women's Sexual Health and The North American Menopause Society

Abstract

Introduction The terminology for the genitourinary tract symptoms related to menopause was vulvovaginal atrophy, which does not accurately describe the symptoms nor is a term that resonates well with patients. Aim In 2012, the Board of Directors of the International Society for the Study of Women's Sexual Health (ISSWSH) and the Board of Trustees of The North American Menopause Society (NAMS) acknowledged the need to review current terminology associated with genitourinary tract symptoms related to menopause. Methods The two societies cosponsored a terminology consensus conference, which was held in May 2013. Main Outcome Measure The development of a new terminology that more accurately described the genitourinary tract symptoms related to menopause. Results Members of the consensus conference agreed that the term genitourinary syndrome of menopause (GSM) is a medically more accurate, all-encompassing, and publicly acceptable term than vulvovaginal atrophy. GSM is defined as a collection of symptoms and signs associated with a decrease in estrogen and other sex steroids involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder. The syndrome may include but is not limited to genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria, and recurrent urinary tract infections. Women may present with some or all of the signs and symptoms, which must be bothersome and should not be better accounted for by another diagnosis. Conclusion The term GSM was presented and discussed at the annual meeting of each society. The respective Boards of NAMS and ISSWSH formally endorsed the new terminology—genitourinary syndrome of menopause—in 2014.

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“…The local vulvo‐vaginal atrophic changes lead to epithelial thinning, loss of vaginal rugae and decreased vaginal vascularisation . In turn, this results in loss of elasticity and lubrication as well as shortening and narrowing of the vaginal canal, with vulvo‐vaginal atrophy (VVA) (more recently referred to as genitourinary syndrome of menopause/GSM), manifesting as vaginal dryness, itching, irritation, abnormal discharge and dyspareunia, with associated urinary symptoms of frequency, urgency and incontinence . Changes to the vaginal microbiome may also lead to an increased risk and recurrence of genitourinary infections …”

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“…Genitourinary syndrome of menopause (GSM) consists of a collection of symptoms and signs associated with a decrease in oestrogen and other sex steroids, involving changes to the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder. The syndrome may include genital symptoms of dryness, burning, and irritation; sexual symptoms of lack of lubrication, discomfort or pain, and impaired function; and urinary symptoms of urgency, dysuria, and recurrent urinary tract infections [14, 15]. These changes are not synonymous with the disappearance of sexual needs.…”

“…During that period follicle stimulating hormone (FSH) continues to increase and estradiol continues to decrease until approximately two years after the final menstrual period, after which the levels of each of these hormones stabilise. The late postmenopause is estimated to start about eight years after the final menstrual period [16] and is represented more by changes of the somatic than reproductive systems [7, 14]. Reduced levels of oestrogens and androgen are associated with dramatic alterations in genital tissue structure, including the nerve network, as well as the response to physiological modulators.…”

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“…However, including vulvovaginal atrophy therapies in Table 2 and excluding more than 12 branded male testosterone products and countless male testosterone generic products is misleading. Vulvovaginal atrophy or dyspareunia, now referred to as genitourinary syndrome of menopause, 11 results from hypogonadism but is erroneously classified as a sexual dysfunction, as if it, too, were a biopsychosocial phenomenon like HSDD. Genitourinary syndrome of menopause is an estrogen deficiency syndrome very effectively treated with estrogenic therapies locally and systemically and often adequately ameliorated with over-the-counter lubricants and moisturizers.…”