title: Deconstructing the genitourinary syndrome of menopause.
abstract: The concept of genitourinary syndrome of menopause (GSM) was recently introduced and has been gaining widespread use. While some justifications for its introduction are straightforward, others may be questionable. Numerous unspecific symptoms and signs were included in the definition of the syndrome, but the minimum number required for diagnosis was not established. While the GSM definition is designed to facilitate identifying vulvovaginal and urinary estrogen-deprivation-associated symptoms and signs, several concerns have evolved: (1) the syndrome may result in the underdiagnosis of vulvar and urinary pathology; and (2) serious conditions (e.g., high-grade squamous intraepithelial lesions of the vulva or vulvar intraepithelial neoplasia, differentiated type) may be missed while others may not receive appropriate treatment (e.g., lichen sclerosus, overactive bladder). In addition, the transformation of urogenital symptoms and signs into a syndrome may create an iatrogenization of menopause, which, consequently, can lead to demand for (and offer of) a panacea of treatments. This can be detrimental to the care of women who require focused therapy rather than global treatment addressing a variety of genitourinary conditions, not all of which even require any form of intervention. Women's needs may be better served by having a more precise urogenital diagnosis.
authors.affiliation: Department of Gynecology and Obstetrics, Centro Hospitalar de São João, Porto, Portugal. pedrovieirabaptista@gmail.com.
authors.forename: Pedro
authors.identifier: http://orcid.org/0000-0001-5335-6770
authors.initials: P
authors.lastname: Vieira-Baptista
authors.affiliation: Department of Gynecology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Claudia
authors.initials: C
authors.lastname: Marchitelli
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Hope K
authors.initials: HK
authors.lastname: Haefner
authors.affiliation: Femicare Clinical Research for Women, Tienen, Belgium.|Department of Obstetrics and Gynecology, University Hospital Antwerp, Edegem, Belgium.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Donders
authors.affiliation: Department of Obstetrics and Gynecology, Hospital Universitario Lozano-Blesa, University of Zaragoza Faculty of Medicine, Zaragoza, 50009, Spain.
authors.forename: Faustino
authors.initials: F
authors.lastname: Pérez-López
mesh_terms: D001284:Atrophy / Q000473:pathology; D005260:Female; D052776:Female Urogenital Diseases / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D059411:Lower Urinary Tract Symptoms; D008593:Menopause; D013577:Syndrome; D009626:Terminology as Topic; D014621:Vagina / Q000473:pathology; D014627:Vaginitis; D014844:Vulva / Q000473:pathology
keywords: Genitourinary syndrome of menopause; Urogenital symptoms; Vulvar conditions; Vulvar lichen; Vulvovaginal atrophy