The Golden Girls Dilemma: Genitourinary Syndrome of Menopause

Genitourinary syndrome of menopause (GSM) is a term used to describe what was formerly known as vaginal atrophy, atrophic vaginitis, or urogenital atrophy. The older terminology was replaced by this more descriptive term with the goal of more accurately describing the constellation of symptoms experienced by GSM patients, including vaginal pain, dryness, dyspareunia, urinary incontinence, urgency, frequency, hematuria, and sexual dysfunction.

Although GSM-like symptoms occur in 15% of premenopausal women and 40% to 54% of postmenopausal women, the condition is associated with social stigma and often remains ignored or underdiagnosed. This presentation will review the clinical manifestations, pathophysiology, etiology, evaluation, and management of the condition. Specific emphasis will be placed on differentiating GSM from other genital pain conditions such as vulvodynia and vulvar dermatoses. Additionally, the presentation will review the impact of postmenopausal pain on quality of life, mental and physical health, and sexual function. Therapeutic recommendations will focus on multimodal therapies to address what is a complex but treatable syndrome.