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

Background 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.

Results and Conclusion 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. The term 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 (GSM) – in 2014.

Key words::

• ATROPHIC VAGINITIS
• GENITOURINARY SYNDROME OF MENOPAUSE
• MENOPAUSE
• URINARY URGENCY
• VULVOVAGINAL ATROPHY
• WOMEN’S SEXUAL HEALTH

ACKNOWLEDGEMENTS

Consensus conference panelists

Sheryl Kingsberg, PhD (conference moderator), MacDonald Women's Hospital and Case Western Reserve University School of Medicine; Margery Gass, MD, NCMP (co-chair), The North American Menopause Society; David Portmann, MD (co-chair), Columbus Center for Women’s Health Research; David Archer, MD, NCMP, Jones Institute for Reproductive Medicine; Gloria Bachmann, MD, Rutgers – Robert Wood Johnson Medical School; Lara Burrows, MD, MSc, Summa Health System; Murray Freedman, MS, MD, Medical College of Georgia; Andrew Goldstein, MD, Center for Vulvovaginal Disorders; Irwin Goldstein, MD, San Diego Sexual Medicine; Debra Heller, MD, Rutgers – New Jersey Medical School; Cheryl B. Iglesia, MD, MedStar Washington Hospital Center and Georgetown University School of Medicine; Risa Kagan, MD, NCMP, University of California, San Francisco, Sutter East Bay Physicians Medical Group, Berkeley; Susan Kellogg Spadt, PhD, CRNP, Sexual Medicine, Pelvic and Sexual Health Institute of Philadelphia; Michael Krychman, MD, Southern California Center for Sexual Health; Lila Nachtigall, MD, NCMP, New York University School of Medicine; Rossella E. Nappi, MD, PhD, Department Ob/Gyn, IRCCS Policlinico San Matteo, University of Pavia, Italy; JoAnn V. Pinkerton, MD, NCMP, University of Virginia – Division Midlife Health; Jan Shifren, MD, NCMP, Massachusetts General Hospital, Harvard Medical School; James Simon, MD, NCMP, George Washington University, Women's Health & Research Consultants; Cynthia Stuenkel, MD, NCMP, University of California, San Diego School of Medicine.

Selection committee

Sarah Berga, MD, Wake Forest University; Margery Gass, MD, NCMP, The North American Menopause Society; Andrew Goldstein, MD, ISSWSH President; Irwin Goldstein, MD, San Diego Sexual Medicine; David Portman, MD, ISSWSH Treasurer.

Disclosures

M. Gass reports no conflicts of interest. David Portman has received research grants from QuatRx, Actavis, Pfizer, Bayer, Endoceutics, Amneal, Sun Pharmaceuticals, Palatin, Noven, Abbvie, Teva, and TherapeuticsMD. He has acted as a consultant for Shionogi, NovoNordisk, Palatin, Noven, Sprout, Pfizer, Teva, Actavis, and TherapeuticsMD. He is in the speaker's bureau of Shionogi, Pfizer, and Noven.

Funding

The Consensus Conference was sponsored by unrestricted educational grants from Apricus Biosciences; Bayer; Novo Nordisk; Shionogi; Tara Allmen, MD; Lil’ Drug Store; Warner Chilcott; and Women's Initiative on Sexual Health (WISH).

Editorial support

The authors wish to acknowledge editorial support provided by Sally Mitchell, PhD; Lynn Brown, PhD; Maribeth Bogush, PhD; Norma Padilla, PhD; Penny Allen, and Kathy Method.

Notes

*Possible differential diagnoses include infectious disease (e.g. candidiasis, bacterial vaginosis, trichomoniasis, gonorrhea/chlamydia); irritant or allergic vaginitis/vulvitis (caused by soaps, perfumes, powders, deodorants, panty liners/pads, diapers, urine, spermicides, latex condoms, semen, warming gels, lubricants, vaginal moisturizers, topical antimycotics); vulvovaginal dermatoses (e.g. lichen sclerosus, erosive lichen planus, mucous membrane pemphigoid, plasma cell vulvitis); hypertonic pelvic floor muscle dysfunction (levator ani spasm); desquamative inflammatory vaginitis; painful bladder syndrome/interstitial cystitis; vulvodynia/vestibulodynia; and pudendal neuralgia.