Genitourinary syndrome of menopause (GSM): recommendations from the Fifth International Consultation on Sexual Medicine (ICSM 2024)
James A. Simon, Rossella E. Nappi, Peter Chedraui, Amanda Clark, Anne Gompel, Shaikh Zinnat Ara Nasreen, Santiago Palacios, Wendy Wolfman
Abstract
INTRODUCTION: Genitourinary syndrome of menopause (GSM) encompasses a cluster of sexual symptoms like dyspareunia associated with genital and urinary symptoms like urinary urgency, which may be variably reported in the clinical setting. OBJECTIVES: To provide a comprehensive guide for healthcare professionals (HCPs) in sexual medicine, helping them effectively recognize and manage GSM, a very common chronic and progressive condition with an impact on quality of life and intimate relationships. METHODS: An expert committee, invited from seven countries by the 5th International Consultation on Sexual Medicine (ICSM), was comprised of eight researchers and clinicians with expertise in menopause medicine, for the purpose of reviewing and grading the scientific evidence on nosology, etiology, diagnosis, and treatment of GSM. RESULTS: Presence of at least one GSM symptom ranges from 14% to 87% in postmenopausal women, with vaginal dryness and dyspareunia being the two most common symptoms. A summary of the recommendations on GSM management deriving from the evaluation of data, subject to its quality published in the scientific literature, is provided. CONCLUSIONS: GSM is a relatively new disorder with an expanded definition to further the older long-recognized condition of vulvovaginal atrophy (VVA) in postmenopausal women to include urinary symptoms and anchor the disorder to menopause and the hypoestrogenic state. This new disorder has provided renewed incentives to formalize a significant amount of multidisciplinary research in the last decade. However, many areas ranging from epidemiology to tailored effective and safe treatment options in clinical practice still require in-depth additional investigations.