(134) Redefining Genitourinary Syndrome: A Proposal to Expand the GSM Nomenclature to Encompass the Full Spectrum of Hypoestrogenic and Hypoandrogenic Urogenital Disorders

Abstract Introduction The term Genitourinary Syndrome of Menopause (GSM) was introduced to replace “vulvovaginal atrophy” and better describe genital, urinary, and sexual symptoms arising from estrogen deficiency. However, the menopausal qualifier limits recognition of identical symptomatology in non-menopausal populations affected by hypoestrogenism or hypoandrogenism. These include lactating individuals, hormonal contraceptive users, transgender individuals on gender-affirming therapy, cancer survivors, and patients with endocrine or iatrogenic hormonal suppression. This restrictive terminology perpetuates underdiagnosis, gender and age bias, research exclusion, and inconsistent insurance coverage. Objective To critically evaluate the limitations of the term GSM, synthesize evidence demonstrating hypoestrogenic and hypoandrogenic genitourinary symptoms across diverse populations, and propose an inclusive, etiologically based reclassification-Genitourinary Syndrome (GS)-to promote equitable diagnosis, research, and care. Methods A narrative, evidence-informed review was conducted including peer-reviewed studies, clinical guidelines, and consensus statements published between 2000–2025 across PubMed, Scopus, and major specialty societies (ISSWSH, NAMS, AUA, ISSM). Literature addressing genitourinary symptoms associated with hormonal deficiency states-menopause, lactation, contraceptive use, gender-affirming therapy, cancer treatment, endocrine disorders, and medication-induced causes-was synthesized. Thematic analysis identified shared pathophysiologic mechanisms, clinical presentations, and systemic gaps in recognition and treatment. Results Hypoestrogenism and hypoandrogenism, regardless of etiology, produce indistinguishable histologic and clinical manifestations: vaginal dryness, dyspareunia, dysuria, urinary frequency, and sexual dysfunction. Lactating individuals experience prolonged hypoestrogenic symptoms termed Genitourinary Syndrome of Lactation (GSL); hormonal contraceptive users exhibit GSM-like symptoms from reduced bioavailable estradiol and testosterone; transgender men on testosterone develop atrophic vaginitis due to estrogen suppression; and cancer survivors face persistent GSM symptoms secondary to chemotherapy or endocrine therapy. Endocrine disorders such as primary ovarian insufficiency, Turner syndrome, and hypoestrogenic medication use (eg, GnRH agonists, SSRIs, isotretinoin, anticholinergics) yield comparable changes. The GSM terminology’s menopausal limitation fosters diagnostic neglect, stigma, inequitable insurance policies, and fragmented research design. To address these gaps, the authors propose the umbrella term Genitourinary Syndrome (GS) with etiologic subtypes: GS of Menopause, GS of Lactation, GS of Hormonal Contraceptive Use, GS of Gender-Affirming Hormone Therapy, GS of Cancer Survivorship or Treatment, GS of Endocrine Disorders, and GS of Medication-Induced Origin. This nomenclature aligns with principles of precision medicine and inclusive clinical care. Conclusions Reframing GSM as Genitourinary Syndrome (GS) acknowledges the shared pathophysiology of hypoestrogenic and hypoandrogenic genitourinary disorders across all populations. An etiologic, gender-inclusive classification enhances diagnostic accuracy, informs guideline development, facilitates research standardization, and promotes trauma-informed, equitable care. This paradigm shift is essential to advance sexual and urogenital health beyond menopausal boundaries, ensuring all individuals receive informed, comprehensive treatment for genitourinary syndromes. Disclosure No.