Redefining genitourinary syndrome: A proposal to expand the GSM nomenclature to encompass the full spectrum of hypoestrogenic and hypoandrogenic urogenital disorders.

The current term "Genitourinary Syndrome of Menopause" (GSM) was introduced to replace "vulvovaginal atrophy" and to better describe a constellation of symptoms affecting the genital and lower urinary tracts due to hypoestrogenism. However, its association with menopause excludes a growing and diverse population of individuals who experience identical symptoms due to non-menopausal etiologies, including perimenopause, lactation, hormonal contraception, cancer therapies, gender-affirming hormone therapy, and other medications. This paper proposes an expanded and updated nomenclature-Genitourinary Syndrome (GS)-with specific subtypes based on etiology. We review the pathophysiologic mechanisms underlying genitourinary symptoms across populations, highlight gaps in clinical recognition due to narrow terminology, and recommend a clinically and scientifically inclusive reclassification system. This shift is crucial for delivering equitable care, advancing research, and providing effective patient education.