{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T01:03:53Z","timestamp":1794013433978,"version":"4.8.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T00:00:00Z","timestamp":1636934400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Reprod. Health"],"abstract":"<jats:p>Genitourinary syndrome of menopause (GSM) is a term used to define a compilation of signs and symptoms arising from decreased estrogenic stimulation of the vulvovaginal and lower urinary tract. Among 27\u201384% of women in postmenopausal are affected for symptoms of GSM, and these can unquestionably impair health, sexual function, consequently the quality of life of these women. The main signs and symptoms of GSM include, among others, burning, irritation, vulvovaginal dryness, dyspareunia, urinary symptoms of urgency, dysuria, or recurrent urinary tract infection. The diagnosis can be made through anamnesis, questionnaires, physical exams, and, sometimes, complementary exams. Objective vaginal assessment is essential and can be complemented by using the Vaginal Health Index (VHI), Vaginal Maturation Index (VMI), or vaginal pH measurement. The acknowledgment of this condition by health professionals is crucial for its identification and proper management and exclusion of other conditions that make a differential diagnosis with it.<\/jats:p>","DOI":"10.3389\/frph.2021.779398","type":"journal-article","created":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T05:38:42Z","timestamp":1636954722000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":86,"title":["Genitourinary Syndrome of Menopause: Epidemiology, Physiopathology, Clinical Manifestation and Diagnostic"],"prefix":"10.3389","volume":"3","author":[{"given":"Ayane Cristine Alves","family":"Sarmento","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Paula Ferreira","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Vieira-Baptista","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo C\u00e9sar","family":"Giraldo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Jos\u00e9","family":"Eleut\u00e9rio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Katherine","family":"Gon\u00e7alves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1016\/j.maturitas.2015.07.020","article-title":"Update on management of genitourinary syndrome Menopause: a practical guide","volume":"82","author":"Palacios","year":"2015","journal-title":"Maturitas."},{"key":"B2","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1080\/13697137.2019.1600499","article-title":"Assessing symptomatic vulvar, vaginal, and lower urinary tract atrophy","volume":"22","author":"Palacios","year":"2019","journal-title":"Climacteric"},{"key":"B3","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.maturitas.2005.06.014","article-title":"Management of post-menopausal vaginal atrophy and atrophic vaginitis","volume":"52","author":"Castelo-Branco","year":"2005","journal-title":"Maturitas"},{"key":"B4","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3109\/13697137.2013.871696","article-title":"Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause","volume":"17","author":"Nappi","year":"2014","journal-title":"Climacteric."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1097\/GME.0000000000000329","article-title":"Vulvovaginal atrophy terminology consensus conference panel. 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","volume":"21","author":"Portman","year":"2014","journal-title":"Menopause."},{"key":"B6","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1097\/GME.0000000000001609","article-title":"The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society","volume":"27","year":"2020","journal-title":"Menopause"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/09513590.2021.1931100","article-title":"Clinical manifestations and evaluation of postmenopausal vulvovaginal atrophy","volume":"26","author":"P\u00e9rez-L\u00f3pez","year":"2021","journal-title":"Gynecol Endocrinol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e046372","DOI":"10.1136\/bmjopen-2020-046372","article-title":"Microablative fractional radiofrequency for the genitourinary syndrome of menopause: protocol of randomised controlled trial","volume":"11","author":"Sarmento","year":"2021","journal-title":"BMJ Open"},{"key":"B9","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1007\/s00192-017-3295-6","article-title":"Deconstructing the genitourinary syndrome of menopause","volume":"28","author":"Vieira-Baptista","year":"2017","journal-title":"Int Urogynecol J."},{"key":"B10","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1097\/GRF.0000000000000380","article-title":"Genitourinary syndrome of menopause","volume":"61","author":"Shifren","year":"2018","journal-title":"Clin Obstet Gynecol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1016\/j.sxmr.2017.11.002","article-title":"Couplepause: a new paradigm in treating sexual dysfunction during menopause and andropause","volume":"6","author":"Jannini","year":"2018","journal-title":"Sex Med Rev."},{"key":"B12","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1016\/0378-5122(95)00956-6","article-title":"Urogenital ageing: an old problem newly recognized","volume":"22","author":"Bachmann","year":"1995","journal-title":"Maturitas."},{"key":"B13","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1097\/gme.0b013e31816c5541","article-title":"Vaginal maturation index self-sample collection in mid-life women: acceptability and correlation with physician-collected samples","volume":"15","author":"Hess","year":"2008","journal-title":"Menopause."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1684","DOI":"10.1016\/S0140-6736(18)31891-9","article-title":"Global, regional, and national age-se specific mortality and life expectancy, 1950\u20132017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"GBD","year":"2018","journal-title":"Lancet"},{"key":"B15","doi-asserted-by":"publisher","first-page":"419","DOI":"10.3109\/13697137.2010.507886","article-title":"Age of menopause and impact of climacteric symptoms by geographical region","volume":"13","author":"Palacios","year":"2010","journal-title":"Climacteric."},{"key":"B16","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1038\/nrendo.2017.180","article-title":"Symptoms of menopause\u2014global prevalence, physiology and implications","volume":"14","author":"Monteleone","year":"2018","journal-title":"Nat Rev Endocrinol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"15004","DOI":"10.1038\/nrdp.2015.4","article-title":"Menopause","volume":"1","author":"Davis","year":"2015","journal-title":"Nat Rev Dis Primers."},{"key":"B18","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.maturitas.2010.08.001","article-title":"Women's voices in the menopause: results from an international survey or vaginal atrophy","volume":"67","author":"Nappi","year":"2010","journal-title":"Maturitas."},{"key":"B19","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/j.jsxm.2017.01.010","article-title":"The women's EMPOWER survey: identifying women's perceptions on vulvar and vaginal atrophy and its treatment","volume":"14","author":"Kingsber","year":"2017","journal-title":"J Sex Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1080\/09513590.2018.1563883","article-title":"Impact of vulvovaginal atrophy of menopause: prevalence and symptoms in Italian women according to the EVES study","volume":"35","author":"Nappi","year":"2019","journal-title":"Gynecol Endocrinol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"615","DOI":"10.3390\/medicina55100615","article-title":"Review: vaginal health in menopausal women","volume":"55","author":"Alvisi","year":"2019","journal-title":"Medicina."},{"key":"B22","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1111\/j.1471-0528.1997.tb10655.x","article-title":"Urogenital ageing and its effect on sexual health in older British women","volume":"104","author":"Barlow","year":"1997","journal-title":"Br J Obstet Gynaecol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/S0378-5122(97)00047-9","article-title":"A study of European women's experience of the problems of urogenital ageing and its management","volume":"27","author":"Barlow","year":"1997","journal-title":"Maturitas."},{"key":"B24","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3109\/13697137.2015.1078206","article-title":"The urogenital system and the menopause","volume":"18","author":"Calleja-Agiusand","year":"2015","journal-title":"Climacteric."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2000","DOI":"10.1007\/s11606-008-0820-9","article-title":"Correlates of sexual satisfaction among sexually active postmenopausal women in the Women's Health Initiative Observational Study","volume":"23","author":"Call-Hosenfeld","year":"2008","journal-title":"J Gen Intern Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1111\/j.1743-6109.2007.00685.x","article-title":"The frequency of sexual intercourse reported by women: a review of community-based studies and factors limiting their conclusions","volume":"5","author":"Schneidewind-Skibbe","year":"2008","journal-title":"J Sex Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"2865","DOI":"10.1111\/jsm.12686","article-title":"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","volume":"11","author":"Portman","year":"2014","journal-title":"J Sex Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1080\/13697137.2018.1529748","article-title":"Vaginal atrophy across the menopausal age: results from the ANGEL study","volume":"22","author":"Cagnacci","year":"2019","journal-title":"Climacteric."},{"key":"B29","doi-asserted-by":"publisher","first-page":"65","DOI":"10.15171\/jlms.2020.11","article-title":"Effect of the fractional CO2 laser on the quality of life, general health, and genitourinary symptoms in postmenopausal women with vaginal atrophy: a prospective cohort","volume":"11","author":"Adabi","year":"2020","journal-title":"J Lasers Med Sci"},{"key":"B30","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1097\/GME.0000000000001333","article-title":"Fractional CO2 laser versus promestriene and lubricant in genitourinary syndrome of menopause","volume":"26","author":"Politano","year":"2019","journal-title":"Menopause."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/ijgo.13561","article-title":"Physical methods for the treatment of genitourinary syndrome of menopause: a systematic review","author":"Sarmento","year":"2021","journal-title":"Int J Gynecol Obstet."},{"key":"B32","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1080\/09513590.2021.1943346","article-title":"Management of postmenopausal vulvovaginal atrophy: recommendations of the International Society for the Study of Vulvovaginal Disease","volume":"37","author":"Perez-Lopez","year":"2021","journal-title":"Gynecol Endocrinol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1111\/j.1464-410X.2008.07626.x","article-title":"Oestrogen receptors and their relation to neural receptive tissue of the labia minora","volume":"101","author":"Martin-Alguacil","year":"2008","journal-title":"BJU Int."},{"key":"B34","doi-asserted-by":"publisher","first-page":"12","DOI":"10.5114\/pm.2017.66178","article-title":"Immunohistochemical evaluation of oestrogen receptors a and b in epithelium of the vaginal mucous membrane in women after oestrogen therapy","volume":"16","author":"Sawczuk","year":"2017","journal-title":"Prz Menopauzalny."},{"key":"B35","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1038\/ijir.2012.25","article-title":"Androgen receptor expression in the human vagina under different physiological and treatment conditions","volume":"25","author":"Baldassarre","year":"2013","journal-title":"Int J Impot Res."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1321","DOI":"10.1097\/GME.0000000000001236","article-title":"Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy","volume":"25","author":"Brotman","year":"2018","journal-title":"Menopause."},{"key":"B37","doi-asserted-by":"publisher","first-page":"e1750","DOI":"10.6061\/clinics\/2020\/1750","article-title":"Impact of microablative fractional radiofrequency on the vaginal health, microbiota, and cellularity of postmenopausal women","volume":"75","author":"Sarmento","year":"2020","journal-title":"CLINICS."},{"key":"B38","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1002\/lsm.23031","article-title":"Energy-based treatment for gynecologic conditions including genitourinary syndrome of menopause: consensus, controversies, recommendations, and FDA clearance","volume":"15","author":"Tadir","year":"2019","journal-title":"Lasers Surg Med."},{"key":"B39","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1080\/13697137.2016.1262840","article-title":"Vulvar and vaginal atrophy as viewed by the Spanish REVIVE participants: symptoms, management and treatment perceptions","volume":"20","author":"Palacios","year":"2017","journal-title":"Climacteric."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.1111\/jsm.12190","article-title":"Vulvar and vaginal atrophy in postmenopausal women: findings from the REVIVE (Real Women's VIews of Treatment Options for Menopausal Vaginal ChangEs) survey","volume":"10","author":"Kingsberg","year":"2013","journal-title":"J Sex Med."},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1080\/09513590.2017.1370645","article-title":"Prevention of recurrent lower urinary tract infections in postmenopausal women with genitourinary syndrome: outcome after 6 months of treatment with ospemifene","author":"Schiavi","year":"2017","journal-title":"Gynecol Endocrinol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"CD005131","DOI":"10.1002\/14651858.CD005131.pub2","article-title":"Oestrogens for preventing recurrent urinary tract infection in postmenopausal women","volume":"2","author":"Perrotta","year":"2008","journal-title":"Cochrane Database Syst Rev."},{"key":"B43","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/S0090-4295(03)00676-9","article-title":"The role of estrogens in female lower urinary tract dysfunction","volume":"62","author":"Robinson","year":"2003","journal-title":"Urology"},{"key":"B44","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/S0090-4295(02)01799-5","article-title":"Special considerations in premenopausal and postmenopausal women with symptoms of overactive bladder","volume":"60","author":"Cardozo","year":"2002","journal-title":"Urology."},{"key":"B45","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1093\/infdis\/164.1.94","article-title":"Control of the microbial flora of the vagina by H2O2-generating lactobacilli","volume":"164","author":"Klebanoff","year":"1991","journal-title":"J Infect Dis"},{"key":"B46","doi-asserted-by":"publisher","first-page":"286","DOI":"10.3109\/00016349309068039","article-title":"Factors influencing vaginal cytology, pH and bacterial flora in elderly women","volume":"72","author":"Milsom","year":"1993","journal-title":"Acta Obstet Gynecol Scand."},{"key":"B47","doi-asserted-by":"publisher","first-page":"e7586","DOI":"10.7759\/cureus.7586","article-title":"The genitourinary syndrome of menopause: an overview of the recent data","volume":"12","author":"Angelou","year":"2020","journal-title":"Cureus"},{"key":"B48","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1002\/9780470753354.ch49","article-title":"Urinary Incontinence","volume-title":"Dewhurst's Textbook of Obstetrics and Gynaecology","author":"Robinson","year":"2007"},{"key":"B49","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1097\/GME.0b013e3182a122c2","article-title":"Management of symptomatic vulvovaginal atrophy: 2013 position statement of The North American Menopause Society","volume":"20","year":"2013","journal-title":"Menopause."},{"key":"B50","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1097\/00006205-199909000-00004","article-title":"Clinical application of the vaginal maturation index","volume":"48","author":"McEndree","year":"1999","journal-title":"Nurse Pract."},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1080\/09513590.2017.1354366","article-title":"Cianci. Randomized crossover study investigating daily versus on-demand vulvar Visnadine spray in women affected by female sexual arousal disorder, Gynecol","author":"Caruso","year":"2017","journal-title":"Endocrinol"},{"key":"B52","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.maturitas.2017.12.015","article-title":"Preliminary results of a single-arm pilot study to assess the safety and efficacy of visnadine, prenylflavonoids and bovine colostrum in postmenopausal sexually active women affected by vulvovaginal atrophy","volume":"109","author":"Lagan\u00e0","year":"2018","journal-title":"Maturitas"},{"key":"B53","first-page":"07","article-title":"Effects of titanium dioxide microcrystals with covalently bonded silver ions and Aloe Vera extract (TIAGIN\u00ae) on the Vaginal Health Index Score (VHIS) and Female Sexual Function Index (FSFI) in patients with vaginal de-epithelialization: a prospective, single-center cohort analysis","volume":"29","author":"Lagan\u00e0","year":"2017","journal-title":"Ital J Gynecol Obstet March."}],"container-title":["Frontiers in Reproductive Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2021.779398\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,15]],"date-time":"2021-11-15T05:38:46Z","timestamp":1636954726000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frph.2021.779398\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,15]]},"references-count":53,"alternative-id":["10.3389\/frph.2021.779398"],"URL":"https:\/\/doi.org\/10.3389\/frph.2021.779398","relation":{},"ISSN":["2673-3153"],"issn-type":[{"value":"2673-3153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,15]]},"article-number":"779398"}}