A Practical Management Approach to Vulvar Dermatoses and Genitourinary Syndrome of Menopause

Genitourinary syndrome of menopause (GSM) is a chronic hypoestrogenic condition characterized by diffuse vulvovaginal pallor, epithelial thinning, loss of rugae, and mucosal atrophy, often accompanied by genitourinary symptoms such as dryness, dysuria, urgency, and dyspareunia. Because many vulvar dermatoses share overlapping symptoms with GSM, accurate diagnosis relies heavily on careful clinical evaluation, with particular emphasis on lesion morphology, distribution, and associated mucocutaneous findings. This review provides a practical, morphology-driven framework for distinguishing GSM from common inflammatory, infectious, and neoplastic vulvar conditions. Given the high degree of diagnostic overlap between vulvar dermatoses and GSM, a structured approach incorporating targeted history, focused physical examination, and timely biopsy when indicated is essential. Referral to dermatology or a vulvar specialist is recommended in cases of diagnostic uncertainty, refractory or multisite disease, or scarring or functional impairment or when escalation to systemic or advanced therapies is required. This approach aims to improve diagnostic accuracy, reduce misclassification as GSM, and facilitate earlier, targeted treatment of vulvar dermatoses.