Clinical insights into vulvar health in menopause, with Melissa Mauskar, MD

At The Menopause Society annual meeting, Melissa Mauskar, MD, dermatologist and associate professor of dermatology and obstetrics and gynecology at UT Southwestern, shared clinical insights on managing vulvar health in postmenopausal women. Mauskar, who also directs the Vulvar Health Program and the Women’s Health Track, emphasized that many patients present with multiple concurrent conditions, making diagnosis and treatment complex.^1,2

Overlapping conditions and diagnostic challenges

“Most patients have more than one thing going on,” Mauskar said. Common presentations include genitourinary syndrome of menopause (GSM) and vulvovaginal atrophy, which can cause dryness, itching, and pain. However, she cautioned that “not everything that itches is related to menopause.”

Patients frequently try over-the-counter products before seeking care, leading to cases of irritant or allergic contact dermatitis. “It may be something they’ve been using for years, and then all of a sudden their body becomes sensitized to it,” Mauskar explained, noting that the vulvar area is particularly prone to irritation because of moisture, occlusion, and body habitus.

The importance of physical examination

Mauskar highlighted the critical role of a thorough physical exam—something that may be missed in the telemedicine era. “Providers really do need to do a physical exam,” she said. Using visual analogies and teaching aids, she described signs of lichen sclerosus, such as a bound-down clitoral hood and changes in the labia or interlabial sulcus.

She also stressed the need to distinguish between irritant dermatitis, chronic yeast infections, and GSM-related changes. “A lot of patients are given antibiotics for their UTIs when maybe they just need vaginal estrogen,” Mauskar said. “That is still the best treatment for postmenopausal UTIs.”

Supporting patients through communication and care

Mauskar encouraged clinicians to normalize conversations about sexual and vulvar health. “A lot of patients have been to several doctors and have waited a long time before they actually feel comfortable bringing this up,” she said. Discussing emotional and relational impacts can open the door to broader support. “I’ll tell them that often it helps when you have a support team,” she said, adding that clinicians should ask if patients have a therapist or partner they can talk to.

Educating patients and pharmacists on topical therapies

One key part of Mauskar’s practice involves demonstrating how to properly apply topical treatments. “We actually go through that in my clinic,” she said. “I’ll show them that a lentil size or half of a pea actually is enough to cover their vulva and perianal area.”

Misconceptions about steroid use can create barriers to care. Mauskar noted that pharmacists and other providers sometimes discourage patients from using prescribed topical steroids. Her team published a review to educate pharmacists about conditions such as lichen sclerosus. “When you use [steroids] safely in the right area, the best thing about lichen sclerosus is we can prevent architectural changes, and we can also prevent the risk for skin cancer,” she said.

Looking ahead in vulvar health research

Mauskar expressed optimism about the growing collaboration across organizations, including The Menopause Society, the International Society for the Study of Vulvovaginal Disease (ISSVD), and the Vulvar Dermatoses Research Consortium, which she helped found. “In the next 5 or 10 years, I’m really hopeful that we’ll be able to get funding to do clinical studies to really dive into these treatments,” she said.

She concluded by summarizing key takeaways for clinicians:

• “More than one thing can be going on at a time.”
• “Patients are often doing things that may make their condition worse.”
• “Multidisciplinary care is huge. When we all collaborate together, we’ll have big wins for our patients.”

Mauskar reports no relevant disclosures.

References

1. Mauskar M. Vulvar dermatoses. Presented at: The Menopause Society’s 2025 Annual Meeting. October 21–25, 2025. Orlando, Florida.
2. Mauskar MM. Recognition and diagnosis of vulvar dermatoses. Case Rep Womens Health. 2021;32:e00344. Published 2021 Jul 24. doi:10.1016/j.crwh.2021.e00344