Unique dermatologic aspects of the postmenopausal vulva

Aging and estrogen deficiency compromise the skin barrier's defense mechanisms, resulting in greater microbial colonization of the skin. Susceptibility to mechanical injury and chemical irritation also increases. Menopause blunts the cell-mediated immune response to microbes and allergens. Healing after an insult is delayed. Skin disorders such as lichen sclerosus or allergic dermatitis may not be clinically obvious. A biopsy interpreted by a dermatopathologist is often helpful. Some conditions require long-term use of topical steroid ointments, and antimicrobial therapy. A compounding pharmacist may be necessary to find a base for the topical cream that does not irritate.