The vulva is the outside (external) part of the genitals. People often use the word “vagina” to describe this area, but that’s not accurate. The vagina is an internal canal that connects the vulva to the cervix and uterus.

“The vulva is the part that we actually see,” Dr. Fenwa Milhouse, a board-certified urologist, urogynecologist, and women’s health specialist, told ThisIsMenopause. “The vagina is the internal part.”

Your vulva will change with age, especially during perimenopause and menopause. Here’s what to know about the vulva, why it changes with age, and how to care for it before and after menopause.

3 Key Facts To Know About the Vulva

Dr. Milhouse believes vulvar health deserves more attention in both medicine and public conversations. There are three key facts she wants everyone to know.

“One thing I wish every woman knew about their vulva is that it is hormone-dependent,” Dr. Milhouse said. “Your vulva is rich in both estrogen and what we call androgen or testosterone receptors.”

Dr. Milhouse also explained that vulvas change with age. As estrogen levels decline during perimenopause and menopause, the same hormonal changes that can cause hot flashes, mood changes, irregular periods, and other symptoms can also affect the vulva.

Women may develop a collection of vulvar, vaginal, and urinary symptoms known as genitourinary syndrome of menopause (GSM), formerly called vaginal atrophy.

GSM symptoms can affect intimacy and bladder health while increasing the risk of urinary tract infections (UTIs).

Common symptoms of GSM include:

• Vaginal dryness
• Vaginal burning or itching
• Changes in vaginal discharge
• Pain during sex
• Bleeding or spotting, especially during or after sex
• Frequent UTIs
• Painful or frequent urination
• Urinary incontinence

GSM is extremely common. It affects an estimated 50 percent to 90 percent of women during perimenopause and after menopause, according to Dr. Milhouse.

Vulva Care Before Menopause

Dr. Milhouse emphasized the importance of understanding your body so you can be proactive about your health.

“Look at your vulva,” Dr. Milhouse said. “Get to know what she looks like. If you’ve never met her or seen her, how do you know she’s changing?”

Dr. Milhouse recommends using a mirror to examine your vulva regularly. Look for changes in the skin, color, texture, sensation, or appearance of the labia, clitoris, and other parts of the vulva.

“Knowledge is power,” Dr. Milhouse said. “Knowing what can happen [due to hormonal changes] and these are the symptoms and signs — so when they occur, as soon as they occur, you can ask for treatment or ask for help — is huge in and of itself.”

What To Do if You Notice Changes to Your Vulva

It’s possible to start noticing changes to your vulva in perimenopause. If you see changes, or if you have persistent dryness, itching, burning, painful sex, changes in urination, recurrent UTIs, or other GSM symptoms, talk with a healthcare provider.

One of the most effective options for treating GSM is vaginal estrogen. Vaginal estrogen delivers estrogen to the vulvar and vaginal tissues and can help improve moisture, elasticity, blood flow, and tissue health. It may also reduce symptoms such as pain during sex, urinary issues, and recurrent UTIs.

Dr. Milhouse believes vaginal estrogen should be considered early in the menopause transition, before symptoms become severe or even occur. “You don’t have to wait to get to menopause to start hormones,” Dr. Milhouse said.

“If you have vaginal dryness or vaginal itching, if sex hurts, you probably need vaginal estrogen,” Dr. Milhouse explained. “Never wait for it to get bad. Because the worse it gets, the harder it is to reverse.”

She said vaginal estrogen can be a safe, effective, and generally affordable option for many, and encourages people to have proactive conversations about it with their care team.

Vulva Care After Menopause

It’s never too late to start learning about your own body. If you’ve already reached menopause and are noticing changes to your vulva but aren’t sure where to start, help is available.

Start by getting to know your body and what is normal for you, and talk with a menopause-informed provider about changes that can occur after menopause and the treatment options that may help.

Your healthcare provider may recommend vaginal estrogen or other treatment options.

Other treatments may include vaginal moisturizers to improve moisture in the vaginal lining, vaginal lubricants to make sexual activity more comfortable, and pelvic floor physical therapy. These approaches all work well in conjunction with vaginal estrogen, Dr. Milhouse noted.

Vulva Care Is ‘Forever’

Vaginal and vulva care after menopause is “forever,” Dr. Milhouse said. Unlike hot flashes, which tend to taper down after menopause, GSM symptoms can progress without treatment. Dr. Milhouse described using vaginal estrogen and other interventions as “your new normal. It’s your new skin care regimen.”