Purpose of reviewMenopause is a time of vulvar and vaginal changes that are physiologic and are often symptomatic. These changes can impact up to 50% of women in menopause. There are also several vulvar dermatoses that are more common after menopause and should be recognized early to allow for symptomatic treatment. Some of these conditions can lead to squamous cell carcinoma over time, and early recognition and appropriate treatment reduce this risk. Treatment for women with symptomatic vulvar and vaginal conditions is important for maintaining the quality of life. Recent findingsThere are multiple review articles, small case series, and small comparative trials, but definitive trials are unavailable for most of these conditions. SummaryCurrent research on pathophysiology and treatment is limited to all of these conditions, and more focus on these life-altering conditions is warranted.