Midlife Vulvovaginal and Sexual Health.

The menopause transition and post-menopause are associated with genitourinary changes that can impact sexual function and overall quality of life. Declining estrogen levels due to cessation of ovarian follicular function triggers these changes and may also contribute to or exacerbate other vulvar conditions. Prompt recognition of the spectrum of normal menopausal vulvovaginal changes, distinguishing them from pathologic conditions, and understanding the multifactorial influences on vulvovaginal health is integral to care of women in midlife and beyond.