All Episodes
E146
July 10, 2026
Vanishing Vulvas & Menopause: What's Really Happening with Dr. Karen Tang
https://podcasts.apple.com/us/podcast/vanishing-vulvas-menopause-whats-really-happening-with/id1846701533?i=1000776233529
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In part two of this conversation, Dr. Mary Claire Haver continues with Dr. Karen Tang, a board certified gynecologist and minimally invasive gynecologic surgeon, and author of It's Not Hysteria: Everything You Need to Know About Your Reproductive Health But Were Never Told. This episode begins with one of the most common complaints women bring into midlife and one of the least discussed: pain, itching, burning, and changes in the vulva and vagina.

Dr. Tang opens by explaining why the vulva is among the most sensitive skin on the body, why menopause accelerates changes that most women are never warned about, and why so much vulvovaginal itching and pain gets dismissed as a yeast infection when it is often something else entirely. She walks through the conditions that frequently go undiagnosed, including lichen sclerosus, vulvodynia, lichen simplex, psoriasis of the vulva, and genitourinary syndrome of menopause, and explains what each one actually is and how it is treated.

The conversation then moves to painful sex, which Dr. Tang is clear is never normal and never something women should have to accept. She explains how to describe pain with sex in a way that helps a clinician pinpoint the cause, why pelvic floor physical therapy is something she recommends to nearly everyone, and why vaginal estrogen remains the most underused and underappreciated tool in menopause care. She and Dr. Haver also discuss vaginal DHEA and why the combination of estrogen and testosterone it delivers is gaining attention in sexual medicine.

Dr. Tang and Dr. Haver also cover what changes in surgical decision-making as women move through perimenopause and into menopause, how to think about ovary preservation at the time of hysterectomy, and why a doctor who offers only one option is a red flag regardless of the condition being treated. The episode closes with a practical guide to advocating for yourself at a medical appointment, including how to prepare, what to bring, and what answers to refuse to accept.

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Chapters

00:00:00 – Intro & Why Vulvar Health Matters
00:01:52 – Common Causes of Vulvar Itching & Burning
00:04:15 – It's Not Always a Yeast Infection
00:06:05 – Lichen Sclerosus, Cancer & When to Get a Biopsy
00:07:50 – What Is Vulvodynia?
00:09:20 – Why Menopause Changes the Vulva
00:11:55 – Vaginal Estrogen & Preventing Symptoms
00:14:10 – Low Estrogen Beyond Menopause
00:15:10 – Painful Sex Is Never Normal
00:17:30 – How Painful Sex Is Diagnosed & Treated
00:19:00 – Vaginal Estrogen vs. DHEA
00:20:10 – Hysterectomy & Menopause Decision-Making
00:23:00 – Choosing the Right Surgeon
00:24:20 – Should You Keep Your Ovaries?
00:27:10 – How to Prepare for a Doctor's Appointment
00:29:45 – Red Flags Your Doctor Shouldn't Ignore
00:31:20 – Finding the Right Specialist
00:33:20 – Final Takeaways & Outro

About the guest

Dr. Karen Tang

Dr. Karen Tang, MD, MPH, is a Columbia and Harvard-trained gynecologist and minimally invasive gynecologic surgeon who is an internationally recognized leader in reproductive health. As @KarenTangMD, she reaches millions of viewers with her educational videos about periods, pelvic pain, sex, and reproductive rights. She's the author ofIt's Not Hysteria: Everything You Need to Know About Your Reproductive Health (but Were Never Told).Dr. Tang is a consultant for the WHO, and has been featured in theNew York Times, theWashington Post, NPR,Forbes, Nightline, NBC News, among other media outlets. She lives in the Philadelphia area with her husband and three children.