390. Vulvar Dermatology, Red Angry Vulvas, and Why Exams Matter

In this episode, I sit down with Dr. Melissa Mauskar, a vulvar dermatologist at UT Southwestern, for a wide-ranging conversation about vulvar skin conditions, common misdiagnoses, and why so many patients are told to just "wait and see" when they actually need an exam. We dig into GSM, estrogen, OTC yeast treatments, soaps, waxing, and the biggest myths that keep women from getting real care.

If you've ever been told itching, burning, or irritation is "normal," this conversation explains why that advice can delay diagnosis for years, and what to do instead.

What We Cover

• What vulvar dermatology is, and why the vulva deserves the same care as skin anywhere else on the body
• Why so many patients see 5 or 6 clinicians before getting the right diagnosis, often because no one ever actually examined the vulva
• How symptoms get mislabeled as yeast when the real culprit is lichen sclerosus, psoriasis, eczema, contact dermatitis, or GSM
• Why numbing products like Vagisil (and benzocaine specifically) can become irritants or allergens that make things worse
• Barrier care for "red angry vulva," including zinc oxide for irritation and moisture-related skin breakdown
• How overcleaning, douching, and scented washes disrupt the vulvar microbiome — and the shame baked into that marketing
• Waxing, microtrauma, and hair as a protective barrier
• GSM, recurrent UTIs, and why vaginal estrogen is still so underprescribed
• Late diagnosis of vulvar melanoma, and why genital skin needs to be looked at, not just talked about over telehealth

Notable Quotes

• "My five year old can say vulva."
• "I really like talking about uncomfortable things and making comfortable people uncomfortable."
• "Just do what brings you joy."

About Dr. Melissa Mauskar

Dr. Melissa Mauskar is an Associate Professor of Dermatology and of Obstetrics and Gynecology at UT Southwestern Medical Center, where she's the founder and Director of the Vulvar Health Program — a tertiary referral center for gynecologists, dermatologists, and primary care physicians across Texas and the nation. She's a Fellow of the International Society for the Study of Vulvovaginal Diseases (ISSVD), founding president of the Vulvar Dermatoses Research Consortium, and serves on the board of the Women's Dermatologic Society. Learn more at utswmed.org/doctors/melissa-mauskar.

As always, this podcast is for educational purposes and is not a substitute for individualized medical advice — talk to your own doctor about your own health.

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