Vanishing Vulvas & Menopause: What's Really Happening with Dr. Karen Tang

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.

Guest links:

• Karen Tang, MD (Instagram)
  
• Karen Tang, MD (Facebook)
  
• Karen Tang, MD (YouTube)
  
• Karen Tang, MD (LinkedIn)
  
• Karen Tang, MD (TikTok)
  
• GynoMight with Karen Tang, MD (Substack)
  
• Thrive Gynecology

Books:

• “It's Not Hysteria: Everything You Need to Know About Your Reproductive Health (but Were Never Told),” by Dr. Karen Tang
  
• “The New Perimenopause,” by Dr. Mary Claire Haver
  
• “The New Menopause,"⁠ by Dr. Mary Claire Haver

Articles:

• The impact of menstrual symptoms on everyday life: a survey among 42,879 women (American Journal of Obstetrics and Gynecology)
  
• Epidemiology of infertility in women with endometriosis (Best Practice & Research Clinical Obstetrics & Gynaecology)
  
• Perspectives From Advancing National Institutes of Health Research to Inform and Improve the Health of Women (Obstetrics & Gynecology)
  
• 2025 SWHR Women’s Health Research Agenda: Prioritizing Uterine Fibroids, Lupus, and Metabolism (Society for Women’s Health Research)
  
• The Health Disparities of Uterine Fibroids for African American Women: A Public Health Issue (American Journal of Obstetrics and Gynecology)
  
• Impacts of endometrioma on ovarian aging from basic science to clinical management (Frontiers in Endocrinology)
  
• The impact of ovarian endometrioma and endometriotic cystectomy on anti-Müllerian hormone, and antral follicle count: a contemporary critical appraisal of systematic reviews (Frontiers in Endocrinology)
  
• Preoperative Diagnosis of Symptomatic Adenomyosis: Limitations and Clinical Insights (Cureus)
  
• The effect of hysterectomy on the age at ovarian failure: identification of a subgroup of women with premature loss of ovarian function and literature review (Fertility and Sterility)
  
• Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses' health study (Obstetrics & Gynecology)
  
• Ovarian conservation at the time of hysterectomy for benign disease (Obstetrics & Gynecology)
  
• Experiences of Care and Gaslighting in Patients With Vulvovaginal Disorders (JAMA)

Other Resources:

• EndoRISE
  
• The McKinsey Health Institute, January, 2024
  
• Spotlight: NIH Panel Explores Endometriosis Advances, Emphasizes Awareness
  
• MIGS Information (Cedars-Sinai)
  
• The Vagina Whisperer (Sara Reardon)
  
• Access to OB-GYNs: Evaluating Workforce Supply and ACA Marketplace Networks
  
• Nowhere to Go: Maternity Care Deserts Across the US (March of Dimes)
  
• Funding for Various Research, Condition, and Disease Categories (RCDC) (NIH)