External vs Internal Menopause Care: Why Both Matter

Have you ever experienced external dryness or irritation that just would not go away, even when using vaginal moisturizers or prescribed therapies?

Many women are surprised to learn that nothing quite compares to the unique discomfort of external vulvar dryness, especially as estrogen levels decline during perimenopause and menopause.

It can feel distracting, uncomfortable, and sometimes even isolating because it is simply not talked about often enough.

As a pharmacist for more than 40 years, I have counseled countless women navigating menopause symptoms. As a woman, I experienced this challenge myself.

While many women receive treatment for internal vaginal dryness, the discomfort affecting external tissue is often overlooked, despite being a frequent source of irritation, sensitivity, and daily discomfort.

Declining estrogen levels impact collagen production, skin thickness, elasticity, and natural moisture levels. These changes can contribute to:

• drynessincreased sensitivity

• irritation from clothing or activity

• discomfort with intimacy

• skin that feels fragile or easily inflamed

Even women using internal prescription therapy may continue to experience external discomfort.

Over time, I began to see a clear gap in care options.

Many women were trying to adapt products never designed specifically for the delicate external vulvar area. Some used oils that were messy or difficult to apply precisely. Others tried vaginal moisturizers, gels, or creams that did not address external skin comfort in a targeted way.

I understand this personally, because I was one of those women.

The external dryness and irritation was persistent and frustrating. I tried messy oils, vaginal moisturizer gels, and creams hoping to find something simple, soothing, and easy to use.

Nothing seemed designed specifically for this need.

This symptom, more than any other, is what ultimately led me to create Vagi LipTwist®.

I wanted an option that was:

precise
discreet
mess-free
non-hormonal
easy to incorporate into daily self-care

The twist-up applicator allows for targeted application exactly where support is needed, without the inconvenience of messy oils or complicated routines.

External comfort care does not replace internal therapy when prescribed, but it can complement it by addressing the tissue most directly affected by dryness, friction, and irritation.

Both internal and external approaches can play a role in helping women feel more comfortable and confident.

Women often tell me they are looking for:

simple solutions
gentle options
non-hormonal support
easy daily comfort

As both a pharmacist and a woman experiencing menopause, I understand how meaningful small improvements in daily comfort can be.

Menopause care is not one-size-fits-all. Often, the best approach includes multiple supportive strategies tailored to individual needs.

Providing education and options allows women to make informed choices about their health and comfort.

Learn more about pharmacist-developed menopause support: https://bit.ly/ShopVLT

Explore additional menopause education: https://bit.ly/VLTblog

Now available on Amazon: https://bit.ly/VLTAmazon

References:

The North American Menopause Society (NAMS). Genitourinary Syndrome of Menopause Position Statement.

Kingsberg SA et al. Vulvar and Vaginal Atrophy in Postmenopausal Women. JAMA.

Portman DJ, Gass ML. Vulvovaginal Atrophy Terminology Consensus.

Mayo Clinic. Vaginal dryness after menopause.

Cleveland Clinic. Genitourinary Syndrome of Menopause.

Alma Y Gutierrez RPh
University of Texas at Austin
Past President Pharmacy Alumni Association