What to know about your skin down there
You may not know to ask your dermatologist about this.
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The first word you think of when you hear “dermatologist” probably isn’t “vagina.”
That was certainly true for me, at least, which is why an Instagram reel from board-certified dermatologist Dr. Samantha Ellis caught my eye. Ellis — who has close to 500,000 followers on the platform — shared that something happened that hadn’t in her previous five years posting dermatology-related content on social media: She had received a notification from YouTube that the content she had posted didn’t meet advertiser guidelines.
She knew what this meant: Fewer people would see it.
The video in question? One titled “Dermatologist’s Guide to Intimate Aging Skin Care” that had gone out on her channel of over 740,000 YouTube subscribers.
From the carpool line, I watched Ellis’ video about YouTube’s decision (filmed from her own car) twice, struck by her emotion and exasperation. Next, I watched the original video, and (still in my car) I emailed Ellis.
In the 10-minute video, Ellis explains that while she was in training, she did an entire rotation on vulvar dermatology and that she wanted to talk about some of the skin changes that can happen in that area as a result of hormonal changes during perimenopause and menopause.
Ellis talks about changes to vaginal tissue, to the vaginal microbiome, and to the labia and clitoris. She talks about the increased risk of certain kinds of skin cancers that can appear in the vulva and how to check for them. And she talks about lubricants and vaginal moisturizers, topical estrogen treatments, and how to talk to your dermatologist.
The whole thing was both innocent and informative.
Ellis got on the phone with me to talk about her frustration with how YouTube treated her video, as well as what she wanted people going through perimenopause and menopause to understand about vulvar health.
Cue the expert (who is really dying to talk about this)
“I’ve been posting content on social media for almost five years and never once have I had a video of anything previously get censored in any type of way,” Ellis said. Ellis has built up a notable presence on social media: In the comments, you’ll see people refer to her as “the Internet’s dermatologist” or “if your best friend were a dermatologist.”
“I was just recognizing that a lot of my patients were asking about vulvar stuff,” Ellis told me. “I was getting emails and DMs from other physicians — generalists, family medicine, OB/GYN — being like, ‘Hey would you ever do a video on this, because it’s something that I don’t feel particularly comfortable on and I have a lot of patients asking about.’”
Ellis wanted to create content that would fill people in without shame and embarrassment, in the comfort of their own home.
“There’s so much information that you can find about a facelift and Botox and acne — and you can’t find good, evidence-backed, candid information about women’s health,” Ellis told me. “It just perpetuates the issues of women feeling like they don’t understand their own bodies. To me, this whole experience was like, ‘Oh let’s just put more shame around women’s bodies’ if even advertisers are like, ‘Look we can’t show ads on a video that talks about women’s health.’ That’s wild to me.”
So what should you know?
Ellis wants these patients to know that perimenopause and menopause can contribute to some very real changes with very real symptoms. The dropoff in estrogen levels can affect the gynecologic tissue, which can include the labia, clitoris, vagina, bladder and urethra. Many people in perimenopause and menopause will experience dryness, painful sex, incontinence or bladder control issues, itching, and “just a new awareness of that area when maybe it was all things that were functioning fine before that.”
People may not know which doctor to talk to and sometimes can run into doctors who dismiss their concerns.
Further complicating things is that most patients’ baseline for information about their vulvar health is low: “No one really talks about it unless you have a really forthcoming book club,” Ellis said. “So people just don’t know what is considered acceptable: Should I be itchy? Should I have this pain? I think a lot of women are taught with a lot of health stuff to just suck it up or expect that whatever they are experiencing is within the normal realm of what can be expected and so they don’t seek help.”
Ellis said that if you start to experience any new symptoms in that area, start by talking with either your dermatologist or your gynecologist. Both specialties have enough foundational knowledge to give guidance or make a referral to the other.
Another danger
Ellis said she would encourage patients to ask their dermatologists to check their vulvar area during their annual skin checks.
“Yes, you can get cancer where the sun doesn’t shine, literally,” Ellis said. “Not all skin cancers are induced by UV radiation.”
Some cancers of the vulva are caused by the human papilloma virus (HPV), the same virus that causes genital warts and can lead to cervical cancer. But you can also get melanoma, the deadliest form of skin cancer, in the vulvar area. Vulvar melanomas are rare — just 1 percent of all melanomas found in women, and just 5 percent of all vulvar malignancies. But up to 10 percent of all women will present at some point with a pigmented vulvar lesion — and while most are overwhelmingly benign, it’s good to know what’s going on down there so you can best address any changes in a timely manner.
“One thing I always drive home with my patients during their skin checks is that you need to get familiar with your anatomy. You need to be checking that area once a month,” Ellis said. Often vulvar cancers are more advanced by the time they’re diagnosed because people aren’t looking for them.
She said that patients with deeper skin tones should be especially aware of the risk of vulvar cancers because they can be harder to spot — another reason it’s good to ask your doctor for a routine check.
Back to basics
But vulvar health at this phase of life is more than just cancer screenings, Ellis said. If you have taken note of the way your face is aging, well, guess what? The skin on your vulvar area is aging too. There are vulva-friendly cleaners and vaginal moisturizers too.
And Ellis’ primary advice?
“Don’t be afraid to advocate for yourself. Don’t be afraid to have a conversation with your doctor, even if you feel embarrassed or awkward or unsure if this is the right person to talk to. We can either help you or guide you towards someone who can help you. Be proactive, because it’s much easier to prevent than to correct.”
Quick question
I have so loved hearing from so many of you over these last few months, learning about your experiences and what you’re thinking and feeling. And one thing I keep hearing is, “Well, how I grew up, we just didn’t talk about this” or, “In my culture, no one talked about menopause.”
For a future edition, I’m looking to connect with some of our readers about just what you did and didn’t hear about menopause growing up. Were there any cultural factors at play? Did you have a cool aunt who always told you that the best things in life happen after 50? Did no one ever say a word and then you hit 40 and had some questions? I would love to hear it all — please write to me!
I almost forgot!
This week, I’m kicking this spot over to a very special guest, my friend and editor Terri Rupar:
Menopause is so hot right now — it’s both a not-particularly-funny joke about symptoms and something that people have recently told both Jen, the writer of this newsletter, and Samantha Bee.
Bee, of “Daily Show” and “Full Frontal” and righteous feminist anger fame, came to Washington this month with a one-woman show full of jokes not about politics (mostly) but about menopause. She talks about it all: the physical symptoms, the emotional ones, the memory issues, and how we are seen (or not) as we age. She pointed out how common all of it is — for you, your friends, even your enemies.
It was 90 minutes, an impressive performance, and I keep thinking about one joke she told, though it wasn’t the funniest one: This was the only show, she said, without the standard stool with a glass of water sitting on it, so she could get through it without a bathroom break. The whole room knew what she meant.
Watching a show called “How to Survive Menopause” in a laughing, nodding supportive room made it all seem a lot less intimidating and uncomfortable and a lot more freeing and entertaining.
Here’s to more for perimenopause and menopause: more attention, more money, more jokes, more support.