Use of OTC Products and Persistent Vulvovaginal Irritation in Postmenopausal Women, with Caroline Mitchell, MD, MPH

Vulvovaginal symptoms are widely experienced during and after the menopausal transition, and many women attempt to manage these issues on their own. In a recent conversation with Patient Care at The Menopause Society 2025 Annual Meeting, Caroline Mitchell, MD, MPH, underscored how often self-treatment perpetuates or worsens symptoms.

Research shows that anywhere from 10% to more than 40% of postmenopausal women report symptoms such as dryness, irritation, or itching, and more than half rely on over-the-counter (OTC) products in an effort to find relief.¹ These self-directed strategies often involve multiple products at once, from barrier creams, powders, and topical anesthetics to antifungals and douches, Mitchell emphasized. A signficant drawback of nearly all of these commonly used remedies is their association with irritation or actual harm. Talcum powder, benzocaine-containing products, and douching are particularly well documented as contributors to vulvar inflammation.² Mitchell stressed that even products intended to soothe symptoms can trigger contact dermatitis simply by virtue of repeated exposure to fragrances, preservatives, or other irritants.

Because OTC use is both common and varied, clinicians may miss an important contributor to persistent vulvovaginal discomfort unless they ask specifically about product use and perineal hygiene practices. Mitchell's comments in the short video above highlight a key clinical opportunity: taking a thorough history of all products reported by a women that come into contact with the vulva or vagina. For many women experiencing genitourinary syndrome of menopause, simply identifying and eliminating irritants can be an essential first step toward effective treatment.

The following trascript has been lightly edited for flow.

Patient Care: You mentioned in your presentation that about 50% of women are treating themselves with over-the-counter products, and some of these can actually worsen irritation. Is this a topic that clinicians should proactively pursue?

Mitchell: When people present with symptoms—or if you identify through a review-of-systems questionnaire or in any other way—that they’re experiencing vulvar irritation or vaginal itching, one of the first things to ask about is product use. Vagisil is notorious for causing contact dermatitis. Incontinence pads can also cause contact dermatitis. Wipes, which people use frequently, can do the same. Whatever initially triggered the symptoms, the self-treatment often continues them and makes them worse.

I also think it’s important that when someone presents with these symptoms, we perform an exam, because there are other potential conditions—vulvar dermatoses, recurrent yeast infection. There are multiple possibilities, and to some extent GSM is a diagnosis of exclusion. You want to be sure it’s not one of these other conditions, then treat the GSM and see how they respond.

References

1. Cottrel BH. An updated review of evidence to discourage douching. MCN Am J Matern Child Nurs. 2010; 35(2):102–7.
2. Bauer A, Rodiger C, Greif C, Kaatz M, Elsner P. Vulvar dermatoses--irritant and allergic contact dermatitis of the vulva. Dermatology. 2005; 210(2):143–149.