Vulvar dystrophy is a relatively frequent gynecologic problem in postmenopausal women and may cause disabling discomfort. All patients with vulvar dystrophy should be carefully evaluated at the time of initial presentation and during therapy. Biopsies of vulvar lesions should be used liberally to define optimal therapy and to exclude atypia or malignancy, not only at the initial visit but also when lesions persist during therapy. In the absence of atypia, the patient can be reassured about the malignant potential of her disease. Most symptoms are relieved with conservative therapy alone.