Variations in estrogen levels across a woman’s lifetime lead to important changes in genital physiology and pathophysiology. Low estrogen states like menopause and the prepubertal period share important physiologic changes, including more friable, dry, and inelastic mucosa that is prone to irritation, injury, and infection. These and other factors lead to unique gynecologic pathologic conditions encountered at the extremes of age. Age-specific pathologic conditions and differences in examination techniques are discussed.