This review addresses the presentation and management of gynecologic disorders in older women. While these conditions are often managed by a primary caregiver, many women may present to the ED because they lack a primary gynecologic caregiver, their established gynecologic caregiver is not available, they are embarrassed to discuss their symptoms with an established caregiver, or they seek immediate relief of symptoms and reassurance. The emergency physician (EP) must be aware of the normal physiologic changes that occur with aging and how these changes may produce symptoms in older women. This review addresses physiologic changes and pathophysiologic conditions. Knowledge of these conditions and their management will facilitate reassurance of the patient, expedite appropriate initial therapy, and enable the EP to efficiently refer patients requiring further gynecologic assessment.