Snapshot A 50-year-old woman presents to her gynecologist reporting difficulty with intercourse. She states having vaginal dryness and pruritus. She also reports increasingly frequent hot flashes and mood swings. Her last menstrual period was 2 months ago. Pelvic exam is notable for thin and dry vaginal vestibule. There is no abnormal discharge. summary Vulvovaginal irritation resulting from estrogen loss login to view 2 more bullets Associated conditions login to view 3 more bullets Etiology Pathogenesis login to view 6 more bullets Presentation Symptoms login to view 7 more bullets Physical exam login to view 2 more bullets studies Labs login to view 6 more bullets Differential Vaginal infections Vulvovaginal lichen planus Vulvar lichen sclerosus login to view 2 more bullets DIAGNOSIS By clinical history and physical exam Treatment Water-based lubricants during intercourse Vaginal estrogen therapy Complications Increased risk of urogenital infection Sexual dysfunction Low self-esteem Prognosis Unlikely to resolve spontaneously without treatment