Review Question - QID 214839

A 67-year-old woman presents to the clinic with complaints of vaginal itching and dyspareunia for 1 year. She recently entered into a serious relationship and describes a sharp pain within the vagina during intercourse and occasional fissures at the perineum after intercourse. The itching is intermittent and occurs at the vulva and the vagina. She has tried lubrication for the past 3 months without any significant improvement. The patient denies any discharge, vaginal bleeding, dysuria, hematuria, or increased urinary frequency or urgency. Her past medical history is significant for hypertension treated with lisinopril. She denies any abnormal pap smears or sexually transmitted diseases. Her temperature is 98.6°F (37.0°C), blood pressure is 134/88 mmHg, pulse is 80/min, and respirations are 15/min. A pelvic examination demonstrates scarce pubic hair with vulvovaginal pallor and loss of vaginal rugae. There are also patches of erythema and petechiae of the vaginal tissue. No discharge was noted. The patient complains of pain throughout the examination. Which of the following is the most appropriate next step in treating this patient’s condition?