Michelle is a 53 year old woman

Michelle is a 53 year old woman who is seeing you today with reports of bilateral vulvar itching. The itching began approximately 4 months ago and started with a yeast infection which she treated for one week with an over the counter vaginal antifungal cream. Although the itching improved, it never completely resolved. She states the itching occurs daily but is worse with perspiration and chafing from clothes. Scratching provides temporary relief but the itching reoccurs and interferes with sleeping. Michelle has tried hydrocortisone 1% cream but stopped after a few days when she didn’t have improvement. She has not been sexually active for the past year and is not currently in a relationship. She reports mild to moderate vasomotor symptoms that have been present for the last 2 years. Michelle is allergic to sulfa medications (rash and hives). Current medications are atorvastatin 20mg orally daily for hyperlipidemia. Information obtained today: LMP 7 months ago; BP 124/80; RR 20; Pulse: 86; BMI 31. 1. Based on the information above, what condition(s) are you considering and what will you look for on physical exam to correlate with your diagnosis? 2. What lab tests or imaging, if any, would you consider related to her chief complaint? 3. What are your treatment recommendations and teaching?

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