Differential Diagnosis for Vaginal Pruritus in a Menopausal Woman with Diabetes on SGLT2 Inhibitors

• Single Most Likely Diagnosis
  • Vulvovaginal atrophy (VVA): This condition is common in postmenopausal women due to decreased estrogen levels, leading to vaginal dryness, itching, and discomfort. The absence of discharge and the patient's menopausal status make this a highly plausible diagnosis.
• Other Likely Diagnoses
  • Candidiasis: Although the patient reports no discharge, candidiasis can sometimes present with minimal or no discharge, especially in diabetic patients who are more prone to fungal infections due to their altered glucose metabolism.
  • Lichen sclerosis: A chronic inflammatory skin condition that can cause itching and discomfort in the vulvar area. It's more common in postmenopausal women and can be associated with autoimmune diseases.
  • SGLT2 inhibitor-associated genital mycotic infections: The use of SGLT2 inhibitors is known to increase the risk of genital mycotic infections, which could present with itching as a primary symptom.
• Do Not Miss Diagnoses
  • Vulvar intraepithelial neoplasia (VIN) or vulvar cancer: Although less common, these conditions can present with persistent itching and should be considered to avoid delayed diagnosis.
  • Lichen planus: An autoimmune condition that can affect the mucous membranes, including the vulva, causing itching and discomfort.
• Rare Diagnoses
  • Contact dermatitis: An allergic reaction or irritation from soaps, douches, or other products could cause vaginal itching.
  • Psoriasis or other dermatological conditions: Though less common in the vulvar area, these conditions can cause itching and should be considered if other diagnoses are ruled out.