Differential Diagnosis
- Single most likely diagnosis
- Genitourinary syndrome of menopause (GSM): This condition is characterized by vaginal dryness, pain with intercourse, and urinary symptoms, which are all present in the patient's history. The patient's postmenopausal status, thin vulvar skin, and elevated vaginal pH support this diagnosis.
- Other Likely diagnoses
- Vulvovaginal candidiasis: Although the patient's symptoms have been present for months, a recent increase in symptoms and a new sexual partner could suggest a yeast infection. However, the normal urinalysis and lack of characteristic discharge make this less likely.
- Lichen sclerosis: This condition can cause vulvar pruritus and pain, but it is less likely given the patient's postmenopausal status and lack of characteristic skin changes.
- Atrophic vaginitis: This condition is related to GSM and can cause similar symptoms, but it is not a distinct diagnosis in this case.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Vulvar cancer: Although rare, vulvar cancer can present with pruritus and pain, and it is essential to rule out this diagnosis with a thorough examination and biopsy if necessary.
- Invasive fungal infections: The patient's poorly controlled diabetes increases her risk for invasive fungal infections, which can be life-threatening if not promptly treated.
- Rare diagnoses
- Desquamative inflammatory vaginitis: This condition is characterized by vaginal discharge and inflammation, but it is rare and less likely given the patient's symptoms and examination findings.
- Sjögren's syndrome: This autoimmune disorder can cause vaginal dryness, but it is rare and would require further evaluation to diagnose.