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A 70-year-old presents with left-sided vulvar itching and pain, which has worsened over the past 12 months. She has been treated with antifungals several times with no relief. The pain keeps her up at night. She is using a petroleum-based ointment to prevent her labia from sticking to her underwear. She has had no vaginal bleeding or urinary leakage. The patient experienced menopause in her early 50s. Her gynecologic history is unremarkable: she has never had an abnormal Pap smear or any sexually transmitted diseases. Her regular, yearly screening mammograms and colonoscopy done 10 years ago have been normal. Her hypertension is well controlled on medications. She denies any surgeries or medication allergies.
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