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PANCE Practice Question for May 19th

A 74-year-old woman comes to the health care provider complaining of itching in the genital area. She states that she has had irritation and itching on the outside of her vagina for the past 2 years and that it has been getting worse. She has seen several health care providers during this time and has been treated with antifungal creams and steroids to no avail. She has hypertension for which she takes an angiotensin-converting enzyme (ACE) inhibitor. She had 2 cesarean deliveries in her thirties and no other surgeries. She has no known drug allergies. The patient has a history of smoking. Physical examination demonstrates numerous excoriations with scarring on the patient's labia majora. Speculum examination reveals a normal vaginal discharge with no clue cells, trichomonads, or hyphae seen on a normal saline "wet prep." The remainder of the physical examination is normal.

Which of the following is the most appropriate next step in management?

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