History
Menstrual and medication history to assess for causes of hypoestrogenism
Complete ROS to rule out other causes of urogenital symptoms
Consider symptoms that may be secondary to infection, inflammation, local irritation
Ask about history of pelvic radiation
Thorough sexual history
Menstrual and medication history to assess for causes of hypoestrogenism
Complete ROS to rule out other causes of urogenital symptoms
Consider symptoms that may be secondary to infection, inflammation, local irritation
Ask about history of pelvic radiation
Thorough sexual history
Pelvic Exam
External genitalia may show scarce pubic hair, diminished elasticity, introital narrowing, or fusion of labia minora
Loss of labial fat pad
Pale, dry epithelium that is smooth and shiny with loss of rugation
Use caution as exam can cause pain and bleeding
Assess for introital stenosis with gloved finger before inserting speculum
External genitalia may show scarce pubic hair, diminished elasticity, introital narrowing, or fusion of labia minora
Loss of labial fat pad
Pale, dry epithelium that is smooth and shiny with loss of rugation
Use caution as exam can cause pain and bleeding
Assess for introital stenosis with gloved finger before inserting speculum
Labs
Not usually necessary in ED unless concern for other causes
Not usually necessary in ED unless concern for other causes
Atrophic vaginitis
Infection 
Bacterial vaginosis
Reaction to irritants 
Rhinorrhea
Vulvovaginal lichen planus
Contact vulvovaginitis
Vulvar lichen sclerosus