Instructions
You are a medical student on placement in general practice in Esperance. Your next patient is Adut Akol, 58, a farmer, on a video call from home about painful sex. Your supervisor examined her a week ago; the notes are below.
Explain your diagnosis and management plan to the patient
- This is a video consultation; the patient is at home.
- You do not need to take a further history or examine the patient.
From the visit a week ago
Vaginal dryness and burning since stopping combined HRT tablets 2 years ago, getting worse. Sex painful, now mostly avoided. Urinary urgency and nocturia; no dysuria, haematuria or fever. Last period 5 years ago; no bleeding since. Thrush cream 3 times this year and a perfumed wash; no relief.
Background
Three vaginal births. No personal history of breast cancer, blood clots or stroke. Cervical screening 2 years ago: HPV not detected. No regular medicines; no known allergies.
Examination a week ago
Vulva pale and thin; no white patches, fissures or ulcers. Speculum (uncomfortable): pale, thin, dry vaginal walls, loss of folds, a few petechiae; no discharge; cervix normal. Bimanual: small, non-tender uterus; no adnexal masses.
Tests a week ago
High vaginal swab: no candida, bacterial vaginosis or trichomonas. Urine culture: no growth.