Patient presents with symptoms consistent with vulvovaginal atrophy (VVA), also known as genitourinary syndrome of menopause (GSM).  She reports vaginal dryness, itching, burning, and dyspareunia.  On examination, the vaginal mucosa appears pale, thin, and friable, with decreased rugation.  Symptoms impact quality of life, including sexual function and overall well-being.  Differential diagnoses considered include vulvovaginitis, lichen sclerosus, and contact dermatitis.  Based on the patient's history, physical exam, and absence of other identifiable causes, the diagnosis of vulvovaginal atrophy is confirmed.  Treatment plan includes discussion of lifestyle modifications, such as lubricants and moisturizers for symptom relief.  Patient education provided on the role of estrogen deficiency in GSM and the available local estrogen therapy options, including vaginal creams, tablets, and the estradiol vaginal ring.  Risks and benefits of each treatment option were discussed, and the patient opted for [Specific treatment chosen - e.g., low-dose vaginal estradiol cream].  Patient instructed on proper application and advised on follow-up appointment for reassessment of symptoms and treatment efficacy.  ICD-10 code N95.2 (Atrophic vaginitis) assigned.