A 55-year-old woman presents with C/O of vaginal discomfo. It first staed 6 months ago and has fluctuated in intensity, most recently causing itching and slight pain when she has intercourse with her husband. She otherwise has been well. She has been postmenopausal for 3 years. Her older sister recommended an estrogen cream, which she has used consistently for >3 months without any change in symptoms. On examination the introital mucosa and labia minora are whitish-pink, with abnormal wrinkling and a small fissure on the right labia minora. Which of the following is the most likely diagnosis?

Lichen sclerosus (also called lichen sclerosus et atrophicus) Most common in postmenopausal women, and causes itching of the anogenital region. Can occur- all ages/both sexes ,anywhere on the skin.. The tissue may be so fragile that minor trauma may cause petechial bleeding or fissures, as seen in this case. The patient described here has early disease. Definitive diagnosis is made by biopsy, Candidiasis cause white plaques, intense itching, and some pain with fissure formation. Estrogen deficiency-atrophy of the vaginal mucosa and many of the same symptoms as seen in lichen sclerosus, such as atrophic change Lichen planus is characterized by inflammatory mucocutaneous eruptions involving oral mucous membranes, the vulva, and hair-bearing skin and scalp.