A 47-year-old woman presents with decreased sexual desire, d…
A 47-year-old woman presents with decreased sexual desire, dyspareunia, and inability to achieve orgasm for the past 8 months. She has type 2 diabetes, hypertension, and depression treated with sertraline. Pelvic exam shows vaginal atrophy and pelvic floor hypertonicity. Which is the most appropriate initial management approach?