A 53-year-old woman is evaluated for a 1-year history of dyspareunia. She has tried using lubricants, but she still has discomfort and has lost interest in sexual intercourse. She reports vaginal itching but no vaginal discharge, bleeding, or odor. She reached menopause 2 years ago and notes occasional hot flushes, but they are not troublesome. There is no history of sexual trauma, sexually transmitted infection, or pelvic surgery. She reports no marital problems. Medical history is otherwise remarkable for hypertension. Her only medication is benazepril.
On physical examination, the patient is afebrile, blood pressure is 130/78 mm Hg, pulse rate is 72/min, and respiration rate is 14/min. BMI is 27. The general medical examination is unremarkable. On pelvic examination, she can only tolerate insertion of a narrow speculum, and the vaginal mucosa is pale and dry with smooth vaginal walls and decreased rugae. There is scant vaginal discharge. Bimanual examination is normal.
Microscopic evaluation of a vaginal preparation reveals no hyphae, yeast, or clue cells.
Which of the following is the most appropriate management?