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Condition/Disorder Synonyms

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  • Painful intercourse

  • Urogenital pain disorders

  • Vaginismus

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ICD-9-CM Codes

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  • 625.0 Dyspareunia

  • 625.1 Vaginismus

  • 625.7 Vulvodynia

  • 625.71 Vulvar vestibulitis

  • 728.2 Muscular wasting and disuse atrophy, not elsewhere classified

  • 728.85 Spasm of muscle

  • 729.1 Myalgia and myositis, unspecified

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ICD-10-CM Codes

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  • M62.83 Muscle spasm

  • M79.1 Myalgia

  • N94.1 Dyspareunia

  • N94.2 Vaginismus

  • N94.81 Vulvodynia

  • N94.810 Vulvar vestibulitis

  • N94.818 Other vulvodynia

  • N94.819 Vulvodynia, unspecified

  • R10.2 Pelvic and perineal pain

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Preferred Practice Pattern

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Key Features

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Description

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  • Vulvodynia is chronic pain in the vulvar region without a definable cause

  • Most often described as burning pain; also stinging, stabbing, or rawness

  • Characterized by provoked or constant vulvar pain of varying intensity

  • Vaginissmus is persistent difficulty with vaginal insertion despite desire to do so; perceived reduction in size of vaginal opening attributed to muscle spasm

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Essentials of Diagnosis

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  • Any diagnosable gynecological disorder is not vulvodynia; rule out gynecological pathology

    • Infectious: candidiasis, herpes, etc.

    • Inflammatory: lichen planus, immunobullous disorders, etc

    • Neoplastic: Paget's disease, squamous cell carcinoma, etc.

    • Neurologic: herpes neuralgia, spinal nerve compression, etc.

  • Cotton swab test: Pain with light palpation of the soft end of a cotton swab at the vaginal introit along Hart's line2

  • Difficulty with or pain with vaginal insertion during gynecological exam, insertion of tampon, or during and after sexual intercourse

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General Considerations

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  • Female only

  • Classified according to site of pain (generalized or localized) and by whether is it provoked, unprovoked, or mixed

  • Chronic pain condition often characterized by distress and fear

  • Urogenital pain disorders are frequently associated with pain in nearby body areas; especially back, pelvic, hip, groin regions

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Demographics

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  • Lifetime prevalence of vulvodynia is 8% of sexually active women of all ages3

  • 16% of women (n = 4,915) reported chronic unexplained vulvar pain greater than 3 months4

  • Hispanic women are 80% more likely to report vulvodynia than African American or Caucasian women4

  • Many patients with pelvic pain will go on develop chronic pain syndrome with depression, pain out of proportion to pathology, and changing roles in marriage, family, and career5

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Clinical Findings

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Signs and Symptoms

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  • Generalized vulvodynia involves the whole vulva

    • Provoked: sexual, nonsexual, both

    • Unprovoked: always present

    • Mixed: provoked and unprovoked

  • Localized vulvodynia: involves a portion of the vulva (e.g., vestibulodynia, clitorodynia)

  • May complain of lower quadrant abdominal pain during sexual intercourse

  • Symptoms may worsen or decrease during and after sexual intercourse

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Functional Implications

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  • Pain during attempted penetration

  • Sexual dysfunction

  • Women with unprovoked vulvodynia may have pain caused by wearing undergarments or tight fitting clothing

  • May lead to sexual abstinence

  • May lead to decision ...

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