- Painful intercourse
- Urogenital pain disorders
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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 to not have a subsequent pregnancy
Possible Contributing Causes
- Possible etiologies include6
- Immunologic factors
- Hormonal influences
- Neuropathic changes
- High levels of urinary oxalates
- Pelvic floor abnormalities...
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