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  • Painful intercourse
  • Urogenital pain disorders
  • Vaginismus

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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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  • 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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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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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 to not have a subsequent pregnancy

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Possible Contributing Causes

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  • Possible etiologies include6
    • Inflammation
    • Infection
    • Immunologic factors
    • Hormonal influences
    • Genetics
    • Neuropathic changes
    • High levels of urinary oxalates
    • Pelvic floor abnormalities
    • ...

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