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  • Painful intercourse

  • Urogenital pain disorders

  • Vaginismus


  • 625.0 Dyspareunia

  • 625.1 Vaginismus

  • 625.7 Vulvodynia

  • 625.71 Vulvar vestibulitis

  • 728.2 Muscular wasting and disuse atrophy

  • 728.85 Spasm of muscle

  • 729.1 Myalgia


  • 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 Other vulvodynia unspecified

  • R10.2 Pelvic and perineal pain


  • 4C: Impaired Muscle Performance1


A 34-year-old woman reports that she has been experiencing burning pain at the opening of the vagina during intercourse for the past several months. Prior to this onset, she was able to have pain-free intercourse with her husband of 10 years. The symptoms started after she used an over-the-counter anti-fungal cream to self-treat what she thought was a yeast infection. Lately, when she attempts intercourse the burning pain is severe and she feels that she cannot allow vaginal penetration for intercourse.



  • 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.

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

FIGURE 264-1

Hart’s line is the outer perimeter of the vestibule. (From DeCherney AH, Nathan L, Laufer N, Roman AS. Current Diagnosis & Treatment: Obstetrics & Gynecology. 11th ed. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Essentials of Diagnosis

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

    • Infectious: Candidiasis, herpes, etc.

    • Inflammatory: Lichen planus, ummunobullous disorders, etc.

    • Neoplastic: Paget 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 examination, insertion of tampon, or during and after sexual intercourse

General Considerations

  • Female only

  • Classified according to site of pain (generalized or localized) and by whether it is 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 found in 8% of sexually active women of all ages.3

  • 16% of women (n = 4915) reported chronic unexplained vulvar pain for more than 3 months.4...

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