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CONDITION/DISORDER SYNONYMS
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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 Other vulvodynia unspecified
R10.2 Pelvic and perineal pain
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PREFERRED PRACTICE PATTERN
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PATIENT PRESENTATION
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.
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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.
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.
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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, 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
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General Considerations
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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
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