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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, 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

Essentials of Diagnosis

  • 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

General Considerations

  • 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

Signs and Symptoms

  • 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

Functional Implications

  • 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
    • Inflammation
    • Infection
    • Immunologic factors
    • Hormonal influences
    • Genetics
    • Neuropathic changes
    • High ...

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