Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Painful intercourseUrogenital pain disordersVaginismus ++ 625.0 Dyspareunia625.1 Vaginismus625.7 Vulvodynia625.71 Vulvar vestibulitis728.2 Muscular wasting and disuse atrophy, not elsewhere classified728.85 Spasm of muscle729.1 Myalgia and myositis, unspecified ++ M62.83 Muscle spasmM79.1 MyalgiaN94.1 DyspareuniaN94.2 VaginismusN94.81 VulvodyniaN94.810 Vulvar vestibulitisN94.818 Other vulvodyniaN94.819 Vulvodynia, unspecifiedR10.2 Pelvic and perineal pain ++ Pattern: 4C impaired muscle performance1 +++ Description ++ Vulvodynia is chronic pain in the vulvar region without a definable causeMost often described as burning pain; also stinging, stabbing, or rawnessCharacterized by provoked or constant vulvar pain of varying intensityVaginissmus 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 pathologyInfectious: candidiasis, herpes, etc.Inflammatory: lichen planus, immunobullous disorders, etcNeoplastic: 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 line2Difficulty with or pain with vaginal insertion during gynecological exam, insertion of tampon, or during and after sexual intercourse +++ General Considerations ++ Female onlyClassified according to site of pain (generalized or localized) and by whether is it provoked, unprovoked, or mixedChronic pain condition often characterized by distress and fearUrogenital pain disorders are frequently associated with pain in nearby body areas; especially back, pelvic, hip, groin regions +++ Demographics ++ Lifetime prevalence of vulvodynia is 8% of sexually active women of all ages316% of women (n = 4,915) reported chronic unexplained vulvar pain greater than 3 months4Hispanic women are 80% more likely to report vulvodynia than African American or Caucasian women4Many 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 vulvaProvoked: sexual, nonsexual, bothUnprovoked: always presentMixed: provoked and unprovokedLocalized vulvodynia: involves a portion of the vulva (e.g., vestibulodynia, clitorodynia)May complain of lower quadrant abdominal pain during sexual intercourseSymptoms may worsen or decrease during and after sexual intercourse +++ Functional Implications ++ Pain during attempted penetrationSexual dysfunctionWomen with unprovoked vulvodynia may have pain caused by wearing undergarments or tight fitting clothingMay lead to sexual abstinenceMay lead to decision to not have a subsequent pregnancy +++ Possible Contributing Causes ++ Possible etiologies include6InflammationInfectionImmunologic factorsHormonal influencesGeneticsNeuropathic changesHigh ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.