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Vulvodynia - Anogenital in
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Vulvodynia - Anogenital in

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Contributors: Mitchell Linder MD, David Foster MD, Mary Gail Mercurio MD, Lynne Margesson MD
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Synopsis

Vulvodynia is the term for vulvar pain when found in the absence of specific pain-producing disorders. No infections, dermatoses, or tumors are found. This pain is lesion-free. The pain can be generalized over the whole vulva or localized over part of the vulva.

Localized vulvar pain when found around the vulvar vestibule was formerly referred to as vulvar vestibulitis. Classically, in this localized condition, there is pain on touching the vestibule or on penetration, with erythema around the glandular orifices of the vulvar vestibule. It is the most common cause of vulvodynia (lesion-free vulvar pain). Onset of symptoms often is between the ages of 18 and 25, but it can take years for patients to present for care. Many patients have seen multiple providers before getting properly diagnosed. Symptoms can be triggered by tight clothing, tampon insertion, sexual intercourse, prolonged sitting, or gynecology exams. Origins of the condition are unclear but are possibly related to an abnormal response to yeast infections, trauma, or irritation such as from laser or trichloroacetic acid. Symptoms could also be triggered by nerve injuries, localized inflammatory issues, or pelvic floor muscle problems. Vulvodynia can be associated with other pain conditions such as fibromyalgia, temporomandibular joint disease, migraines, interstitial cystitis, and irritable bowel syndrome. Patients will complain of burning and/or itching as well as pain with intercourse. Pain can have sudden onset and then gradual recovery.

In the generalized form, there is diffuse, constant vulvar pain. It is described as rawness, burning, or a lancinating pain. It may be associated with an injured nerve from back problems, trauma to the pelvic area, or herpes simplex virus (HSV) or herpes zoster (VZV) infection causing neuropathy. Less commonly, it can be associated with centralized pain / complex pain conditions such as fibromyalgia, temporomandibular joint disease, interstitial cystitis, or irritable bowel syndrome. This can be found in women of any age but is more common in patients over the age of 40. Generalized vulvodynia should be differentiated from localized vulvodynia.

Codes

ICD10CM:
N94.819 – Vulvodynia, unspecified

SNOMEDCT:
238968009 – Vulvodynia

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Vaginismus – Often co-exists in some form with vulvodynia. Look for contraction of pelvic floor muscles with exam. Patients will often complain of difficulty with or inability to insert a tampon or have penetrative intercourse due not being able to "get in."
  • Lichen planus – Look for ulcerations in vagina / mouth.
  • Pudendal neuralgia – Look for generalized vulvar pain in the distribution of the pudendal nerve. Pain is worse with sitting.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 05/09/2017
Last Updated: 09/29/2017
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Vulvodynia - Anogenital in
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Vulvodynia : Labia minora/vestibule, Vaginal opening, Vaginal-labial burning, Vulvar pain, Dyspareunia
Lab image of Vulvodynia
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