Diagnosis
Diagnosis
Since vulvodynia is both a pain condition and affects the vulva, health care professionals from multiple disciplines may be involved in its treatment at different points in time. A gynecologist, urogynecologist or other provider knowledgeable about vulvodynia should perform your first examination to rule out conditions that mimic the symptoms of vulvodynia. Then, based on your symptoms, you may be referred to other specialists for continued care.
| After taking a thorough medical history and asking questions about your symptoms, your provider should carefully examine the vulva, vagina and vaginal secretions to rule out an active infection or skin disorder. Routine cultures for yeast and bacterial infections should be performed. Your provider may also recommend that you have blood drawn to assess levels of estrogen, progesterone and testosterone. He/she will likely perform a cotton-swab test (pictured on the right). During the test, gentle pressure is applied to various vulvar sites and you’re asked to rate the severity of the pain. If any areas of skin appear suspicious, your provider may examine them with a magnifying instrument or take a biopsy of the area. |  |
| Upon examination, the vulvar tissue may either appear red and swollen, or perfectly normal. By comparing the vestibular tissue (marked by a yellow arrow in the photos to the right), you can see that the vestibule on the top is very red. Even though the vestibule in the bottom photo shows very little redness, this woman had severe pain that made sexual intercourse and inserting a tampon impossible. Thus, the severity of a woman’s pain doesn’t necessarily correlate with the degree of visible redness. |   Reprinted with permission from: Ledger, W.J. and Witkin, S.S.,Vulvovaginal Infections, Manson Publishing, London, 2007, page 103. |
Prior to your appointment, you should consider downloading and completing the International Pelvic Pain Society’s thorough pelvic pain questionnaire. You can either fax the form to your provider prior to your appointment or bring it with you. In addition, you should bring your pain diary. You can download a pain diary here.
Co-Existing Conditions
Some women with vulvodynia also suffer from other disorders, such as interstitial cystitis (painful bladder syndrome), irritable bowel syndrome, fibromyalgia, temporomandibular joint and muscle disorders, endometriosis and/or chronic fatigue syndrome. When you are seeking care and treatment, it is important to discuss all of your symptoms/conditions with your health care provider, even if you don’t think they are related.
The NVA and five other non-profit organizations formed the Chronic Pain Research Alliance to advocate for those who suffer from more than one of the above disorders. Additional information on these conditions can be viewed at http://www.chronicpainresearch.org.