Open Access
Feature Article

Vulvovaginal pain and dyspareunia. Part 1: An often challenging presentation

Gayle Fischer, Jennifer Bradford, Tracey Cragg
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Patients presenting with chronic vulvovaginal pain are often perplexing to diagnose and treat, particularly when examination appears to be normal. This first part of a two-part article discusses the aetiology, pathophysiology and clinical presentation of vulvovaginal pain.

Key Points

  • Patients with vulvovaginal pain, particularly when it is chronic, are often distressed and frustrated by both the pain and its adverse effects on sexual functioning.
  • Vulvovaginal pain can be divided into:
      – lesional pain, where the pain is directly attributable to an observable vulval/vaginal lesion or disease
      – nonlesional pain, where the pain is experienced in the absence of observable vulvovaginal pathology and physical examination is normal for the patient’s age and ethnic group.
  • Patients with nonlesional vulvovaginal pain are likely to have a physical cause for their pain, but lateral and multidisciplinary thinking is necessary to arrive at the correct diagnosis.
  • It can be helpful to consider vaginal dyspareunia as a subset of vulvovaginal pain rather than a separate entity.