Open Access
Feature Article

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

Gayle Fischer, Jennifer Bradford, Tracey Cragg



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.