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.
- 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.