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Vulvodynia: A Common and Under-Recognized Pain Disorder in Women and Female Adolescents -- Integrating Current Knowledge into Clinical Practice

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This proposed diagnostic algorithm for vestibulodynia has been adapted from King M, Rubin R, Goldstein A. Current Uses of Surgery for the Treatment of Genital Pain. Current Sexual Health Reports. 2014, Oct 3. Volume 6, Issue 4, pp. 252-8. Shown on this slide are two potential causes of pain that affect the entire vestibule. King et al. postulate that if the entire vestibular endoderm (mucosa) is painful, it is likely that there is pathologic process occurring in this tissue. The next three slides show additional causes of vestibulodynia with different underlying pathological mechanisms. Subtle differences in the history (HX) and physical examination (PE) may help to differentiate between potential causes of vestibulodynia, which may lead to disease-specific treatments.

 

 

This proposed diagnostic algorithm for vestibulodynia has been adapted from King M, Rubin R, Goldstein A. Current Uses of Surgery for the Treatment of Genital Pain. Current Sexual Health Reports. 2014, Oct 3. Volume 6, Issue 4, pp. 252-8. 

 

 

This proposed diagnostic algorithm for vestibulodynia has been adapted from King M, Rubin R, Goldstein A. Current Uses of Surgery for the Treatment of Genital Pain. Current Sexual Health Reports. 2014, Oct 3. Volume 6, Issue 4, pp. 252-8.

 

 

This proposed diagnostic algorithm for vestibulodynia has been adapted from King M, Rubin R, Goldstein A. Current Uses of Surgery for the Treatment of Genital Pain. Current Sexual Health Reports. 2014, Oct 3. Volume 6, Issue 4, pp. 252-8. In this slide are the potential causes of pain in the posterior vestibule or pain that extends beyond the vestibule. King et al postulate that if only part of the vestibular endoderm is painful, it is not likely that there is an intrinsic pathologic process occurring within the vestibular tissue. More likely, pain affecting only part of the vestibule is the result of a pathologic process extrinsic to the vestibule such as overactive pelvic floor muscle dysfunction (aka vaginismus or levator ani syndrome). Tenderness that extends outside of the vestibule is likely pudendal neuralgia. 

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