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Chapter 28 Vulvodynia
Lisa Jambusaria, MD
❍ What is vulvodynia?
Pain/burning persistently at the vulva or vagina that is not explained by a clear medical finding.
❍ What important information of social history should you elicit from a patient with vulvodynia?
History of sexual abuse.
❍ What is the first-line medical treatment of different types of vulvodynia?
Tricyclic antidepressants and anticonvulsants such as amitriptyline and gabapentin.
❍ What is vaginismus?
Pain with insertion during intercourse causing spasm of the perineal muscles.
❍ What is the treatment of vaginismus?
Vaginal dilators and perineal massage.
❍ What are other causes of pain with intercourse?
Uterine fibroids, vaginal atrophy, vaginal infections, prolapse, and endometriosis.
❍ What is the name of point pain on entry/penetration at the introitus?
Vestibulitis.
❍ What is the test for vestibulitis?
The Q-tip test where a Q-tip is used to place pressure at 4 and 8 o’clock positions at the introitus to see if the pain
is reproduced.
❍ What is the treatment of vestibulitis?
Amitriptyline and/or gabapentin orally or topically, topical anesthetics, as well as pelvic floor physical therapy.