Editing Vulvodynia (section)

==Diagnosis==
The condition is one of exclusion and other vulvovaginal problems should be ruled out. The diagnosis is based on the typical complaints of the patient, essentially normal physical findings, and the absence of identifiable causes per the differential diagnosis. Cotton swab testing is used to differentiate between generalized and localized pain and delineate the areas of pain and categorize their severity. Patients often will describe the touch of a cotton ball as extremely painful, like the scraping of a knife. A diagram of pain locations may be helpful in assessing the pain over time. The vagina should be examined, and tests, including wet mount, vaginal pH, fungal culture, and Gram stain, should be performed as indicated. Fungal culture may identify resistant strains.<ref>{{cite journal |pmid=15870521 |year=2005 |last1=Haefner |first1=H. K. |title=The vulvodynia guideline |journal=Journal of Lower Genital Tract Disease |volume=9 |issue=1 |pages=40–51 |last2=Collins |first2=M. E. |last3=Davis |first3=G. D. |last4=Edwards |first4=L |last5=Foster |first5=D. C. |last6=Hartmann |first6=E. D. |last7=Kaufman |first7=R. H. |last8=Lynch |first8=P. J. |last9=Margesson |first9=L. J. |last10=Moyal-Barracco |first10=M |last11=Piper |first11=C. K. |last12=Reed |first12=B. D. |last13=Stewart |first13=E. G. |last14=Wilkinson |first14=E. J. |doi=10.1097/00128360-200501000-00009|s2cid=18081230 |doi-access=free }}</ref>

Surveys have estimated that only about half of the women who meet the criteria for vulvodynia will seek medical help.<ref name="Harlow"/> Many will see several doctors before a correct diagnosis is made.<ref name="Harlow"/> Less than 2% of the people who seek help obtain a diagnosis.<ref>{{Cite journal|last1=Reed|first1=Barbara Diane|last2=Harlow|first2=Siobán Denise|last3=Sen|first3=Ananda|last4=Legocki|first4=Laurie Jo|last5=Edwards|first5=Rayna Monique|last6=Arato|first6=Nora|last7=Haefner|first7=Hope Katharine|date=February 2012|title=Prevalence and demographic characteristics of vulvodynia in a population-based sample|url= |journal=American Journal of Obstetrics and Gynecology|language=en|volume=206|issue=2|pages=170.e1–170.e9|doi=10.1016/j.ajog.2011.08.012|pmc=3779055|pmid=21963307}}</ref> Many gynecologists are not familiar with this family of conditions. Affected women are also often hesitant to seek treatment for chronic vulvar pain, especially since many women begin experiencing symptoms around the same time they become sexually active. Moreover, the absence of any visible symptoms means that before being successfully diagnosed many patients have been told that the pain is "in their head".<ref>{{Cite journal|last1=Shallcross|first1=Rebekah|last2=Dickson|first2=Joanne M.|last3=Nunns|first3=David|last4=Taylor|first4=Kate|last5=Kiemle|first5=Gundi|date=2019-04-01|title=Women's Experiences of Vulvodynia: An Interpretative Phenomenological Analysis of the Journey Toward Diagnosis|url= |journal=Archives of Sexual Behavior|language=en|volume=48|issue=3|pages=961–974|doi=10.1007/s10508-018-1246-z|issn=1573-2800|pmc=6418055|pmid=30047005}}</ref> The misattribution of women's vulvo-vaginal pain to a psychological origin rather than a medical one is traceable back to the influence of Freudian [[psychoanalysis]].<ref name="ImperfectIntercourse">{{cite journal |last1=Srajer |first1=Hannah |title=Imperfect Intercourse: Sexual Disability, Sexual Deviance, and the History of Vaginal Pain in the Twentieth-Century United States |journal=Journal of American History |date=March 2023 |volume=109 |issue=4 |pages=782–803 |doi=10.1093/jahist/jaad001 |url=https://academic.oup.com/jah/article/109/4/782/7109655 |access-date=29 March 2024}}</ref>

===Differential diagnosis===
# Infections: [[urinary tract infection]],<ref>{{cite journal|doi=10.1007/s00192-017-3472-7| title=Lower urinary tract symptoms that predict microscopic pyuria | year=2018 | last1=Khasriya | first1=Rajvinder | last2=Barcella | first2=William | last3=De Iorio | first3=Maria|author3-link=Maria De Iorio | last4=Swamy | first4=Sheela | last5=Gill | first5=Kiren | last6=Kupelian | first6=Anthony | last7=Malone-Lee | first7=James | journal=International Urogynecology Journal | volume=29 | issue=7 | pages=1019–1028 | pmid=28971220 | pmc=6004270 }}</ref> [[candidiasis]], [[herpes]], [[Human papillomavirus infection|HPV]], [[vaginitis]]
# Dermetological diseases: [[lichen sclerosus]], [[lichen planus]]
# Neoplasm: [[Extramammary Paget's disease|Paget's disease]], [[vulvar carcinoma]]
# Neurologic disorder: [[neuralgia]] secondary to herpes virus, spinal nerve injury,<ref>{{Cite journal |last1=Torres-Cueco |first1=Rafael |last2=Nohales-Alfonso |first2=Francisco |date=2021-06-21 |title=Vulvodynia—It Is Time to Accept a New Understanding from a Neurobiological Perspective |journal=International Journal of Environmental Research and Public Health |volume=18 |issue=12 |pages=6639 |doi=10.3390/ijerph18126639 |doi-access=free |issn=1661-7827 |pmc=8296499 |pmid=34205495}}</ref> [[pudendal nerve entrapment]]

In recent years, diagnostic algorithms for the diagnosis of the various sub-types of and causes of vulvar pain have been developed and refined. The [[International Society for the Study of Women's Sexual Health]] ([[ISSWSH]]) supports this diagnostic algorithm.<ref>https://www.isswsh.org/images/Persistent_Vulvar_Pain_Diagnostic_and_Treatment_Algorithm.jpg</ref>