What to Expect From a Visit to The Health Care Provider
Normally, the health care provider will take a gynaecological history but may also ask specific questions about pain, mood disorders, sexual health and relationship status and histories.
The physical examination of women with vulvovaginal symptoms will include an inspection of the external vulvar anatomy and skin. The health care provider will note any changes to the vulvar structure, the skin texture and color, and the presence or absence of inflammation or lesions. If there are objective changes to the appearance of the vulvar skin (change in color or texture), a skin biopsy may be recommended.
Next, the examiner will touch the outside of the vulva with a Q-tip to determine what areas are painful when touched. (Normally touching the vulva with a Q-tip is not painful.)
If it is possible a speculum will be inserted into the vagina to see the vaginal skin and vaginal discharge. The vaginal discharge can be assessed by checking the pH (acidity) and obtaining a vaginal sample (slide or culture) that can be sent for a gram stain. A gram stain of the vaginal discharge will identify the presence (or absence) of healthy bacteria (lactobacilli), white blood cells, and active yeast elements.
Finally a bimanual examination (palpation of the uterus, ovaries and pelvic floor muscles) may be done. In general, there is no need to have additional lab and or x-ray tests done.
The accepted diagnostic criteria for vestibulodynia are:
- severe pain during attempted vaginal entry,
- tenderness to pressure (palpation with a Q-tip) localized in the vulvar vestibule,
- redness of the vestibule.
However, many women presenting with chronic vulvar symptoms will have minimal objective physical findings. The health care provider may often tell the patient “everything looks normal”.
Although the above criteria for diagnosing vestibulodynia are useful, there is a spectrum of presentations and the patient’s pain history alone is usually enough to diagnose vulvodynia.