How do health care providers diagnose vulvodynia?

Vulvodynia tends to be diagnosed only when other causes of vulvar pain, such as infection or skin diseases, have been ruled out.

To diagnose vulvodynia,¹ a health care provider will take a detailed medical history, including pain characteristics and any accompanying bowel, bladder, or sexual problems.² The provider may recommend that a woman have blood drawn to assess levels of estrogen, progesterone, and testosterone. The provider may also perform a cotton swab test, applying gentle pressure to various vulvar sites and asking the patient to rate the severity of the pain. If any areas of skin appear suspicious, these areas may be further examined with a magnifying instrument or a tissue sample may be taken for biopsy.

Because vulvodynia is often a diagnosis of exclusion, it can be difficult and time-consuming to arrive at an actual diagnosis. The diagnostic process can be especially problematic for women who lack health insurance because they may not have the resources to continue seeking care to exclude the many possible causes of pain. Moreover, some women may be reluctant to discuss their pain or seek treatment.

Researchers sponsored by NICHD are investigating how to better evaluate and understand vulvar pain. Some have proposed ways to better map the pain to identify nerves that may be involved.³ Some researchers believe that vulvodynia and vulvar vestibulitis syndrome involve dysfunction in the pathways that process pain.^3,4