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A Journal on Obstetrics and Gynecology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Minerva Ginecologica 2016 Sep 08
Sexual pain in women: exploring the manifestations of vaginismus versus vulvodynia
Anna GHIZZANI 1, Piersante SESTINI 2 ✉
1 Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy; 2 Department of Clinical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy
BACKGROUND: Sexual pain is frequently seen in gynecological practice as a consequence of lower tract pathology. When organic causes are ruled out we must think of a functional pain syndrome such as the genital pelvic pain/penetration disorder (GPPD) whose diagnostic criteria are defined by the Diagnostic and Statistic Manual-5; these criteria describe both vaginismus and vulvodynia that present themselves with somewhat different clinical dimensions and require different treatments. Even if gynecologists do not usually manage functional sexual pain, they can easily reach the differential diagnosis through the sexual pain anamnesis because some symptoms are specific of one or the other condition.
METHODS: To verify our hypothesis we retrospectively evaluated the clinical records of 44 women affected by functional sexual pain. The words patients used to describe their pain were categorized in the following symptoms: dyspareunia, burning pain, stabbing pain, dryness, itching, and obstacle to penetration, each coded as present or absent.
RESULTS: The unsupervised cluster analysis of the reported symptoms identified two groups: one with 19 out of 20 women who were clinically diagnosed as having vaginismus; the second with all the 24 women clinically diagnosed with vulvodynia plus one vaginismic patient.
CONCLUSIONS: The high adherence between clinical and statistical findings supports that the differential diagnosis between vaginismus and vulvodynia can be reached on the basis of the elements collected during intake, including pain history.