Sexual pain in women: exploring the manifestations of vaginismus versus vulvodynia.
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). Vaginismus and vulvodynia 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: 19 out of 20 women were clinically diagnosed as having vaginismus, while the second group included 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.
Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy - annaghizzani@gmail.com.|Department of Clinical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy - annaghizzani@gmail.com.
Anna
A
Ghizzani
Department of Molecular and Developmental Medicine, Obstetrics and Gynecology, University of Siena, Siena, Italy.|Department of Clinical and Surgical Sciences and Neurosciences, University of Siena, Siena, Italy.
Piersante
P
Sestini
D000293:Adolescent; D000328:Adult; D016000:Cluster Analysis; D003937:Diagnosis, Differential; D004414:Dyspareunia / Q000209:etiology*; D005260:Female; D006801:Humans; D017699:Pelvic Pain / Q000209:etiology*; D012189:Retrospective Studies; D052065:Vaginismus / Q000175:diagnosis* / Q000503:physiopathology; D056650:Vulvodynia / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult