Misdiagnosis of Sexual Pain

A series of posts on the vaginismusMD.com Forum indicate that women were often misdiagnosed with vulvodynia for their sexual pain as follows:

“Hi ladies. There have been several posts of late on the need to educate physicians and clinicians concerning the condition of vaginismus. Prior to finding Dr. Pacik I remember visiting several different Ob/Gyn doctors. I would describe my symptoms of increased pain with intercourse and they continuously diagnosed me with vulvodynia. I asked them if I had vaginismus as I had researched the condition and my presenting symptoms and they continuously brushed this off and returned to the diagnosis of vulvodynia. For those ladies reading this post, how many of you were also misdiagnosed with vulvodynia? Also, Dr. Pacik can you give us the clinical difference between vaginismus and vulvodynia? How many of your patients treated also had vulvodynia in addition to vaginismus?”

I answered as follows:

Currently, the default diagnosis of sexual pain is vulvodynia. That means that when a physician is faced with a patient who is unable to have intercourse because of pain, the diagnosis is automatically vulvodynia or “vestibulitis” Very few clinicians think of asking about vaginismus and therefore most of my patients have been misdiagnosed as suffering from vulvodynia, when in actual fact the correct diagnosis was vaginismus. This is doubly unfortunate because not only is there a misdiagnosis, but also failure to treat. Of the many conditions responsible for sexual pain, vaginismus is the easiest to treat.

The word ODYNE means pain. Therefore vulvodynia is pain anywhere in the vulva. Vestibule means room and refers to the area just before entry into the vagina, inside the labia. This potential space (just prior to entry) is called the vestibule. Pain here is vestibulodynia, and the old term is vulvar vestibulitis syndrome, or vestibulitis for short.

When I test my patients with a cotton tipped applicator, “Q-tip test”, about 1/2 test positive for I Botoxed My Vaginaeither or vulvodynia and/or vestibulodynia, These are mostly “false positive ” tests in that the woman does not have this condition, but rather it is a manifestation of fear and anxiety to penetration. It is “too close for comfort”. Many of my more severe vaginismus patients are unable to differentiate between pain and anxiety when tested and have a marked aversion to be touched in these areas. To date I know of only one patient who had true associated vulvodynia and she is the one whose article appeared in the November 2011 issue of Cosmo. I would love to hear from others who were misdiagnosed. I have enough data that this would make an excellent scientific presentation. Let me know if you were falsely diagnosed with either or both of vulvodynia and/or vestibulodynia.

Our Forum is private. We encourage anyone with sexual pain to join in our discussions. We learn from each other. Please sign up and participate. If you have any questions about our Botox treatment for vaginismus and progressive dilation under anesthesia, please contact us via our contact us form.

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About Dr. Pacik

Peter Pacik, MD, FACS is a recognized pioneer in treating patients with Botox for vaginismus and the author of When Sex Seems Impossible: Stories of Vaginismus and How You Can Achieve Intimacy. He has been in practice for over thirty years and belongs to a small group of prestigious surgeons who are double board certified by both the American Board of Surgery and the American Board of Plastic Surgery. In 2010, Dr. Pacik received FDA approval to continue his study to treat vaginismus using intravaginal injections of Botox together with progressive dilation under anesthesia.
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