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Provoked vestibulodynia — DRCOG MCQ

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HardGynaecologyProvoked vestibulodyniaDRCOG

A 39-year-old woman has burning vulval pain for 9 months, worse with intercourse and tampon insertion. Examination is normal except marked tenderness when a cotton bud touches the vestibule. Swabs are negative. What is the most likely diagnosis?

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Correct answer: D — Provoked vestibulodynia

Chronic provoked vestibular pain with normal examination and negative swabs is consistent with provoked vestibulodynia. Recurrent candidiasis would usually have episodic discharge or positive tests. Herpes causes ulcers or episodic lesions rather than isolated cotton-bud tenderness. The pearl is that vulval pain syndromes are real diagnoses and benefit from multidisciplinary management.

Reference: NICE CKS vulval pain; British Society for the Study of Vulval Disease guidance