May 29th, 2022

Authors:  Barbara D. Reed, M.D., M.S.P.H., Hope K. Haefner, M.D., and Libby Edwards, M.D.
  We appreciate Dr. Dennerstein‘s comments suggesting vulvodynia should be considered a ėsymptomî rather than a ėdiagnosis.î The characterization of this disorder has been associated with ongoing controversy for years. A diagnosis allows recognition of a set of characteristics that identify a clinical presentation, have verifiable examination or laboratory findings that are consistent and tend to respond to certain treatments. This information allows practitioners to identify, characterize and treat the condition. Many common and similar scenarios might be classified as symptoms for this reason, especially if the underlying physiology is unclear, or might be attributed to a number of different causes. Some common examples of such conditions are migraine headaches, low back pain and hypertension. Vulvodynia has a set of characteristics, diagnostic examination findings and treatments that are often successful; thus, most clinicians who work with this condition have agreed that it meets the criteria for a disorder, not just a symptom.
In time, patients presenting with ėvulvodyniaî are likely to be further divided into subgroups that differ in subtle or more substantial ways in etiology, physiology, and response to treatment. Dr. Dennerstein‘s comments, as well as those of others,1 are valuable reminders that there is much we do not understand about this disorder and that an open mind and willingness to alter previous opinions about the disorder will be helpful as we continue to gather data on similarities and differences between women diagnosed with vulvodynia. In the meantime, it is important to recognize this group of patients whose presentation has been poorly understood, for whom diagnoses have often been erroneous or nonexistent, and whose management has often been unsuccessful and who constitute a group of women with substantial similarities to each other in clinical presentation, physical findings and treatment responses. This allows further research to proceed and progress to be made.
Keywords:  vulvodynia, diagnosis
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