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Vulvar vestibulitis vs vulvodynia

Vulvodynia and Vulvar Vestibulitis - ChristianaCar

Dr. Echenberg continues, This location is known as the 'vulvar vestibule.' and when this area is highly inflamed and sensitized, the term used is vestibulodynia or vestibulitis. This subset of vulvodynia is the most common reason for entrance pain in reproductive age women Vulvodynia. Odyne was the Greek goddess of pain. Therefore, the term vulvodynia literally means vulvar pain. Vulvodynia is currently defined as vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable disease This classification acknowledges that vulvar pain may be attributable to diagnosable and. literature to provide new definitions for vulvar pain and to describe treatments for this condition. Results. Vulvodynia has been redefined by the Interna-tional Society for the Study of Vulvovaginal Disease as vulvar discomfort in the absence of gross anatomic or neurologic findings. Classification is based further on whether the pai Pudendal neuralgia is often the source of chronic pelvic and vulvar pain. Vulvodynia and pudendal neuralgia symptoms can be very similar, sometimes even identical. However, there are at least 24 signs that are good indicators and can help you to initially determine if your vulvodynia is possibly caused by pudendal neuralgia (or any problem. 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

Numbers of women affected by vulvodynia are thought to be between 200,000 and six million. However, vulvodynia and vulvar vestibulitis syndrome are more likely to happen to women who have the autoimmune conditions Sjogren's Syndrome and lupus erythematosus; fibromyalgia is also now linked vulvodynia and VVS. What causes a vulvodynia flare-up Vulvodynia is a complex issue, more recently theorized as a neuropathic problem by experts - it has even been called a diabetic neuropathic syndrome. In other words, the problem is thought to start in the brain rather than the vulva, and the vulvar nerves over-respond to stimuli. Many other things may have to be ruled out first, due to the. Vulvar vestibulitis syndrome (also know as vestibulodynia or vestibular adenitis) is a subset of vulvodynia that is characterized by severe pain during attempted vaginal entry (intercourse or tampons insertion), tenderness to pressure localized to the vulvar vestibule and redness of the vulvar vestibule (click for photos of vestibulitis) Most women have pain at only one vulvar site. If the pain is in the vestibule, the tissue surrounding the vaginal opening, the diagnosis is vestibulodynia (formerly known as vulvar vestibulitis syndrome (VVS)). (See diagram on right.

What is the difference between vulvodynia and vulvar

Vulvodynia is chronic pain around the opening of your vagina in the area of your vulva. It isn't known exactly what causes it. But there's plenty you can do to ease the symptoms. Use these. Vulvodynia (vul-voe-DIN-e-uh) is chronic pain or discomfort around the opening of your vagina (vulva) for which there's no identifiable cause and which lasts at least three months. The pain, burning or irritation associated with vulvodynia can make you so uncomfortable that sitting for long periods or having sex becomes unthinkable Vulvodynia is a chronic pain condition that affects a woman's outer genitals, including the vulva. WebMD explains how vulvodynia is diagnosed and treated

Vulvodynia, Vestibulodynia, and Vaginismus: what's the

  1. Vulvodynia is further classified as localised or generalised, and provoked, unprovoked or both. Most chronic vulvar pain falls into two broad groups: localised provoked vestibulodynia (formerly vestibulitis or vulvar vestibular syndrome) and generalised vulvodynia (formerly essential or dysaesthetic vulvodynia) (Figures 1, 2)
  2. Vulvodynia or Pudendal Neuralgia By Lori Montgomery, MD, CCFP and Magali Robert, MD, FRCSC Introduction Vulvodynia (say: vul-vo-DYNE-ee-uh) is a word used to describe pain that involves the vulva. The vulva is the area around the vagina. This pain can come from many different sources. The symptoms can range from quite mild to very severe.
  3. Vulvodynia is described as chronic vulvar discomfort with complaints of burning and superficial irritation. Drugs used to treat Vulvodynia The following list of medications are in some way related to, or used in the treatment of this condition

Vulvodynia. A subset of interstitial cystitis (IC) patients has vulvar pain known as vulvodynia. An alternative spelling is vulvadynia. Vulvodynia is chronic vulvar pain without an identifiable cause. Vulvodynia affects women of all ages, beginning as early as adolescence. According to a Harvard study funded by the National Institutes of Health. Vulvar vestibulitis remains an enigma. It is a significant cause of vulvar pain in young women.1, 2 Until 1981, dyspareunia was considered to be a result of vaginismus, a psychosexual dysfunction that leads to involuntary contractions of the introital muscles. 1 Since then, it has been discovered that in many cases dyspareunia is caused by vulvar vestibulitis, a physical condition. Vulvodynia: Chronic pain around the vulva, characterized as burning, stinging, or irritating. This can occur even during everyday activities. This can occur even during everyday activities. Vulvar Vestibulitis Syndrome : Chronic pain caused by touch or pressure in the vestibule (entrance) of the vagina

Differentiating overlapping symptoms of vulvodynia and

Vulvar vestibulitis is a condition marked by redness and inflammation in the vaginal opening. This includes tenderness and profound burning. The cause of this condition is not understood. Increased sensitivity of the nerves on the skin's surface may contribute. Women of all ages experience Vulvar vestibulitis A total of 88% of the women with a sexual partner reported having sexual dysfunction vs. 43% in the general population . Gardella et al. evaluated women diagnosed with IC/BPS (n=47) and a control group (n=47) for the characteristics of vulvodynia. The prevalence of vulvodynia was 85.1% in the IC/BPS group compared to 6.4% in controls (P<0.0001)

Does Degree of Vulvar Sensitivity Predict Vulvodynia Characteristics and Prognosis? Reed BD, Plegue MA, Harlow SD, Haefner HK, Sen A. Journal of Pain 2016 Volume 18, Issue 2, Pages 113-123. Various Terms Utilized for Vulvar Pain Prior to 2003 • Essential vulvodynia • Dysesthetic vulvodynia • Vulvar vestibulitis syndrom Download Citation | Vulvodynia and Vestibulitis | Chronic vulvar pain was first described in the late 1800s as hyperesthesia by Skene [1] with further reports by Thomas and Munde [2] and Kelly in. Vulvar Anatomy. The vulva is the external part of the female genitalia. It protects a woman's sexual organs, urinary opening, vestibule and vagina and is the center of much of a woman's sexual response. The outer and inner 'lips' of the vulva are called the labia majora and labia minora . The vestibule surrounds the opening of the. Vulvodynia or vulvar pain syndrome is a multifactoral clinical syndrome of vulvar pain, sexual dysfunction, and psychological distress. Recognizing the four specific subtypes of vulvodynia is important in the management approach. The most common four subtypes are vulvar vestibulitis syndrome, cyclic vulvovaginitis, dysesthetic vulvodynia, and.

Understanding and treating vulvodynia and vestibulitis

  1. Vulvodynia is characterized by chronic discomfort in the vulvar region; the discomfort may range from mild to severe and debilitating. The diagnosis depends on a consistent history, lack of a.
  2. My Vagina: An Endometriosis and Vulvodynia Story. It started when I was 11 with my first surgery. Doctors did not know what was causing my abdomen pain so they the scheduled exploratory surgery. They found a huge cyst which had cut off the blood supply to ovary which killed it. They removed that ovary and tube
  3. ation diet helped in resolving recurrent vulvodynia and multigenerational IBS. A connection between food sensitivities and vulvodynia was identified in the study. Foods that triggered pain and discomfort in the vulvar area were eli
  4. Recommended guidelines for healthy vulvar skin includes decreasing and removing chemicals, moisture, or rubbing (friction). Products listed have been suggested for use because of their past success in helping to decrease or relieve vulvar/vaginal burning, irritation, or itching

Vulvar disease (other than vulvodynia)-lichen planus, lichen sclerosis, neoplasia, tissue damage due to radiation. The subject is deemed unsuitable for enrollment by the investigators based on their history or physical examination. Neuropathy. Currently in pelvic floor physical therapy However, the proportion of yeast infections diagnosed by a clinician did not differ among those with and without vulvodynia before onset of vulvar pain (36.5% vs 39.8%) or subsequent to onset of vulvar pain (31.7% vs 30.5%). 78 The researchers argued that these findings may be explained by the risk of recall bias, meaning that women with PVD. Vulvar pain is an enigma. Its etiology, pathophysiology, and treatment have not yet been elucidated. The most perplexing presentation is pain during intercourse, sometimes prevents the possibility to have intercourse. Around the enigma of vulvar pain, myths about its causes and treatments emerged. This chapter breaks these myths Vulvodynia. Vulvodynia (said 'vul-vo-din-ia') is a condition where there is pain, burning and discomfort in the vulva that cannot be linked to a specific cause. This pain may or may not be triggered by touch and may be felt in one area or across the whole vulva. Women with vulvodynia have a normal-looking vulva

Vulvodynia vs. Vaginismus: Doctor Explains the Differences ..

Introduction: Vulvodynia, vulvar pain syndrome, is defined as vulvar pain of at least a 3-month duration without a clear identifiable cause, which may have associated factor and the etiology and. Vulvodynia usually manifests itself following a problem with the nerves supplying the vulva, but its exact causes are unknown. The possible triggers for vulvodynia include damage due to surgery or childbirth, trapped nerves or previous severe vaginal thrush. Return buyer here - having vulvodynia/vulvar vestibulitis, this is the ONLY. Vulvodynia is a term used to describe pain affecting the vulva when the cause of the pain is unknown. Vulvodynia is defined by the International Society for the Study of Vulvovaginal Diseases ( ISSVD) as vulvar pain of at least 3 months duration, without a clear identifiable cause, which may have potential associated factors Painful Sex (Dyspareunia) Menopause & Painful Sex Vulvodynia Treatment for Vulvar Vestibulitis. Sexual Dysfunction; Pelvic Floor Dysfunction. Incontinence Bowel Dysfunction Organ Prolapse. Cancer. Breast Cancer Female (Gynecologic) Cancer Cancer Resources. Additional Services. Psychotherap Vulvodynia is defined as chronic vulvar burning, stinging, rawness, soreness or pain in the absence of objective clinical or laboratory findings to explain these symptoms. Vulvodynia is a chronic pain syndrome affecting up to 18% of the female population and is generally regarded as an underdiagnosed difficult to treat gynecological disorder

A woman had suffered from vulvar vestibulitis (vulvodynia) for four years. Pain from the disorder had disrupted her ability to function at work and home as well as sexually. An initial full range of treatments, including multiple operations, had produced no relief. Examination of the urine for evide Vulvar vestibulitis is a component of dysesthetic vulvodynia, a complex condition that requires careful assessment and individualized management. However, despite its complexity, there is a cure — it requires finding the right clinician who will be patient enough and knowledgeable enough to spend the time it may take to get to the root of the. Vulvodynia is a chronic and painful condition that can affect any part of the pelvic region. It is easily misdiagnosed at first as some type of infection. However, antibiotics and antifungal medications do not help vulvodynia, and in fact, antibiotics can make vulvodynia worse •Vulvodynia may be triggered by peripheral factors in the skin and underlying musculature •Varying degrees of central dysregulation may develop •Hypersensitivity at extragenital sites •Understanding of the mechanistic (central vs. peripheral) implication of clinical signs and symptoms in vulvodynia is a necessary first ste The diagnosis of vulvodynia refers to ongoing pain in the vulva. There are two kinds of vulvodynia that women suffer from; they are localized vulvodynia and generalized vulvodynia. Localized vulvodynia presents chronic pain in the skin around the vaginal opening or less commonly on the clitoris

Even symptoms of vulvodynia, an idiopathic dysfunction affecting 4-16% of women, have been shown to correlate to diet. In a single case study of a 28 year old female athlete in Integrative Medicine (Drummond et al., 2016), vulvodynia and irritable bowel syndrome (IBS) were addressed with an elimination diet. After being treated by a pelvic. Vestibulodynia, previously known as vulvar vestibulitis, is a descriptive term used for recurrent pain arising at the entrance to the vagina, the vestibule. By definition, there is no known cause for the pain and the affected tissue appears normal. Vestibulodynia, like 'itch' or 'headache', is not a disease Feeling increasingly crippled by the vulvodynia, Sherry sought out doctor after doctor for help. Most looked baffled. Several implied that the pain was a way to get out of having sex with her. Vulvodynia (vulval pain) Vulvodynia is persistent, unexplained pain in the vulva. The vulva is the female genital area including the skin surrounding the opening of the vagina. It can happen to women of all ages. Vulvodynia can become a long-term problem that's very distressing to live with, but much can be done to help relieve the pain Vulvodynia can be confused with other vulvovaginal problems, such as chronic tension or spasm of the muscles of the vulvar area called vaginismus. Diet A change in diet may help

Conditions - The Centers for Vulvovaginal - vulvodyni

Evidence For and Against. A case report published in The Journal of Reproductive Medicine in 1991 found that a woman who experienced chronic pain from vulvodynia had extremely high levels of oxalate in her urine 5 6.After following a low-oxalate diet combined with calcium citrate supplements, the woman was able to reduce her levels of urinary oxalate, as well as her vulvodynia symptoms 3 Introduction and background. This guideline is to help clinicians assess and manage patients with vulvodynia. Vulvodynia has been defined by the International Society for the Study of Vulvovaginal Diseases (ISSVD) as vulval discomfort, most often described as a burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurological disorder

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nosis was vulvar vestibulitis in 47 women (77%). Thir-teen women (23%) had other concomitant diagnoses Table 1. Characteristics of Eligible Subjects Patient characteristics Values n* Mean SD (y) 30 661 Race 61 White 94% Black 2% Other 3% Duration of symptoms (mo)† 31 (5-216) 60 Diagnosis 61 VS 47 (77%) VS vulvodynia 1 (2%) VS others 13 (21% Many women with vulvodynia have tension in the muscles of the pelvic floor, which supports the uterus, bladder and bowel. Exercises to relax those muscles can help relieve vulvodynia pain. Surgery. In cases of localized vulvodynia or vestibulodynia, surgery to remove the affected skin and tissue (vestibulectomy) relieves pain in some women Lidocaine is a type of local topical anesthetic mostly used for vulvar vestibulitis treatment. Vulvar vestibulitis is also called vestibulodynia and it is a type of localized vulvodynia to the vulvar vestibule. It is usually administered in cream or ointment form

Vulvodynia is common in people with fibromyalgia (FMS) and chronic fatigue syndrome ( ME/CFS ). 1  It's a chronic pain condition that affects the vulva, which is the external portion of the female genitalia. Vulvodynia can have a major impact on your life. While a lot of us with FMS and ME/CFS deal with, it is not a symptom—it's a separate. Vulvar Vestibulitis A Case Report Clive C. Solomons, Ph.D. M. Herzl Melmed, M.D. Susan M. Heitler, Ph.D. A woman had suffered from vulvar vestibulitis (vul- vodynia) for four years, Pain from the disorder had dis- rupted her ability to function at work and home as well as sexually. An initial full range of treatments, includin

Vulvar vestibulitis refers to increased sensitivity to pain at the opening of the vagina, making even gentle touch or stimulation painful . Localized provoked vulvodynia (LPV) is the final term used for vestibulitis following consensus meetings [ 2 ] Ontology: Vulvodynia (C0406670) Definition (MSH) Complex pain syndrome with unknown etiology, characterized by constant or intermittent generalized vulva pain (Generalized vulvodynia) or localized burning sensations in the VESTIBULE area when pressure is applied (Vestibulodynia, or Vulvar Vestibulitis Syndrome) Vulvodynia What a Health Practitioner Should Know Catherine M. Leclair, MD Associate Professor Director, Program in Vulvar Health Objective: To present a clinically based approach to vulvodynia •Identify and review vulvar anatomy •Basic understanding of how to approach the patient with vulvar complaints •Recognize vulvodynia as part of th Vulvar disorders; Vulvar graft vs host disease; Vulvar vestibulitis; Vulvodynia Vulvar and Vaginal Conditions. Aphthous ulcers (canker sores) Bartholin's cysts or abscess; Chronic candidiasis (chronic yeast infections) Clitorodynia (clitoral pain syndrome) Crohn's disease; Desquamative inflammatory vaginitis; Genital warts (condylomata) Lichen. Hi,I have had vulvodynia for 8yrs.I have know idea what started it,and you are very right about the doctors i dont know why they wont do more studies on this disease!I have been to many doctors that had know clue what it is.It is very hard to treat,I have tryed so many things with know help! I have some good days and some very bad ones! Good thing my husband is a very understanding man.I get.

24 Signs Your Vulvodynia Might Be Caused by Pudendal

Vulvodynia refers not to a specific disease, but rather to a symptom - vulvar pain. In this case the pain is chronic and either recurrent or almost constant. Vulvodynia can be primary, i.e., starting from the first episode of intercourse, or secondary, starting after a specific event. There are 4 main categories of vulvodynia: vulvar dermatoses Friday, 27 April 2007. As Awareness Grows, So does Diagnosis and Treatments: Vulvar vestibulitis syndrome (VVS) is a subset of vulvodynia that is characterized by severe pain during attempted vaginal penetration to pressure localized to the vulvar vestibule (see diagram), and redness (erythema) of the vulvar vestibule dition of vestibulodynia (vulvar vestibulitis [VVS]), considered a subtype of vulvodynia, is defined as chronic pain in the vestibule associated with allo-dynia of the introital margin (outer edge of hymen and inner edge of inner surface of labia minora), often extending to the openings of the Skene ducts on each side of the urethra. There was. Support from the National Vulvodynia Association 2015 Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia A. Vulvar pain caused by a specific disorder* • Infectious (eg, recurrent candidiasis, herpes) • Inflammatory (eg, lichen sclerosus , lichen planus, immunobullous disorders In the past ten years, the problem of vestibulitis has been increasingly recognized as a cause of painful sexual intercourse. Women with this disorder report burning pain that is right at the opening (vestibule) of the vagina. In more severe cases, the pain is present during normal daily activities, as well as during sex. Careful Continue

Misdiagnosis of Sexual Pain: Vulvodynia, Vestibulodynia

The Vulvar Vestibulitis Clinical Trial, Development of the National Institutes of Health, was a randomized, placebo controlled, double-blinded clinical trial to study the clinical efficacy of four medical treatments for vulvar vestibulitis syndrome (localized vulvodynia): topical lidocaine, oral desipramine, combined lidocaine and desipramine. Vulvodynia is a chronic pain condition of the vulva defined by pain that lasts more than three months. This pain doesn't have a clear cause and negatively impacts the woman's life. Treatment for vulvodynia takes time and can include a combination of topical medicines, oral medicines and physical therapy It's been about ten years since I first developed my chronic vulvar pain condition. I didn't know what was happening at first. By the time I figured it out and got my self-diagnosis confirmed at Planned Parenthood, I knew vulvar vestibulitis meant a condition that virtually no one knew how to treat, let alone cure Vulvodynia or Pudendal Neuralgia By Lori Montgomery, MD, CCFP and Magali Robert, MD, FRCSC Introduction Vulvodynia (say: vul-vo-DYNE-ee-uh) is a word used to describe pain that involves the vulva. The vulva is the area around the vagina. This pain can come from many different sources. The symptoms can range from quite mild to very severe

Vulvodynia: An Under-recognized Pain Disorder Affecting 1

The first charity in the world for vulva health awareness and the only UK charity to provide a dedicated helpline for women with any vulva disorder. No matter what your vulva diagnosis or problem is, the VHAC helpline is available to support you Background. Vulvodynia and pudendal neuralgia comprise significant contributors to vulvar-related pain and its impact on daily life. Aim. A retrospective clinical audit was conducted at the Women's Health & Research Institute of Australia, Sydney, to determine the pattern of use and the efficacy of the application of topical amitriptyline 0.5% plus oestriol 0.03% in organogel (AOO), to the. Vestibulodynia (vulvar vestibulitis) Vulvodynia; Vulvar graft vs host disease To request an appointment, fill out our online form on the Contact Us page. A coordinator will contact you to schedule an appointment and send you a questionnaire. This questionnaire must be filled out and returned before your first visit so that it may be reviewed by. Abstract. Background: Among the several subtypes of vulvodynia or idiopathic vulvar pain lasting for at least 3 months, Localised Provoked Vulvodynia (LPV) is the most highly prevalent clinical variant identified by the 2015 classification. The pathophysiology underlying LPV is still elusive and unclear. The association with recurrent vulvovaginal candidiasis and aerobic vaginitis is.

Vulvodynia, Acupuncture, Vulvar Dysesthesia, Vulvar Pain, Visual Analog Scale (VAS) INTRODUCTION The prevalence of vulvodynia, or generalized vulvar dysesthesia, is largely unknown in the general population. 1 It was described by Tovell and Young in 1978 2 as an undetermined disorder in 26 patients (2.6%) in a series of 877 consecutive cases Provoked vestibulodynia (vulvar vestibulitis) is increased sensitivity to pain at the opening of the vagina (vestibule), making even gentle touch or stimulation painful. Provoked vestibulodynia is the most common cause of superficial pain that is felt when sexual intercourse is attempted or is occurring (dyspareunia—see Dyspareunia )

Why Does Vulvodynia Flare-Up? - Vuvatec

vulvar itching vulvar itching in an older womanin an older woman Know the treatment of conditions that cause itching and burning of the vulva cause itching and burning of the vulva in in an older woman Vulvodynia Often a silent disease 30% of women with these conditions will suffer without seeking medical car On October 10 th, ABC's new hit show viewed by more than 12 million, Private Practice, dealt with vulvodynia by featuring a character suffering from a combination of vaginismus and vulvar vestibulitis. The show accurately portrayed some of the symptoms of vestibulitis, but depicted an unrealistic quick fix for the condition Women with a final diagnosis of vulvodynia were more likely to be on a neuromodulator at the intake visit [4/15 (27%) vs 2/70 (3%), p < .008] (see Figure 5). FIGURE 5: Bland vestibular erythema without erosion or demarcated border; clinical diagnosis was vulvodynia and biopsy (site indicated) was performed to exclude LP Tagged emla, vestibulitis, vestibulodynia, vestibulodynia blog, vulvar vestibulitis, vulvodynia, vulvodynia blog, vulvodynia stories, vulvodynia treatment. May 18 2012. Leave a comment. botox, dilating, treatment, vaginismus. Vaginismus vs. Botox, Round Two. Oh goodness. So much has happened on the vagina front over the last 24 hours. I'm not. Vulvar vestibulitis is a subset of vulvodynia in which the burning or pain only occurs with light touch in the vestibule, the area immediately surrounding the vaginal opening. The International Society for the Study of Vulvovaginal Disease developed a new set of definitions for vulvodynia in 2003. They created two subgroups: (i

Vulvodynia: A Common and Under-Recognized Pain Disorder inVulvar Vestibulitis(PDF) Epidemiology of Vulvar vestibulitis syndrome: AnVulvodynia; Generalized Vulvodynia; VestibulodyniaPatent US6150400 - Method for treating vulvar vestibulitis

Yeast Infections, Candida Allergy, and Vulvodynia. By Marjorie Crandall, Ph.D. The typical woman with vulvar pain recently had yeast vaginitis and was treated with an antifungal for a short time. After her severe symptoms of itching and vaginal discharge resolved, she was left with vulvar redness and burning Dr. Oz and Dr. Ashton discuss vulvodynia in the no-embarrassment zone. Learn what causes vulvodynia by watching the video, but some common treatments are:Self-Care Measures Many women who have vulvodynia will develop personal strategies that help to control the pain. Here are some tips for everyday. A Medline search was conducted using several terms related to and including the terms vulvodynia, vulvar vestibulitis, vestibulodynia, and pudendal neuralgia. Results. A thorough review of vulvodynia. Conclusion. Vulvodynia most likely represents several disorders without an identifiable cause in many cases The current classification differentiates: vulvar pain due to a known cause vs idiopathic chronic vulvar pain (ie, vulvodynia). Slide 23. Pain is first classified by location, ie, generalized (several areas of the vulva), localized (a specific area of the vulva), or mixed; secondly, it is classified by provocation (provoked, spontaneous, or mixed) While it has been suspected that HPV may play a role in vulvar vestibulitis, recent controlled studies are against HPV as an etiology. ( R) There is such a condition of primary vulvar vestibulitis that occurs from the time of the first intercourse. Not much is known about this but it responds the same as a secondary vulvar vestibulitis Vulvar vestibulitis syndrome (also know as vestibulodynia or vestibular adenitis) is a subset of vulvodynia that is characterized by severe pain during attempted vaginal entry (intercourse or tampons insertion), tenderness to pressure localized to the vulvar vestibule and redness of the vulvar vestibule