6.3 Indication phase
Women suffering form PVD often have a long history of seeking treatment. A journey of five years or more is no exception! PVD is not only hard to recognize, it is also hard to distinguish from other gynecological diseases, such as:
- recurrent vulvar vaginal candidiasis. Sometimes this is the onset of PVD;
- normal dyspareunia. Insufficient excitement and therefore insufficient lubrication makes intercourse a painful experience. This may provoke a psychological vicious circle of pain-fear-pain etc.
- if sufficiently sexually excited sometimes intercourse itself can be pleasurable, even in the presence of PVD. In those cases the pain comes afterwards;
- vaginismus and other (hyper tined) pelvic floor related complaints;
- the presence of ano-genital dermatoses, like lichen sclerosis, vulvitis of Zoon, mucosal lichen planus, etc. In doubt, a vulva-scopy (?) and further histological examinations are required.