Examination of the vulva and vagina
The need for physical examination is guided by the individual’s history; it is particularly relevant for anyone with concerns regarding sexual pain.
If an individual has experienced trauma (from sexual assault or a previous examination that was distressing) or is anxious about examination, discuss their feelings and outline how a stepwise examination could be done (with checks at each point for signs of distress and for consent to continue). Offer that a chaperone or support person could be present. See the International Menopause Society website for more detail on examination. Depending on the clinician’s expertise and the patient’s circumstances (such as a history of trauma or the presence of distress) referral to another clinician to undertake a genital and vaginal examination may be appropriate.
An assessment for vulvovaginal and pelvic conditions includes examination for:
- vulvovaginal atrophy
- provoked vulvodynia or vestibulodynia1; vulvodynia is a chronic pain syndrome in which a moistened cotton bud tip gently applied to the vestibule elicits pain, usually of a burning, itching or stabbing nature (vestibulodynia is the local form of vulvodynia affecting the vaginal entrance)
- dermatological conditions such as lichen sclerosus and candidiasis
- persisting thick hymenal tissue or other vulval or vaginal structural anomalies
- pelvic floor disorders; this involves careful assessment of the tone and tenderness of pelvic muscles2 or other patterns of tenderness, which could indicate endometriosis or pelvic inflammatory disease.