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A 27-year-old G0 woman presents with a three-year history of dyspareunia. She reports a history of always having painful intercourse, but she is now unable to tolerate intercourse at all. She has avoided sex for the last six months and describes severe pain with penile insertion. Additionally, she reports an inability to use tampons due to painful insertion. She notes a remote history of frequent yeast infections while on antibiotics for recurrent sinusitis. Her medical history is otherwise unremarkable, and she is not on medications.

During the pelvic examination, her external genitalia appear normal. Palpation of the vestibule with a Q-tip elicits marked tenderness and slight erythema. A normal-appearing discharge is noted. Saline wet prep shows only a few white blood cells, and potassium hydroxide testing is negative. Vaginal pH is 4.0. The cervix and uterus are unremarkable.

Which of the following is the most likely diagnosis in this patient?

A. Vaginal cancer
B. Genital herpes infection
C. Vestibulodynia
D. Contact dermatitis
E. Chlamydia infection

Answer :

Final answer:

The most likely diagnosis in this patient is vestibulodynia, which is characterized by pain in the vestibular area. This condition can be caused by previous yeast infections and antibiotic use, and is consistent with the patient's symptoms and examination findings.

The correct option is C. Vestibulodynia

Explanation:

The most likely diagnosis in this patient is Vestibulodynia. Vestibulodynia is a condition characterized by pain or discomfort in the vestibular area, which is the opening of the vagina. The symptoms the patient is experiencing, such as severe pain with penile insertion and inability to tolerate tampon insertion, are consistent with vestibulodynia.

Vestibulodynia can be caused by various factors, including previous yeast infections and antibiotic use. The tenderness and erythema observed during pelvic examination further support this diagnosis.

Other possibilities such as vaginal cancer, genital herpes infection, contact dermatitis, and chlamydia infection can be ruled out based on the patient's history, symptoms, and examination findings.

The correct option is C. Vestibulodynia

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