Persistent vestibular irritation/pain

[Matthew_B]

(Canadian question, couldn't find better forum)

26 yo patient presents with persistent vestibular vaginal pain during daily activities, and increased pain during intercourse. The patient describes the pain as "knife-like, stabbing" and/or "burning", and having lasted for "as long as [she] can remember". During examination, no lesions or sores are visible; patient complains of excruciating pain. A Papanicolaou test reveals no evidence of vaginosis, trichomoniasis, candidiasis, HPV, or HSV. Patient was prescribed Clobetasol propionate cream 0.05% for topical application, but has not improved. What is the most reasonable diagnosis from the information given?

Cheers

[student-2]

I think the question is faulty. Where did you get it?
PAP tests dont test for vaginosis/trichomoniasis/candidiasis/HSV and not even HPV!!!
What it does test is for the epithelial cells of the cervix!!! It can tell if the cervical cells underwent any type of cytological change (atypia etc....)
These changes in cervical epithelium can either be due to nothing or inflamation or due to a neoplastic process which is highly associated with HPV.
All the pathologies mentioned need to be smeared directly, or cultured for or taken for PCR etc... Most of the pathologies mentioned (vaginosis/candida etc...) display a discharge of some sort, nothing was mentioned in the stem!!!
My gut feeling is that thie question was aiming for endometriosis but there should also be some info in regard to menses!

[sarab]

there is some lines in q are missing other wise this q is about endometriosis