The Q-tip test inefficacy for vaginismus, vulvodynia, vulvar vestibulitis

Vaginismus (vaginal penetration pain disorder) and vulvodynia/vulvar vestibulitis (irritation disorders) are often intertwined, making a differential diagnosis a daunting task for most medical professionals.  The Q-tip test is a commonly-used diagnostic tool for these conditions: the clinician touches the vulva and vestibule in a clockwise (or counterclockwise) direction while asking the patient to rate her pain/symptoms using a 0-to-10 scale (zero = no pain, 10 = the worse).  It has been accepted as an objective measure of level of discomfort.

Our clinical experience has proven, again and again, the inefficacy of this test because EVERY woman with vaginismus or vulvudynia/vulvar vestibulitis will be either apprehensive about being touched in the area and/or fearful of contact to the area, and will thus have a positive Q-tip test.

Furthermore, her rating on the 0-to-10 scale will ALWAYS be of somatic nature, making ascertaining on the spot how much of it is physical vs how much is emotional/anxiety-based merely impossible.

What is needed is better professional education, training, and standardization regarding diagnosing these female somatic genital disorders.