A 24-year-old G0 presents to your office complaining of vulvar dis- comfort. More specifically, she has been experiencing intense burning and pain with intercourse. The discomfort occurs at the vaginal introitus primarily with penile insertion into the vagina. The patient also experiences the same pain with tampon insertion and when the speculum is inserted during a gynecologic exam. The problem has become so bad that she can no longer have intercourse, which is causing problems in her marriage. She is otherwise healthy and denies any medical problems. She is experiencing regular menses and denies any dysmenorrhea. On physical exam, the region of the vulva around the opening of the vagina appears erythematous and inflamed and is tender to touch with a cotton swab.
What is the most likely diagnosis?
a. Vulvar vestibulitis
b. Atrophic vaginitis
c. Contact dermatitis
d. Lichen sclerosus
e. Vulvar intraepithelial neoplasia