Is a biopsy necessary for diagnosis?

I'm curious, as I know that vulvodynia is what I have but I have not been diagnosed yet. Before I had my hymen removed, I was sure that that was what was causing my pain. However, I also suspected some form of vulvodynia, because I knew that I had pain even without penetration (sitting, tight clothes, etc). I lied to my gynecologist about this, because I knew that if she thought I had vulvodynia she would assume that that was my only problem, and she wouldn't want to give me the hymenectomy. And I knew that I needed my hymen removed. I was right, because it turns out my hymen was much thicker than it should have been and would not have broken naturally.

Anyway, now that it's gone, I can rule it out as a source of pain and I know that I have vulvodynia, but I am worried about all of the 'testing' they apparently have to do to rule out other things. I'm wondering, is it possible for a doctor to diagnose and treat you for vulvodynia without doing a biopsy? If I tell her my history in detail, and tell her about the 'cotton swab/q-tip test' I performed on myself, etc, can she diagnose and treat me after simply hearing this info? I am terrified of getting a biopsy, because I assume you would have to have it done awake, which either means scraping/slicing my vagina (OUCH) or giving me a vaginal anaesthetic (ALSO OUCH). I can't face the idea of any more pain there, I just want to be given the lidocaine cream and skip all of this stuff. After years and years of pain, I can't handle any more.

If I've had vulvar pain all of my life, which I have, surely this means that it can't be some form of cancer, and a biospy wouldn't be necessary?

I was like you and absolutely terrified of a biopsy, the day I first went to see the vulvar dermatologist I doped myself up on painkillers and was so nervous I was shaking but then she said it wouldn't be necessary when I got there! It really depends on who you see, what there is to see in the vulval area and what the symptoms are. If you have itching it might make them think one is a good idea and if you have areas that could be a skin condition that might too. I have some red inflamed skin but it didn't look classicly like any skin condition and I didn't have itching so the dermatologist left it alone. There's several women on here who have had biopsies done though who will be able to discuss them with you.

Thank you, that eases my mind a little. There is really nothing to see down there in my case. Everything LOOKS normal. There is no redness, no inflammation, no swelling of any kind. And I have no itching. I would have thought that a biopsy would only be necessary if they suspected cancer of some kind, but surely they would only consider that as an option if the pain came out of nowhere after years of pain free sex? Whereas I've had pain all my life.

I would think having pain all your life would make it much less likely you'll need a biopsy. Mine came on suddenly after years of no pain and I still didn't have a biopsy done, it depends alot on what they can see. If you can't see anything at all it's very unlikely they'll think a biopsy is necessary. It's not just cancer they biopsy for, some skin conditions like Lichen Sclerosus are diagnosed through biopsies but again there would be something to see and itching for that. I doubt you'll be offered a biopsy in your situation.

I went to 3 seperate dermatologists...one was a vulvar specialist.

At each appointment the doctor would perform a physical examination of the area and never once did they suggest a biopsy. If on the surface your tissue appears within normal range they most likely wont biopsy...I guess because it causes more pain and they just dont see it fitt for the situation.

According to them, my tissue is normal (whatever that means...I guess mild redness and swelling is normal?????)

Anyways...

Hello, all i had was some mild redness and swelling. after months and months of trying to figure out what was wrong w/ me, the doc did do a biopsy to rule out cancer and a skin disorder. I think it's just part of the process of trying to identify what disorder a woman may have. It's ruling out all possibilities. but, may not be necessary.

Just to add....

alot of biopsies show, at most, inflammation.

So, what does that mean ??!! Is it from yeast or nerve irritation?