Abstract Introduction Convergent diagnostic criteria and lived experiences of vaginismus and dyspareunia/vulvodynia have led to questions about whether they should be diagnosed separately or combined, as in the DSM-5. Objective The present study leverages a large dataset of online discussion groups (Reddit) to determine whether (1) symptoms discussed in relation to vaginismus and vulvodynia are differently represented across sub-Reddits focusing on vaginismus and vulvodynia; (2) whether co-occurrences of symptoms differ across these sub-Reddits, and (3) whether adjectives used in relation to vaginismus and vulvodynia differ along the dimensions of concreteness/abstractness and negative affectivity. Methods Sub-Reddit discussions for vaginismus (n = 133 543; from 2013-2022) and vulvodynia (n = 55 984; from 2012-2022) were obtained. Symptom-specific proportion scores were calculated by dividing the total number of sub-Reddit submissions/comments that included each symptom divided by the sum of sub-Reddit submissions/comments that included any symptom. The Dice index was used to examine symptom co-occurrences, providing the degree of overlap in symptom pairs relative to their overall frequencies. Finally, to test for differences in concreteness and negative affectivity of the adjectives used in relation to specific symptoms, random effects models were used treating symptoms as a random factor and sub-Reddit (vaginismus vs vulvodynia) as a fixed factor. Measures of adjective concreteness and affectivity were taken from Brysbaert, Warriner, .0001), affectively more negative (F(1, 29 882) = 13.21, p .001) and more hopeless/helpless (F(1, 29 771) = 7.09, p .01), than those used for vaginismus (see Fig. 2). Conclusions These results show that in an open context in which people communicate regarding vaginismus or vulvodynia, there are clear differences in what symptoms are discussed for each condition, how those symptoms overlap, and in relation to the concreteness and affectivity of the adjectives used when discussing those symptoms. Thus, these results provide evidence that vaginismus and vulvodynia are distinguishable on these parameters, and that maintaining distinct diagnostic categories may be justified. The lack of spasms in either sub-Reddit is consistent with past concerns raised regarding the relevance of spasms for a diagnosis of vaginismus. Although vaginismus is more strongly associated with psychological symptoms, adjectives used in relation to vulvodynia are affectively more negative. These results have clinical implications as they contribute to the important discussion on whether and how these conditions are distinct, what symptoms are most relevant to each condition, and how these symptoms are experienced cognitively and affectively. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Pelva Health; SPM therapeutics; Initiator Pharma; Cari Health; World Quant Foundry.
Kiesner et al. (2026) studied this question.