Vulvodynia is chronic vulvar pain lasting more than three months without an identifiable cause. It is classified as primary, present at the first physical contact, or secondary, arising after an initial pain-free period. The pain may be localized to a specific area, such as the vestibule. A cotton swab test is used to localize and quantify pain. For example, penetrative sex is painful, the pain is burning and localized around the opening of the vagina. In the affected person, the pain gradually increases over the last year.