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A 21-year-old nulligravid woman presents complaining of vulvar pain and irritation noted during exercise and with tampon insertion. She is an avid cyclist and rides approximately 75 miles per week as her routine. Her gynecologic history is unremarkable, but upon further questioning, she notes frequent friction and a “pulling sensation” with sexual activity. She has no medical or surgical history and uses a levonorgestrel intrauterine system for contraception. She takes no medication and has no allergies.
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