The symptom of a heavy feeling in the vulva is caused by smooth muscle tumors of the vulva or inflammation of the vagina, prolapse of the vaginal wall, or pressure symptoms from pelvic inflammatory disease that cause the vulva to drop. This symptom is called vulvovaginal cramping. Diagnosis and examination of vulvovaginal cramping: The diagnosis can be made by the patient’s self-perceived symptoms. Differential diagnosis of vulvar cramping: 1. Non-specific vaginitis: smear of secretions and microscopic examination with Gram stain can find common pathogens without the presence of mycobacteria or trichomonas. 2. Mycotic vaginitis: take a smear of the discharge and stain it with Gram stain. Microscopically, clusters of Gram-positive intensely stained ovoid spores can be found, or pseudomycorrhizal filaments can be seen connected with outgrowth cells in a chain or branched form. The most reliable method is to perform a mycological culture test. 3. Trichomonas vaginalis: Take the discharge and mix it with a small amount of warm saline that has been dripped on a glass slide and examine it microscopically. Active Trichomonas vaginalis can be seen. If trichomonas cannot be detected in special cases, culture test can be used instead and the results are highly accurate. 4. senile vaginitis: taking secretions for examination should be distinguished from trichomoniasis and mycosis. Pay attention to the cervix, uterine body size and its morphology, source of bleeding and vaginal cytology results, and if necessary, make a biopsy of the cervix or endometrium to exclude the possibility of uterine cancer.