Management of vulvar pain

  Vulvodynia is a frequently used medical term that literally means “vulvar pain”. Therefore, vulvodynia is a symptom, not a disease. The term itself indicates a variety of unpleasant chronic vulvar sensations, including burning, rawness, soreness, irritation, sensitivity, and formication. This may or may not include dyspareunia. Primary vulvodynia occurs when these sensory disturbances occur in the absence of observable dermatologic disease or vulvovaginal infection. There are several causes for this, including neuropathy, referred pain, and pelvic floor muscle dysfunction. For the purist, it is the patient in whom there is no observable reason for vulvar pain who represents the true case of vulvodynia. However, vulvodynia can also occur secondarily as a symptom of vulvar skin disease. Restricting the present paper to patients without objective signs leaves out all the important conditions which come into the differential diagnosis of vulvar pain which should be ruled out first. The first step in managing vulvodynia is making an accurate diagnosis of its cause. The present review summarizes the diagnosis and management of the chronic dermatologic diseases which may cause primary and secondary vulvodynia. The etiology of primary vulvodynia is much more poorly understood than secondary vulvodynia, and treatment of some aspects remains controversial.