Postherpetic neuralgia after shingles: an under-recognized cause of chronic vulvar pain

Vulvar shingles, an uncommon presentation of a common disease, probably affects 1.5 million American women during their lifetime and leaves about 150,000 with postherpetic neuralgia, a chronic neuropathic pain syndrome. Prompt diagnosis and treatment can minimize pain severity and duration.

The case of an 88-year-old woman with sacral shingles is described. Complications led to her demise. A 35-year-old with a 6-year history of disabling vulvar pain and many diagnostic procedures was ultimately diagnosed with postherpetic neuralgia.

Shingles needs to be included in the differential diagnosis of vulvar rashes because it is a modifiable risk factor for chronic vulvar pain. The possibility of postherpetic neuralgia must be considered in women with unexplained vulvar dysesthesia.