Vulvodynia in Pediatric and Adolescent Populations: A Case Series on Presentation and Management

Vulvodynia is a chronic vulvar pain condition that remains underrecognized in pediatric and adolescent gynecology (PAG), often resulting in delayed diagnosis and management. Although topical gabapentin (TG) has demonstrated promise in adults, pediatric outcome data remain limited. This case series aims to characterize the presentation, management, and outcomes of vulvodynia in PAG patients at a single academic institution.

Medical records of 78 patients diagnosed with vulvodynia at a PAG clinic between July 2021-2025 were reviewed.

The median age at presentation was 16 years. The cohort was diverse, with 56% of patients identifying as Hispanic/Latino. 41% were previously evaluated elsewhere, yet none were diagnosed with vulvodynia. Dysuria was the most reported symptom (44%), and vestibular tenderness or a positive Q-tip test was documented in 95% of patients. Symptom presentation varied by menarchal status, with pruritus, burning, and irritation more common among premenarchal patients, while dyspareunia, tampon intolerance, and dysmenorrhea were observed exclusively among postmenarchal patients. TG ± lidocaine was prescribed to 85% of patients. Among treatment-adherent TG patients, 63% reported significant improvement or symptom resolution at 3 months, and 92% at 1 year. Sustained improvement at both time points was observed in 59%. Three patients discontinued treatment because of local irritation.

Vulvodynia remains an underrecognized condition in PAG, with many patients experiencing delayed diagnosis and misdiagnosis. TG appeared well tolerated and was associated with favorable clinical outcomes, supporting further research comparing its use to other treatment modalities in PAG populations.