Vulvodynia. Theory and management

Vulvodynia, defined as vulval pain, soreness or burning as opposed to itching or pruritus, is a common and important problem. Although not a sexually transmitted disease, it often presents to physicians working in that field. The main groups of vulvodynia are those where the symptoms are the consequence of an active dermatosis or infection, and those where it is not attributable to such conditions. In the latter group, the patients fall into two main categories: those of dysesthetic vulvidynia, with constant unprovoked pain, and vulval vestibulitis, with pain provoked by attempted vaginal entry. The recent realization that dysesthetic vulvodynia and vulval vestibulitis may be regarded as pain syndromes is proving a fruitful concept as regards both theory and management of these troublesome conditions.