Vulval pain

Abstract

Vulval pain gives an overview of the aetiology, clinical features, management, and prognosis of this, at times, poorly understood and distressing clinical condition. Definitions of provoked, spontaneous, and mixed vulvodynia are given, and local (vestibulodynia) and generalized vulvodynia are differentiated. Important features to explore on history-taking and examination are highlighted, and practical advice on management is given. This includes patient information, topical treatment, systemic treatment (with neuropathic pain agents) and the role of psychosexual therapy, clinical psychology, and pelvic floor physiotherapy are outlined. There is a section on ‘other’ treatments to consider, including more advanced pain management and surgical options. Prognostically partial relief of symptoms occurs in 40–50% of women.