Vulvodynia and its differential diagnoses

Vulvodynia is the symptom of chronic vulvar discomfort characterized by the patient's complaint of burning and sometimes stinging or rawness. It is a multifactorial problem in which no single etiologic factor or pathogenetic mechanism has been identified. Patients with vulvodynia exhibit several features of neuropathic pain, such as allodynia, hyperalgesia, dysesthesia, and chronic pain in the absence of ongoing noxious stimuli. The treatment of vulvodynia has, in the past, focused on irradicating suspected infective causes, such as human papillomavirus, with varying success. More recently, approaches mimicking the therapy of other chronic pain syndromes, eg, the use of low-dose antidepressants, has met with some success. There is a need for uniformity in terminology and therapeutic approach, epidemiologic studies, and controlled trials to advance our management of this problem.