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Treatment of vulvodynia

Elizabeth Gunther Stewart, MD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Kristen Eckler, MD, FACOG


Vulvar pain can impact quality of life through detrimental effects on daily comfort and sexual function. Approximately 15 percent of women have experienced vulvar pain lasting three or more months [1].

There are few high-quality data regarding the management of vulvodynia. Treatment is based upon the few randomized trials, but largely upon findings of small observational studies, case reports, and clinical experience. Studies with long-term follow-up are lacking. In addition, few interventions have been compared with placebo. Such research is needed, since treatment of vulvodynia has the potential for a large placebo effect, similar to other chronic pain conditions [2].

Successful therapy often requires trial and more than one type of therapeutic intervention may be needed. The process of finding an effective treatment is often time-consuming and frustrating to patients and clinicians. A multidisciplinary team approach is useful and should address the psychology of pain, sexual issues, involvement of the pelvic floor, and the possibility that multiple sources of pain may be present in some women.

The management of women with vulvodynia will be reviewed here. Clinical manifestations and diagnosis of the two main types of vulvodynia, as well as of vulvar pain related to a specific disorder, are discussed separately. (See "Clinical manifestations and diagnosis of localized vulvar pain syndrome (formerly vulvodynia, vestibulodynia, vulvar vestibulitis, or focal vulvitis)" and "Clinical manifestations and diagnosis of generalized vulvodynia" and "Approach to the woman with sexual pain" and "Vulvar lichen sclerosus" and "Vulvar lichen planus".)


The terminology used to describe vulvar pain syndromes has varied over time. The current classification system, which was agreed upon at the 2003 Congress of the International Society for the Study of Vulvovaginal Disease, consists of two major categories [3,4]:


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