Vulvodynia: diagnostic techniques and treatment modalities.
Vulvodynia is a chronic vulvar discomfort often characterized by the patient's complaint of burning, stinging, irritation, or rawness. Vulvodynia has been recorded for centuries. Successful diagnostic techniques and treatment modalities, however, have come about only in the last decade. An accurate diagnosis is based on an exhaustive history and detailed physical examination. Highly technical and costly diagnostics provide little supplemental information. Differential diagnosis, previously called subsets of vulvodynia, includes infections (Candida, human papillomavirus, and herpes simplex virus), dermatoses (lichen sclerosus and inflammatory dermatoses), vulvar vestibulitis, iatrogenic causes, and dysesthesias (pudendal neuralgia and reflex sympathetic dystrophy). Primary care providers are fully capable of accurately diagnosing and managing vulvodynia patients, relying on subspecialty referral only for surgical intervention in selected cases.