Chronic vulval discomfort, most often described as a burning pain, occurring in the absence of relevant visible findings or a specific, clinically identifiable, neurological disorder

Aetiology

• Aetiology not understood, likely to be multifactoral
• Usually requires a trigger in a vulnerable individual
• Associated with other chronic pain conditions e.g. fibromyalgia

Clinical features

Symptoms

• Vulval discomfort often described as burning, stinging, irritation or rawness
• Generalised (affecting whole vulval area) or localised (affecting a specific area)
• Provoked (e.g. by touch, sexual intercourse, interting a tampon), unprovoked, or mixed

Signs

• Little or nothing abnormal is apparent on inspection
• The purpose of examination is to localise the pain and to exclude other diagnoses

Investigations

• Diagnosis of exclusion
• Vaginal swab may be useful to rule out infection

Management

• Information
• Genital skin care advice and emollients
• Localised provoked pain - lidocaine 5% ointment, vaginal trainers, physiotherapy