Vulval Pain

Vulval pain affects a significant number of women and can negatively impact quality of life and sexual function. Management should therefore take a holistic approach. Vulval pain may be due to a number of specific disorders or pain syndromes, such as vulvodynia or vestibulodynia (see Box 1). Previously used terms such as vestibulitis should be avoided. Box 1 <target id="page_328" target-type="page">328</target>International Society for the Study of Vulvovaginal Diseases (ISSVD) classification of vulval pain (adapted from Moyal-Barracco 2004) Vulval pain related to a specific disorder Infectious (see Vulval itching and Vulval ulceration)

Sexually transmitted

herpes simplex virus

lymphogranuloma venereum

granuloma inguinale

chancroid

syphilis

Non-sexually transmitted

candidiasis

tuberculosis

fununculosis

diphtheria

apthous ulcers

Inflammatory

Lichen planus

Lichen sclerosus

Immunobullous disorders

Crohn’s disease

Lipschütz ulcers

Behçet’s disease

Neoplastic (see <xref ref-type="book-part" rid="chapter90">vulval swellings</xref>)

Squamous cell carcinoma

Basal cell carcinoma

Melanoma

Sarcoma

Bartholin’s glands adenocarcinomas

Vulval intraepithelial neoplasia

Extramammary Paget’s disease

Undifferentiated tumours

Possible secondary tumours

Neurological

Herpes neuralgia

Spinal nerve compression

Pudendal nerve entrapment

Pudendal neuralgia

Vulvodynia Generalised

Provoked (sexual, nonsexual, or both)

Unprovoked

Mixed (provoked and unprovoked)

Localised (vestibulodynia: previously known as vulval vestibulitis, clitorodynia, hemivulvodynia, etc.

Provoked (sexual, nonsexual, or both)

Unprovoked

Mixed (provoked and unprovoked)