Subsets of vulvodynia.

The frustrated patient with vulvar "burning" seldom has grossly abnormal physical findings, and the clinical significance and prognosis of vulvodynia have eluded both gynecologists and dermatologists. Evaluation of the physical findings on initial and follow-up visits of such patients during various treatment protocols has revealed distinct subsets of vulvodynia. In one series of 52 patients at the Emory Clinic, the following subsets were identified in decreasing order of frequency: (1) vulvar dermatoses, (2) cyclic candidiasis, (3) squamous papillomatosis, (4) vulvar vestibulitis, and (5) essential vulvodynia. These subsets may occur alone, simultaneously or sequentially; treatment for one condition may affect the onset of another. Vulvodynia may have multiple causes; use of the term for a patient's problem should prompt a thorough diagnostic evaluation. Although the subsets are not entirely exclusive of one another, each is identified by an improvement with specific therapeutic modalities. The recognition of multiple factors in vulvodynia is important to appropriate patient evaluation and management.