Vulvar pain syndrome: a review.

Vulvar pain syndrome (vulvar vestibulitis, vulvodynia, burning vulvar syndrome) was first described at the end of the last century. Although more than 100 years have passed, the cause(s) of the disorder remains elusive. This review of the literature endeavors to collate the known facts relating to vulvar pain syndrome and to expose those hypothetical etiologies which fall short of establishing any scientific foundation. The diagnosis of vulvar pain syndrome is established on the basis of historical data which detail a rather abrupt onset of vestibular itching, burning, dryness which may be intermittent or continuous. Commonly, patients present with a history of chronic treatment for recurrent fungal infections. Sexual relations become uncomfortable or intolerable. Unanimously, the patients describe a panorama of topical creams and ointments which fail to alleviate the symptoms. Physical examination typically verifies hyperesthesia of the vestibular skin when touched lightly with a cotton-tipped applicator. Similarly, the vestibular skin shows varying degrees of redness. The treatment programs for vulvar pain syndrome are as diverse as the multitude of etiological hypotheses. This review includes data pointing out those therapeutic measures that appear valueless and that may add to the patient's chronic discomfort.