Clinical management of vulvodynia.

Vulvodynia represents a group of vulvar disorders that can be clinically perplexing. Unfortunately, there are no simple tests for its diagnosis. Patients often are reluctant to report vulvar pain. Some are embarrassed to reveal their perceived "sexual dysfunction" caused by dyspareunia. Others have been told in the past "It's all in you head," or "It's just a yeast infection." Most patients with vulvodynia are seen by multiple practitioners and are placed on a variety of treatments before a correct diagnosis is made. All too often, these treatments are not only ineffective but also damaging. Careful clinical investigation is required for the correct diagnosis and treatment of vulvodynia (Figure 2).