Nonlesional vulvovaginal pain is more challenging to manage than lesional pain, which usually resolves with resolution of the underlying problem. The required multidisciplinary approach includes neuropathic pain-directed medication, physiotherapy and counselling.
- The most likely explanation in a patient with chronic vulvovaginal pain who has a genuinely normal physical examination is neuropathy, referred pain and/or pelvic musculoskeletal dysfunction.
- These neuromuscular disorders are amenable to neuropathic pain-directed medication, physiotherapy and/or counselling.
- Occasionally, patients with psychiatric conditions have vulvovaginal pain as a symptom of their condition.
- Patients with vulvovaginal pain and an apparently normal examination should never be dismissed. Once lesional causes have been excluded, patients should be categorised into nonlesional diagnostic groups and specific targeted therapy initiated.