Vulvodynia

Vulvodynia is vulvar pain lasting 3 months or more without an identifiable cause such as infection, dermatosis or neurological disease. It is often described as burning, stinging or rawness, and divides usefully into provoked vestibulodynia - pain triggered by touch, tampon use or intercourse and localised to the vestibule - and generalised unprovoked vulvodynia, which is more diffuse and constant. Central sensitisation and pelvic floor muscle overactivity are thought to drive much of it, which explains why examination is often normal and why treatments aimed at the nervous system and muscles work better than those aimed at the tissue. Diagnosis is one of exclusion, so infection, lichen sclerosus, lichen planus and oestrogen deficiency should be assessed first, since each is treated differently. Management is genuinely multimodal: pelvic floor physiotherapy with manual therapy and dilators has good support, topical lidocaine gives symptom relief, topical oestrogen helps where hormonal contributors exist, and tricyclic antidepressants or gabapentinoids are used for neuropathic features. Cognitive behavioural therapy and sex therapy improve pain and function meaningfully and are not an afterthought. Supplement evidence is thin. A low-oxalate diet with calcium citrate was popularised decades ago but has not held up in controlled study. Vitamin D correction where deficient and magnesium for muscle-related discomfort are reasonable but unproven for this condition.