EDITOR--Although Butcher's review of female sexual problems discusses the causes of superficial vulval pain, it omits to mention vulvodynia--in our experience an important cause of vulval pain and superficial dyspareunia.[2 3] The International Society for the Study of Vulvar Disease defines vulvodynia as chronic vulvar discomfort, especially that characterised by the patient's complaint of burning, stinging, irritation, or rawness.
Dysaesthetic vulvodynia is thought to be an abnormal pain syndrome analogous to trigeminal neuralgia and postherpetic neuralgia. Physical examination gives essentially normal results, with no evidence of vestibulitis. The most successful treatment is low dose amitryptiline, starting at 10 mg daily and increasing to a maximum of 75 mg daily in conjunction with 5% lignocaine gel.
Patients with superficial vulval pain should be assessed in a specialist vulval clinic, as vulvodynia is otherwise often not recognised.
 Butcher J. Female sexual problems II: sexual pain and fears. BMJ 1999;318:110-2. (9 January.)
 Harrington CI. Vulvodynia. Dermatol in Pract 1990:June/ July:18-21.
 Byth J. Understanding vulvodynia. Australasian J Dermatol 1998;39:139-50.
 International Society for the Study of Vulvar Disease Taskforce. Burning vulvar syndrome: report of the ISSVD taskforce. J Reprod Med 1984;29:457.
 McKay M. Dysesthetic ("essential") vulvodynia. Treatment with amitriptyline. J Reprod Med 1993;38:9-13.
B Kirby Specialist registrar
J A Yell Consultant dermatologist Vulval Clinic, Department of Dermatology, Hope Hospital, Salford M6 8HD firstname.lastname@example.org
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