Box 1: Causes of persistent vulvar pain14
OriginTreatable cause
HormonalVulvovaginal atrophy (hypoestrogenic states such as menopause, breastfeeding, use of low-dose birth control)
InfectiousCandidiasis, herpes simplex virus
Inflammatory or dermatosesDermatitis, lichen sclerosis, lichen planus, immunobullous disorders
MuscularVaginismus, myofascial pain
NeurologicHerpes neuralgia, pudendal neuralgia, spinal nerve compression or injury, neuroma
AnatomicClitoral adhesions, narrowing of the vaginal opening
NeoplasticPaget disease, squamous cell carcinoma
IatrogenicPostoperative, chemotherapy, pelvic radiation
TraumaFemale genital cutting, obstetrical