Vulvodynia: a therapeutic challenge.

Vulvodynia is a poorly understood, distressing and debilitating disorder. The management of this disorder remains insufficient and the lack of consistent terminology is confusing. The management of classic dysesthetic vulvodynia is fairly straightforward, using drugs effective against chronic neuropathic pain. However, vulvar vestibulitis syndrome remains a therapeutic challenge. A pragmatic approach is recommended for the management of patients with vulvar vestibulitis syndrome. In refractory cases, vestibulectomy has a high success rate, although the evidence is based mainly on small, descriptive studies. Comparative studies of conservative versus surgical management of vulvar vestibulitis syndrome are needed.