The current International Society for the Study of Vulvovaginal Disease (ISSVD) definition of vulvodynia is a vulvar pain of at least three months' duration, without a clear, identifiable cause, which may have potential associated factors. It is a diagnosis of exclusion and is an idiopathic pain disorder.
The cause of vulvodynia is not known. Research is being done to learn what contributes to the condition. Possible contributing causes include injury or irritation to the nerves that transmit pain from the vulva to the spinal cord, an increase in the number and sensitivity of nerve fibers in the vulva, elevated levels of inflammatory substances including cytokines in the vulva, abnormal response to environmental factors, genetic susceptibility, and pelvic floor muscle weakness, spasm or instability. 
The annual incidence cited by Reed was 3.1% in 2012. In 2014, the incidence was 4.2 cases per 100 woman-years and differed by age, ethnicity, and marital status. Independent NIH-funded population-based studies by Harlow, 2003; Reed 2004 and 2006; and Arnold, 2007 demonstrated a point prevalence of 3% to 7% in reproductive-aged women. Three of the studies included clinical confirmation components. According to Harlow, 7% of American women will have symptoms consistent with vulvodynia by age 40. Interestingly, only 1.4% of women seeking medical care were correctly diagnosed. 
The anatomy of the vulva and vulvar vestibule is very important to understand vulvodynia.
The vulva and vulvar vestibule: the vulva is the external female genitalia, which includes the mons pubis, labia majora, labia minora, clitoral hood, clitoris, and vestibule. The vulva is innervated by the anterior labial branches of the ilioinguinal nerve, genitofemoral nerve, and branches of the pudendal nerves. The pudendal nerve divides into three branches near the medial aspect of the ischial tuberosity: (1) the dorsal nerve of the clitoris, (2) the perineal nerve which innervates the labia majora and perineum, and (3) the inferior rectal nerve which innervates the perianal area. The pudendal nerve also innervates the external anal sphincter and deep muscles of the urogenital triangle.
The pelvic floor muscles are divided into three categories:
The internal pudendal artery, vein, and nerve pass through the Alcock canal and provide a neurovascular function for the pelvic floor musculature.
Vulvodynia is a vulvar pain of at least three months' duration without a clear, identifiable cause. It may be generalized or localized with respect to location. It may always occur spontaneously or have to be provoked. It could occur throughout a patient's life or just with a new partner (primary or secondary) and/or it can be intermittent, persistent, constant, immediate, or delayed in timing. 
Other diagnoses must be ruled out, such as:
The patient should undergo a thorough gynecologic examination. Once all infectious, inflammatory, hormonal, neoplastic, and neurologic causes are investigated and treated, a visual inspection of the vulva and vulvar vestibule should be performed. 
There are no blood tests necessary. A thorough history and physical with medication and drug allergy review should be performed.
Treatment requires a multidisciplinary treatment approach. It is important to believe that the woman has pain. In many cases, the woman has been struggling for a long time in silence, or she has seen many practitioners, and no one has helped her. Different practitioners may be involved in the care of this patient. When a patient finds the correct practitioners, they may include a gynecologist with a special interest in vulvovaginal disease health usually involved in the societies ISSWSH and ISSVD, a dermatologist, a neurologist, a pain management specialist, a urologist, and/or a physical therapist who specializes in women's health. 
Research on the topic of vulvodynia is ongoing. Twenty-five percent of adult Americans suffer from a chronic pain condition. Patients in pain are often neglected and under-treated. This pain condition is severe and debilitating and can be devastating to the patients suffering from it. The scientific level of evidence for almost all treatment regimens is poor, with very few randomized controlled trials having been performed. Treatment outcomes vary in the studies we have, but the majority of women improve with treatment. Practitioners should be encouraged to take their patients seriously and remember that this condition exists. If the practitioner is uncomfortable treating the condition or does not have the education and experience to treat the condition, they should query the National Vulvodynia Association and find a practitioner who does.
The cause of vulvodynia remains unknown and hence its treatment remains unsatisfactory. Treatment requires an interprofessional treatment approach. It is important to believe that the woman has pain. In many cases, the woman has been struggling for a long time in silence, or she has seen many practitioners and no one has helped her. Different practitioners may be involved in the care of this patient. When a patient finds the correct practitioners they may include a gynecologist with a special interest in vulvovaginal disease health usually involved in the societies International Society for the Study of Women's Sexual Health (ISSWSH) and ISSVD, a dermatologist, nurse practitioner, a neurologist, a pain management specialist, a urologist, and/or a physical therapist who specializes in women's health.  Unfortunately, despite adequate treatment, the pain is recurrent and seriously affects lifestyle and interpersonal relationships.  [Level 5]
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