Management of common vulval conditions

□ Community-based surveys indicate that about a fifth of women have significant vulval symptoms lasting over three months at some time in their lives. □ Common causes of itch or pain are dermatitis, recurrent candidiasis and the recently recognised pain syndromes -vulvar vestibular syndrome and dysaesthetic vulvodynia. □ Diagnosis is usually apparent after a thorough history and examination, although conditions commonly coexist and are complicated by prior treatment. □ Skin lesions not responding to treatment require biopsy. □ Treatment aims to control symptoms rather than to cure; avoiding soaps and other irritants is central to management. □ An early, accurate diagnosis should enhance management of vulval conditions, particularly pain syndromes.