While not typically associated with any lesions apparent on the vulva, vulvodynia should be considered in the differential for complaints of chronic vulvar itching and/or burning. Generalized vulvodynia generally manifests as chronic, unprovoked vulvar burning in menopausal women but may be provoked. Localized vulvodynia presents with pain restricted to the vestibule, or other focal area, and provoked with pressure or touch to the area but may be unprovoked. While women with vulvodynia localized to the vestibule may have erythema of the vestibular mucosa at times, these disorders are thought to be due to neuropathic pain and therefore are not usually associated with significant physical findings on examination.
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