When should I refer a patient with vulvodynia to a specialist for further evaluation or management?

Refer a patient with vulvodynia to a specialist for further evaluation or management if:

• They have persistent vulvar pain that is unresponsive to initial conservative treatments such as analgesics, topical therapies, or physiotherapy.
• There is pain provoked by movement or sexual activity that significantly affects quality of life.
• There are associated symptoms such as urinary problems, bowel symptoms, or neurological signs that suggest a more complex pelvic pain syndrome.
• There is suspicion of mesh-related complications if the patient has a history of pelvic mesh surgery, including palpable, exposed, or extruded mesh, or unexplained symptoms after mesh procedures.
• Initial assessment does not identify a clear cause, or symptoms are severe, multifactorial, or atypical, warranting multidisciplinary specialist input.

Specialist referral should be to clinicians experienced in managing complex vulvar pain, such as gynaecologists with expertise in pelvic pain, urogynaecologists, or multidisciplinary pelvic pain teams.