What investigations should be considered for a patient with chronic vulval pain before initiating treatment?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 22 August 2025Updated: 22 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Before initiating treatment for a patient with chronic vulval pain, a thorough assessment including targeted investigations should be considered to identify underlying causes and exclude secondary pain sources. This includes:

  • Clinical history and focused examination to identify symptoms such as vaginal discharge, bleeding, painful intercourse, urinary or bowel symptoms, and neurological signs that may indicate specific causes or mesh-related complications if relevant ,.
  • Vaginal and vulval examination to assess for atrophy, mesh exposure, or other local pathology ,.
  • Urine analysis and culture to exclude urinary tract infection .
  • Neurological assessment if pain distribution suggests nerve involvement or sensory changes .
  • Pelvic floor and rectal examination if indicated by symptoms, to exclude prolapse, fistula, or bowel involvement ,.
  • Imaging investigations such as MRI or ultrasound may be considered if mesh-related complications or deep tissue pathology are suspected, to map anatomy and guide management .
  • Other investigations to exclude systemic causes such as diabetes, inflammatory conditions, or malignancy based on clinical suspicion .

These investigations help differentiate chronic primary vulval pain from secondary causes and guide appropriate management ,,.

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