Vulvodynia is a genital pain syndrome presenting in 7% to 8% of women. Whilst common, most practitioners are not comfortable with the diagnosis and management of these women’s pain, and many believe this is psychologically based. Multifactorial in origin, ubiquitous factors include pelvic floor muscle abnormalities, neuropathic pain, anxiety, and primary or secondary sexual dysfunction. Although there are many published studies on vulvodynia, quality trials that evaluate therapy are lacking. However, experience would suggest that most patients are substantially improved with pelvic floor physical therapy, medication for neuropathic pain, psychological support, and attention to sexual function.