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Postherpetic Neuralgia After Shingles: An Under-Recognized Cause of Chronic Vulvar Pain

From the Neuropathic Pain Study Group, Departments of Anesthesiology, Neurology, and Neuropathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Address reprint requests to: Anne Louise Oaklander, MD, PhD, Massachusetts General Hospital, 55 Fruit St./Clinics 3, Boston MA 02114. E-mail: aoaklander{at}partners.org.

ABSTRACT

BACKGROUND: Vulvar shingles, an uncommon presentation of a common disease, probably affects 1.5 million American women during their lifetime and leaves about 150,000 with postherpetic neuralgia, a chronic neuropathic pain syndrome. Prompt diagnosis and treatment can minimize pain severity and duration.

CASES: The case of an 88-year-old woman with sacral shingles is described. Complications led to her demise. A 35-year-old with a 6-year history of disabling vulvar pain and many diagnostic procedures was ultimately diagnosed with postherpetic neuralgia.

CONCLUSION: Shingles needs to be included in the differential diagnosis of vulvar rashes because it is a modifiable risk factor for chronic vulvar pain. The possibility of postherpetic neuralgia must be considered in women with unexplained vulvar dysesthesia.