Of 105 women referred for vulvar discomfort, 77 had idiopathic vulvodynia (pain, dyspareunia, burning or pruritus not explicable by a standard diagnosis). Physical examination showed that patients with those complaints fell into one of two categories: (1) diffuse, irritative acetowhitening of both the cutaneous and mucosal surfaces (42 patients), and (2) painful vestibular erythema, with or without acetowhitening (35 patients). The physical findings appeared to be predictive of therapeutic response. Among women with only diffuse, irritative acetowhitening, low-dose topical 5 fluorouracil was about 75% effective in milder cases, while CO2 laser photovaporization controlled 77% of cases with moderate and severe symptomatology. In contrast, medical regimens succeeded in just 8% of women with painful vestibular erythema, and only 59% were cured by hymenal resection. Several of the remaining cases have responded to selective argon laser photocoagulation of the hyperemic blood vessels within symptomatic areas.