OBJECTIVE To determine whether women with vulvodynia differ psychologically from women with other vulvar pathology and whether women with essential vulvodynia differ psychologically from women with vulvodynia in whom a cause has been identified. METHODS Women attending a vulvar clinic were given a package consisting of the Brief Symptom Inventory, the Center for Epidemiologic Studies-Depression Scale, the Barsky Somatosensory Amplification Scale, the Whitely Index for hypochondriasis, and a study questionnaire. A gynecologist and dermatologist then took a careful history and performed a gynecologic examination, colposcopy, biopsies, and laboratory examinations. RESULTS Vulvodynia patients (n = 50) were more symptomatic than women with other vulvar pathology (n = 32) on questions about interference with sexual function (mean difference 1.29, 95% confidence interval [CI] 0.36-2.23, P = .01) and number of doctor visits (mean difference 1.0, 95% CI 0.12-2.12, P = .03). Vulvodynia patients also scored higher than other vulvar patients on the Whitely Index (mean difference 0.45, 95% CI 0.04-0.86, P = .04) and on the Brief Symptom Inventory anxiety subscale (mean difference 0.31, 95% CI 0.09-0.51, P = .05) and somatization subscale (mean difference 0.29, 95% CI 0.10-0.46, P = .04). Women with essential vulvodynia (n = 32) were more anxious (mean difference 0.28, 95% CI 0.02-0.54, P = .02) and more suggestible (mean difference 0.62, 95% CI 0.48-1.72, P = .05) than women with vulvodynia with a physical cause (n = 18). CONCLUSIONS Vulvodynia patients are more psychologically distressed than women with other vulvar pathology, and women with essential vulvodynia are more distressed than vulvodynia patients with an identified physical cause. Optimal management of vulvodynia patients should include attention to anxiety reduction, sexual function, normalization of every-day bodily sensations, reassurance about the absence of serious disease, and coordination of clinical care to ensure the maximum benefit from consultations.