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.