We encountered a case of persistent clitoral aching and itching, a condition that to the best of our knowledge has not been reported before in the medical literature. Briefly, a 32-year-old woman, G2P2, presenting with persistent, discomforting vulvar itch and irritation extending from the clitoris over the right labium minus, was referred to us. The patient reported a history of recurrent vulvovaginal candidiasis, while having an otherwise uneventful medical history and in particular no history of dermatological disease, allergy or atopy. Careful history taking revealed no intimate hygiene practices that could have led to contact dermatitis. In the absence of any visible signs of mucocutaneous disease a biopsy of the right labium minus was taken and sent to the dermatopathology laboratory. The biopsy showed epithelial hyperplasia and a modest lymphohistiocytic infiltrate of the underlying stroma. There was no evidence of any histologically classifiable disorder, and therefore the biopsy was considered to be consistent with discrete, non-specific chronic dermatitis. Repeated fungal cultures did not reveal the presence of Candida. The patient was prescribed an empirical treatment course with betamethasone dipropionate 0.064 % ointment once daily for 14 days. Upon re-assessment, the patient reported that she had not experienced any improvement of her complaints under this regimen. Careful re-assessment revealed that she continued to suffer from discomforting itching and aching in the clitoral area. She described the pain as stinging and tingling. A cotton-tip test of vestibular area was negative for provoked pain. We therefore concluded that patient might suffer from clitorodynia, a less common presentation of localized unprovoked vulvodynia [1], and prescribed the tricyclic antidepressant nortriptyline at increasing doses until a daily dose of 75 mg was reached after 2 weeks. The patient returned after 3 weeks and reported significant improvement of her complaints, but also disturbing side effects including dry mouth, tremor, impaired concentration and extreme dizziness. We recommended the patient to discontinue nortriptyline and to initiate duloxetine. The patient returned 1 month later and reported she had continued the nortriptyline treatment for 7 weeks now. She no longer experienced side effects except for a dry mouth, while having almost complete resolution of the disabling clitoral aching and itching. She was particularly relieved. The patient was recommended to continue the treatment for another 3 months and she remained symptom-free. Clitorodynia has previously been associated with a variety of causes including female genital mutilation, posttraumatic neuroma, neuropathic pain following hysterectomy, pudendal nerve entrapment, epidermoid cyst of the clitoris, preclitoral abscess, vulvar cancer, priapism of the clitoris, pubic hair tourniquet, lichen sclerosus, urethral sphincter dyssenergia, multiple sclerosis, Guillain–Barre syndrome, and indeed also with vaginismus and vulvodynia [2]. It may be acknowledged that itch as a presenting symptom of vulvodynia may be misleading as it primarily reminds of candidiasis or common vulvar cutaneous conditions like lichen Simplex chronicus and lichen sclerosus. In summary, vulvodynia, most commonly known for H. Verstraelen (&) K. Roelens M. Temmerman Department of Obstetrics and Gynaecology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium e-mail: hans.verstraelen@ugent.be