Bothersome genital symptoms (pruritus, irritation, dyspareunia, vaginal discharge, malodour, burning) are common problems. The main challenge for clinicians is to correctly diagnose the cause of the symptoms as they are non-specific and often have multiple overlapping aetiologies. The aim of this chapter, written by a multidisciplinary team of vulvovaginal experts (gynaecology, dermatology and infectious disease) is to present a clinical flow chart algorithm that can help the clinician reason through overlapping symptoms to obtain a more accurate diagnoses. Six principles were endorsed: (1) locating the discomfort (vulva, clitoris, vestibule, vagina, cervix, pelvis); (2) considering more than one entity; (3) evaluating each symptom separately (4) using pH and wet mount microscopy; (5) obtaining a follow-up visit after 2–4 weeks; (6) performing a biopsy for dermatological conditions that are resistant to treatment.