Vulvodynia—when vulvar pain affects everyday life and sex

Vulvodynia means pain in the vulva and is the diagnosis previously known as vulvar vestibulitis. It involves long-lasting pain in the external genital area, most often around the vaginal opening. An estimated 8–16% of people with a vulva experience it at some point, but many cases are likely unrecorded. Some people never seek care or do not receive the correct diagnosis.

It is important to know that vulvodynia is a real and treatable condition—and that you are not alone.

Common symptoms of vulvodynia

The most common symptom is pain during penetrative vaginal sex. Many people also experience pain when inserting a tampon, during a gynaecological examination, after sitting for a long time or when wearing tight clothing.

The pain is often described as stinging, burning, prickling or cutting. Some people feel as though something “blocks the way” when they try to insert something into the vagina, even when they want to and feel mentally relaxed.

Why does vulvodynia develop?

Vulvodynia almost always has several contributing causes. There may be an underlying vulnerability, such as hereditary factors, previous pain conditions, stress or psychological strain. The pain may then be triggered by something specific, such as a yeast infection, an injury during childbirth or a period of high tension in the pelvic-floor muscles.

The pain usually involves two interacting components:

• Hypersensitive nerves in the mucous membrane. Nerve endings in the vulva have become unusually sensitive and send pain signals to the brain in response to touch that would not normally hurt.
• Tense pelvic-floor muscles. Many people have unconsciously tensed their muscles in response to pain. Over time, the muscles may remain in a state of tension that itself causes pain.

Seeking care for vulvar pain—where can you turn?

Many people with vulvodynia hesitate to seek care, often because of previous negative experiences or a feeling that they were not taken seriously. We know, however, that early support can make a major difference.

You can contact a youth clinic, midwifery clinic, primary care centre, sexual-health clinic or gynaecology clinic. In some cases, you may be referred to a specialist vulvar clinic where several professional disciplines work together on treatment.

How is vulvodynia diagnosed?

Before diagnosing vulvodynia, other causes of the pain must be ruled out, such as infections, skin conditions or nerve problems. A gynaecological examination is therefore important.

With vulvodynia, examining the external genital area is usually sufficient at first. An internal vaginal examination is rarely necessary initially and can wait until the pain has decreased. One common procedure is a cotton-swab test, in which gentle pressure is applied to different points around the vaginal opening to map where pain occurs and how intense it is. This helps assess how much of the pain is triggered by hypersensitive nerve endings. The pelvic-floor muscles are also assessed to see whether they are tense or tender and whether they can relax.

Treatment—several approaches working together

Treatment for vulvodynia often combines several approaches:

Understanding and diagnosis. Receiving an explanation for the pain is often an important first step and can itself reduce worry and stress.

Vulvar care. The aim is to strengthen the skin and mucous membrane barrier. Wash with lukewarm water or oil, avoid soap and regularly apply a rich, fragrance-free cream.

Medication. A local anaesthetic ointment or gel may reduce nerve sensitivity. One treatment approach involves applying the local anaesthetic around the vaginal opening four to five times a day for three months. In some cases, oral medication that reduces pain signalling in the central nervous system is also used.

Physiotherapy. Treatment with a physiotherapist who specialises in the pelvic floor is often essential. The focus is on relaxation, breathing, body awareness and gradually normalising muscle tension. Stretching exercises, dilator training, TENS and acupuncture may also be considered.

Psychosexual support. Long-term pain affects not only the body but also mental wellbeing. It can affect self-image, relationships, work or studies and confidence in one’s ability to recover. Conversations with a sexologist, psychologist or counsellor can help with pain, worry and relationships, and with finding new ways to explore desire and closeness—with or without a partner.

Vulvodynia, pregnancy and childbirth

People with vulvodynia have fewer children on average than others, partly because of pain during sex and concerns about pregnancy and childbirth. Another reason may be that some people with vulvodynia avoid intimate relationships entirely.

For someone who wants children but cannot have vaginal intercourse, options include home insemination or assisted reproduction such as IVF.

Most people with vulvodynia have a typical pregnancy, although pain may sometimes increase as tissue becomes more swollen towards the end of pregnancy. The method of delivery is always decided individually, based on symptoms, the possibility of vaginal examinations during labour and the wishes of the person giving birth. Some studies have found an association between a very tense pelvic floor in vulvodynia and a higher risk of major tears. In such cases, it is important to discuss with the maternity-care team whether a planned caesarean birth may be a better option.

Outlook—there is hope

Most people with vulvodynia improve or become symptom-free with appropriate treatment. Treatment can take time, often one or two years. Patience, self-compassion and support from a partner and healthcare professionals are important parts of recovery.