Vulval pain can feel like burning, stinging, irritation, rawness or sensitivity, and for some people even light touch, clothing or sitting can become uncomfortable.
Vulvodynia describes persistent vulval pain that cannot be explained by another identifiable condition. The pain may affect a particular area, such as around the vaginal opening, or be experienced more generally across the vulva.
Vulval pain is real, and it can have a significant impact on everyday activities, exercise, sexual health and quality of life. Understanding where your pain occurs, what triggers it and whether other conditions may be contributing is an important part of assessment.
Vulvodynia & Vulval Pain: Why Does My Vulva Hurt or Burn?
Vulvodynia doesn't feel the same for everyone.
Symptoms may include:
Burning
Stinging
Rawness or irritation
Aching or throbbing
Increased sensitivity
Pain around the vaginal opening
Pain with touch or pressure
Pain when inserting a tampon
Pain during or after sex
Discomfort wearing tight clothing
Pain when sitting for prolonged periods
Symptoms triggered by exercise or cycling
Pain may be constant, intermittent or only occur when the area is touched.
What Does Vulvodynia Feel Like?
Vulvodynia is a broad term used to describe persistent pain affecting the vulva when another clear cause hasn't been identified.
Vestibulodynia describes pain specifically affecting the vulval vestibule, the tissue surrounding the vaginal opening.
Some people experience pain mainly when this area is touched or pressure is applied, such as during penetrative sex, tampon insertion or a vaginal examination.
These terms can overlap, and appropriate assessment is important because there are many other conditions that can also cause vulval pain.
What Is the Difference Between Vulvodynia and Vestibulodynia?
Burning doesn't always mean there is an infection.
Vulval burning or irritation can have several potential causes, including skin conditions, hormonal changes, nerve sensitivity, pelvic floor dysfunction and vulvodynia.
For some people experiencing persistent pain, investigations for thrush, bacterial vaginosis or other infections repeatedly come back negative.
This doesn't mean that nothing is wrong or that the symptoms aren't real.
Persistent or recurrent vulval symptoms should be medically assessed so that infections, dermatological conditions and other causes can be appropriately considered.
Why Does My Vulva Burn if I Don't Have an Infection?
Some people with vulval pain notice that prolonged sitting or pressure against the vulval area aggravates their symptoms.
However, pain with sitting can also occur with other pelvic pain presentations, including pudendal neuralgia, pelvic floor muscle dysfunction and coccyx-related pain.
Where sitting is a significant trigger, understanding exactly where your symptoms occur and whether you experience other neurological or pelvic symptoms can help guide further assessment.
Why Does My Vulva Hurt When I Sit?
Can a Tight Pelvic Floor Contribute to Vulval Pain?
Pelvic floor muscle overactivity can occur alongside vulval pain for some people.
When the pelvic floor muscles are guarding or have difficulty relaxing, this may contribute to pain around the vaginal opening or discomfort with penetration.
However, the pelvic floor isn't necessarily the original cause of vulvodynia.
Persistent pain can involve interactions between the pelvic floor, vulval tissues, nerves and nervous system. This is why management may need to consider more than the muscles alone.
Why Does Touch or Clothing Hurt My Vulva?
Persistent pain can sometimes result in the nervous system becoming more sensitive to input that wouldn't normally be painful.
As a result, light touch, underwear, tight clothing or pressure may become uncomfortable.
This increased sensitivity is sometimes referred to as allodynia when a normally non-painful stimulus produces pain.
Importantly, increased sensitivity doesn't mean the pain is imagined. It reflects changes in the way the nervous system is processing sensory information.
Can Vulvodynia Cause Painful Sex?
Yes. Vulvodynia, and particularly vestibulodynia, can contribute to pain with penetration.
Pain may occur when penetration first begins, with deeper penetration or after sexual activity.
Over time, anticipating pain can also contribute to protective pelvic floor guarding, which may add another layer to the symptoms.
This means vulval pain, pelvic floor muscle function and painful sex sometimes need to be considered together.
Can Hormones Cause Vulval Pain?
Hormonal changes can influence the vulval and vaginal tissues.
Some people experience changes in dryness, sensitivity, irritation or discomfort during perimenopause and menopause, postpartum or while breastfeeding.
Hormonal factors are only one possible contributor to vulval pain, so persistent symptoms should be appropriately assessed.
Where hormonal changes may be relevant, management may involve discussion with your GP, gynaecologist or other medical practitioner.
No, although the two can occur together.
Vulvodynia describes persistent vulval pain without another identifiable cause adequately explaining the symptoms.
Vaginismus involves involuntary pelvic floor guarding or tightening when vaginal penetration is attempted or anticipated.
Someone experiencing vulval pain may begin guarding their pelvic floor in anticipation of pain, so there can be overlap between the two presentations.
Is Vulvodynia the Same as Vaginismus?
How Is Vulvodynia Diagnosed?
There isn't one single test that diagnoses every case of vulvodynia.
Assessment generally involves understanding your symptoms and medical history and excluding other conditions that could explain the pain.
Depending on your presentation, this may involve assessment by your GP, gynaecologist, dermatologist or other appropriately trained healthcare professionals.
A pelvic health assessment may also examine pelvic floor function and other musculoskeletal factors that could be contributing to your symptoms.
How Is Vulvodynia Managed?
Management depends on your symptoms and contributing factors and may involve several healthcare professionals.
Depending on the individual, care may include:
Vulval care and reducing potential irritants
Pelvic floor rehabilitation
Pelvic floor relaxation and coordination
Pain education
Gradual desensitisation where appropriate
Strategies for comfortable sexual activity
Medical management
Management of hormonal or dermatological factors
Psychological or sex therapy support
Other pain-management strategies
There isn't one treatment that works for every person with vulvodynia, so management should be individualised.
How Can Pelvic Health Care Support Vulval Pain?
Pelvic health care may be useful where pelvic floor or musculoskeletal factors are contributing to vulval pain.
Depending on your presentation and preferences, management may include:
Assessment of pelvic floor function
Pelvic floor relaxation and coordination
Education around pain and sensitivity
Breathing strategies
Gradual desensitisation where appropriate
Movement and exercise advice
Strategies around comfortable penetration
Self-management techniques
Collaboration with your medical and other healthcare providers
An internal pelvic floor examination is not automatically required and should only occur when appropriate and with your informed consent.
When Should I See a Doctor About Vulval Pain?
New or persistent vulval pain should be appropriately assessed, particularly because several medical and dermatological conditions can produce similar symptoms.
Seek medical advice if you notice:
New vulval skin changes
Sores, ulcers or lesions
Unexplained bleeding
Persistent itching
Unusual discharge
Recurrent suspected infections
A new lump or swelling
Significant or worsening pain
Getting an appropriate diagnosis is important before assuming persistent vulval pain is vulvodynia.
Vulvodynia & Pelvic Health Care in Healesville
At Yarra Valley Women's Health, our pelvic health osteopaths provide individualised assessment and management where pelvic floor and musculoskeletal factors may be contributing to vulval pain, painful penetration and associated pelvic health concerns.
Our aim is to help you better understand your symptoms and provide education, knowledge and appropriate management options, while working alongside other healthcare professionals where required.