Pelvic & Sexual Health
Vulvodynia: Causes, Symptoms and Treatment for Chronic Vulvar Pain
Vulvodynia is pain in the vulva, the skin and tissue outside the vagina, that lasts at least three months and has no other identifiable cause like an infection or skin disease. It usually feels like burning, stinging or rawness, and it can be constant or only happen with touch. It's real, it's common, and it's treatable, though finding the right mix of treatments can take time.
Many people with vulvodynia spend years hearing "everything looks normal" while their pain is anything but. If you've been told that, here's the key thing: a normal-looking exam doesn't mean the pain isn't real. With vulvodynia, a normal-looking vulva is actually part of the diagnosis.
What it feels like
- Burning, stinging, itching, throbbing, or a raw feeling, like a paper cut or sunburn on the vulva
- Pain with sex, inserting a tampon, or a pelvic exam
- Pain from sitting a long time, cycling, or wearing tight jeans or leggings
- Pain in one spot or spread across the vulva
- Pain that's constant, comes and goes, or only happens with touch
The vulva usually looks normal, though some people have mild redness.
The types
Experts classify vulvodynia by where the pain is and what sets it off.
| Type | Where | When it hurts |
|---|---|---|
| Localized provoked vestibulodynia | The vestibule, the area just around the vaginal opening | With touch or pressure, like sex or tampons. This is the most common type. |
| Generalized vulvodynia | Spread across the vulva | Often constant or spontaneous, with or without touch |
| Mixed | Either area | Both provoked and spontaneous pain |
| Clitorodynia | The clitoris | Varies |
Why it happens
There's no single known cause. Several factors are thought to be involved, often together:
- Nerve changes: nerves in the vulva get oversensitive and send pain signals in response to light touch
- Pelvic floor muscle tension: tight, tender muscles under the vulva
- Inflammation in the vestibule
- Hormonal factors, like low estrogen from menopause, breastfeeding, or some hormonal birth control in certain people
- A history of repeated yeast infections or irritating treatments
- Genetic factors that affect pain sensitivity
- Other pain conditions, like interstitial cystitis, irritable bowel syndrome or fibromyalgia
It's not caused by poor hygiene, it's not an STI, and it isn't contagious.
"I keep getting treated for yeast." Here's why.
Many people with vulvodynia are treated for yeast infections over and over before anyone looks further. How they usually differ:
| Vulvodynia | Yeast infection | |
|---|---|---|
| Main feeling | Burning, rawness, stinging | Itching, burning |
| Discharge | Usually normal | Often thick and white |
| Lab tests | Negative for infection | Yeast found on testing |
| Response to antifungals | No lasting improvement | Usually improves |
| How long it lasts | Three months or more | Days to a couple of weeks |
If you've used several antifungals with no lasting relief, ask for testing to confirm what's going on. Repeated treatments can irritate the skin and make the pain worse.
The exam: what to expect
Vulvodynia is diagnosed after other causes are ruled out. ACOG recommends the evaluation include:
- A detailed history of your pain, sexual history, past infections and treatments. Expect questions like "Does it hurt with tampons? With your partner's fingers? When you sit?"
- A careful look at the vulvar skin for lichen sclerosus, eczema or dermatitis
- Tests for yeast and other infections, often with a culture
- A cotton swab test: the clinician gently touches different spots around the vulva and vestibule with a moistened cotton swab and asks you to rate the pain at each, often on a 0 to 10 scale. It's quick, and it maps exactly where it hurts.
- A pelvic floor muscle exam for tightness or tenderness
You can ask for a smaller speculum, or to skip it entirely if it isn't needed that day. A clinician who knows vulvar pain will go slowly and stop when you ask.
Treatment: usually a combination
It often takes weeks to months to find what works, and most people use more than one approach.
Daily vulvar care
- Wear cotton underwear, and skip underwear at night if that's comfortable
- Avoid soaps, wipes, douches, scented pads and bubble baths
- Rinse the vulva with plain water and pat dry
- Use a fragrance-free barrier like plain petroleum jelly if your clinician suggests it
- Use plenty of lubricant during sex, without warming agents or fragrance
Medicines
Your clinician may suggest:
- Topical anesthetics like lidocaine before sex
- Topical hormone creams in some cases
- Oral nerve-pain medicines, such as certain antidepressants or anticonvulsants used at low doses for pain
Your clinician will pick the option and dose. Don't start or stop these on your own.
Pelvic floor physical therapy
Because many people with vulvodynia have tight pelvic floor muscles, pelvic floor physical therapy is a core part of treatment: relaxation training, manual therapy, biofeedback and dilators.
Therapy for the pain itself
Cognitive behavioral therapy and sex therapy have good evidence for reducing pain and improving sexual function. That's not because the pain is imagined. Chronic pain changes how the nervous system processes signals, and these therapies help retrain it.
Surgery, for some
For localized provoked vestibulodynia that hasn't improved with other treatment, a surgery called vestibulectomy removes the painful tissue at the vaginal opening. It can work very well for carefully selected patients, but it's usually considered only after other options have been tried.
Sex, partners and the rest of life
Pain with sex can strain a relationship and how you feel about yourself. It helps to talk openly with your partner, focus on non-penetrative intimacy while you heal, and consider couples sex therapy. If fear of pain is making your muscles clench, you may also have features of vaginismus, which is treated in similar ways.
Keep a pain diary
A simple note on your phone works. Each day or each flare, jot down:
- Pain level, 0 to 10
- What triggered it (sex, a long subway ride sitting, a spin class, a new soap)
- What helped
- Where you are in your cycle
Improvement is often gradual, so week-to-week notes show progress you'd otherwise miss, and they give your clinician something concrete to work with.
Questions to bring
- Have infections and skin conditions been ruled out with testing?
- Which type of vulvodynia do I have?
- Which treatments should I try first, and for how long before we reassess?
- Would pelvic floor physical therapy help me?
- Can you recommend a therapist experienced in chronic pain or sexual health?
- What should I stop using that might be irritating my skin?
When to see a doctor
See a gynecologist if vulvar burning or pain lasts more than a few weeks, keeps coming back after "yeast infection" treatments, or makes sex, tampons or sitting painful. Go sooner for:
- Sores, blisters, white patches or skin changes on the vulva
- Unusual discharge, odor or fever
- Bleeding after sex or after menopause
Some gynecologists and nurse practitioners focus on vulvar pain, and it's worth asking when you call: "Does anyone in the practice see a lot of vulvar pain patients?" Browse gynecologists in New York by borough and county, or search the directory.
Frequently asked questions
What does vulvodynia feel like?
Most people describe burning, stinging, rawness, or a feeling like a cut or irritation on the vulva. It may be constant or only triggered by touch, such as sex, tampons or tight clothing.
Is vulvodynia an STI?
No. Vulvodynia isn't an infection and can't be passed to a partner. It's a chronic pain condition diagnosed after infections and skin conditions have been ruled out.
Does vulvodynia go away?
For some people it improves or resolves over time, especially with treatment. Many others find their pain becomes much more manageable with the right combination of therapies.
Sources
- ACOG — Persistent Vulvar Pain (Committee Opinion 673)
- ISSVD/ISSWSH/IPPS — Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia
- NICHD — Vulvodynia
- ACOG — Vulvodynia (patient FAQ)
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.