If you’re experiencing persistent vulval pain or burning without any obvious cause, and you’ve been told “everything looks normal,” you’re not alone—and you’re definitely not imagining it. What you’re experiencing has a name: vulvodynia.
Vulvodynia is persistent vulval pain lasting three months or longer, when other potential causes of the pain (such as infections, skin conditions, or other medical issues) have been ruled out. It’s estimated to affect up to 16% of women at some point in their lives, yet many suffer for years before receiving a proper diagnosis. The pain is real, the impact on your life is real, and help is available.
What Does Vulvodynia Feel Like?
Vulvodynia can present differently for different women, but common descriptions include:
- Burning, stinging, or rawness
- Throbbing or aching sensation
- Irritation or soreness
- Feeling like the area is swollen (even when it’s not)
- Sharp, stabbing pain with touch or pressure
The pain may be constant or triggered by specific activities like sitting, wearing tight clothing, inserting tampons, exercising, or sexual activity. For some women, even the touch of underwear or toilet paper can be unbearable. This isn’t “just in your head”—it’s a real pain condition that deserves proper treatment.
Types of Vulvodynia
Vulvodynia is often categorised in 2 ways:
1. Generalized vulvodynia: where pain affects the entire vulval area. It may be constant or come and go. Activities like sitting for long periods or wearing certain fabrics can trigger or worsen symptoms.
2. Localized vulvodynia (vestibulodynia): where pain is confined to a specific area, most commonly the vestibule (the entrance to the vagina). This type is often triggered by touch or pressure, making intercourse, tampon use, or pelvic examinations extremely painful.
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What Causes Vulvodynia?
The exact cause of vulvodynia isn’t fully understood, but research suggests it’s a complex condition involving multiple factors:
- Nerve hypersensitivity: The nerves in the vulval area may become overly sensitive, sending pain signals even when there’s no tissue damage
- Pelvic floor muscle dysfunction: Overactive, tight pelvic floor muscles can contribute to compression of nerves and reduced blood flow, perpetuating pain
- Inflammation: Low-level chronic inflammation in the vulval tissues
- Central sensitization: Changes in how the brain and nervous system process pain signals, making the area more sensitive over time
- Previous infections or trauma: Some women develop vulvodynia following recurrent yeast infections, trauma, or childbirth
Understanding that vulvodynia is multifactorial helps explain why a single treatment approach often isn’t enough—and why a comprehensive, whole-person approach works best. It is also why women often experience better results from a multidisciplinary approach. In particular, where your GP, psychologist and pelvic physio are all involved.
How Pelvic Health Physiotherapy Can Help
Pelvic health physiotherapy is a key component of vulvodynia treatment. Here’s how we can help:
Assessment and education: We take time to understand your pain patterns, identify triggers, and help you make sense of what’s happening in your body. Knowledge is powerful when dealing with persistent pain.
Pelvic floor muscle treatment: Many women with vulvodynia have overactive, tight pelvic floor muscles that contribute to pain. Through internal and external manual therapy, we can release muscle tension, improve blood flow, and reduce nerve compression.
Desensitization techniques: Using graduated, gentle touch and pressure, we can help calm oversensitive nerves and gradually reduce your pain response. This is always done at your pace, with your full control.
Pain management strategies: We teach breathing techniques, relaxation strategies, and nervous system regulation tools that help calm your pain system and reduce symptom flare-ups.
Functional rehabilitation: Gradually reintroducing activities that have become painful—whether that’s sitting comfortably, wearing normal clothing, or eventually returning to intimacy—using a trauma-informed, patient-paced approach.
A Trauma-Informed Approach Matters
Living with vulvodynia is HARD. The constant pain, the impact on intimacy and relationships, the frustration of being dismissed by healthcare providers—all of this takes an emotional toll. At Women’s Wellnest, I use a trauma-informed approach that prioritizes your comfort, autonomy, and sense of safety throughout treatment.
You’re always in control. Internal examinations are never required—we can assess and treat effectively using external techniques if that’s what you prefer. Every step is taken with your full consent, at your pace, with ongoing communication about what feels safe and manageable.
You Deserve Support and Relief
Vulvodynia is isolating. Many women feel like they can’t talk about it, can’t explain the impact it has on their daily life, and struggle to be understood even by partners or healthcare providers. But you don’t have to navigate this alone.
Treatment works—but it takes time, patience, and often a multidisciplinary approach involving your GP, a pain specialist, and a pelvic health physiotherapist working together. Progress may be gradual, but with the right support and treatment, most women see significant improvement in their symptoms and quality of life.
If you’re living with vulval pain, please reach out. You deserve to feel comfortable in your own body, to wear what you want, to sit without pain, and to reclaim intimacy if that’s important to you. The pain is real—and so is the possibility of relief.
References:
- Bornstein, J., Goldstein, A. T., Stockdale, C. K., Bergeron, S., Pukall, C., Zolnoun, D., & Coady, D. (2016). 2015 ISSVD, ISSWSH, and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. Journal of Lower Genital Tract Disease, 20(2), 126-130.
- Morin, M., Carroll, M. S., & Bergeron, S. (2017). Systematic review of the effectiveness of physical therapy modalities in women with provoked vestibulodynia. Sexual Medicine Reviews, 5(3), 295-322.
