Vulval pain

Vulvodynia

Vulvodynia is the medical term for chronic pain or discomfort in the vulva that lasts for at least three months. Any pressure applied to your vulva, such as having sex, inserting a tampon, using toilet paper or sitting for prolonged periods of time can be unbearable.

Vulvodynia can affect women of all ages, but it usually affects women from their mid-20s to 60s. It’s estimated about 16% of women will experience vulvodynia in their lifetime.

Types of vulvodynia

There are two main types of vulvodynia:

• Generalised vulvodynia: Pain occurs all over the vulva at different times. It can be constant or happen every now and then.
• Localised vulvodynia: Pain occurs in specific areas of the vulva and often involves a burning or stinging sensation. It can happen in the clitoris (clitorodynia) or the area around your vaginal and urinary openings (vestibulodynia).

Some women may experience a mixed vulvodynia – a combination of generalised and localised vulvodynia.

Vulvodynia pain can be caused by pressure or touch (‘provoked’), or it can happen for no reason (‘unprovoked’).

Symptoms

The most common symptom of vulvodynia is a painful, raw or burning sensation. Some women describe the pain as stinging, tearing, stabbing, throbbing or itching. Most sexually active women will report that sex is painful or impossible.

Causes

We don’t know what causes different types of vulvodynia. Some studies suggest vulvodynia is associated with:

• chronic yeast infections (e.g. thrush)
• injury or tissue damage (e.g. childbirth, laser treatment, surgery, sexual abuse)
• skin conditions (e.g. allergic reactions to soaps and scented toiletry products).

Diagnosis

Vulvodynia is usually diagnosed after ruling out other conditions.

Your doctor will ask about your symptoms and your medical, sexual and surgical history. They will do a pelvic examination to look for infection or other reasons for the pain.

Your doctor might check where the pain is coming from by using a moistened cotton swab to gently apply pressure to different parts of your vulva.

They might also check your pelvic floor muscles to see if they are tight, contracted and painful to touch.

If you have vaginal discharge or urinary symptoms, they may also take samples for testing.

Risks and complications

Vulvodynia can have a big impact on your life. It can stop you from doing everyday activities and reduce your sexual desire. Fear of sex can also cause spasms in and around your pelvic floor muscles (vaginismus).

You might experience:

• anxiety
• depression
• sleep problems
• sexual problems, including painful sex
• relationship issues
• body image issues.

Treatment and management

Treatment of vulvodynia aims to reduce your pain and improve your quality of life.

In about 40% of women, vulvodynia will get better on its own.

Depending on your symptoms, your doctor may recommend different treatment options:

• Pelvic floor physiotherapy – Techniques to relax your pelvic floor muscles and manage symptoms.
• Medicine – Oral prescription medicines, certain antidepressants, medicines for nerve pain, hormone or anaesthetic creams and nerve-block injections (if other treatments haven’t worked).
• Psychology – Counselling can help with relationship, intimacy and self-esteem issues. It may also help with sleep problems.
• Surgery – Removal of some skin and tissue inside the inner lips of the vulva may reduce pain in that area. But this treatment is a little controversial and is usually only performed if other treatments haven’t worked.

It may take some time to find the best treatment for you.

Treatment for vulvodynia may involve different health professionals such as:

• a GP
• a gynaecologist
• a dermatologist
• a pelvic floor physiotherapist
• a psychologist
• a pain specialist
• a sexual health physician
• a sex therapist.

What you can do

It’s important to take extra care of your vulva and vagina when managing this condition. For example, use a soap-free wash, avoid tight-fitting clothes and try not to rub or scratch affected areas.

Learn more about vulval care and treatments for vulval irritation.

When to see your doctor

If you have vulval pain, it’s important to see your doctor and ask them to examine you. Not all cases of vulval pain are due to vulvodynia – your symptoms might be caused by something that is easily treated. If you are diagnosed with vulvodynia, your doctor or specialist will help you to reduce symptoms so you can start feeling better.

There are many issues that can cause sex to hurt for women. This discussion with Jean Hailes GP Dr Amanda Newman from ABC Life Matters focuses on vaginismus and vulvodynia. Listen now

Pudendal neuralgia

Pudendal neuralgia (also known as pudendal nerve entrapment) is a chronic condition that causes vulval pain. The pudendal nerve is one of the main nerves in your pelvis. It carries sensations from your vulva and anus. If your pudendal nerve has been damaged, irritated or compressed, it can cause pain and discomfort.

Symptoms

The most common symptom is pain when sitting, which gets worse the longer you sit.

Some women describe the pain as burning, shooting, aching, itching or like an electric shock. You can feel pain in your clitoris, labia, vagina, urethra, anus, rectum, buttocks, thighs or feet.

You might also:

• have bladder or bowel irritation
• feel the need to go to the toilet often
• find it hard to start weeing
• feel like you have a bladder infection
• feel an urgent need to poo
• feel numbness or ‘pins-and-needles’ in your pelvic area, including your vulva
• feel swelling in your perineum, like a golf ball or tennis ball
• experience pain during sex and find it hard to reach orgasm
• notice the pain is worse after certain types of exercise.

Causes

Pudendal neuralgia may be caused by one or more factors, including:

• repeated minor damage from sitting, cycling, or horse riding for long periods of time
• repetitive heavy lifting and excessive exercise
• straining when trying to poo due to chronic constipation
• nerve, muscle or soft tissue trauma due to childbirth
• surgery (e.g. gynaecological).

It may also be caused by:

• trauma from a fall or broken bone in your pelvis or lower spine
• nerve damage from surgery (e.g. in your pelvic or perineal areas)
• lesions or growths (cancerous or benign) that press on your pudendal nerve
• nerve damage associated with diabetes and other vascular conditions
• overactive pelvic floor muscles that press on your pudendal nerve
• persistent pelvic pain, even if the pain isn’t associated with physical injury.

Diagnosis

Pudendal neuralgia is usually diagnosed via a clinical examination. Your doctor will ask about your medical history, your symptoms and where the pain is located. If they suspect pudendal nerve entrapment, they might do other tests.

For example:

• a vaginal or rectal examination to see if pressure on your pudendal nerve causes pain or other symptoms
• an MRI scan, ultrasound or CT scan of joints, ligaments and muscles of your pelvis to check for physical abnormalities, tumours around the nerve or other problems
• a nerve study to see how nearby nerves respond to mild electrical impulses
• a pudendal nerve block to see if symptoms go away when the nerve is numbed with anaesthetic.

Risks and complications

Pudendal neuralgia can cause ongoing pain and discomfort and interfere with daily activities. It can also lead to:

• high levels of stress
• anxiety
• depression
• sexual problems, including painful sex
• problems related to weeing and pooing.

Treatment and management

Your medical team will help you learn to manage and understand your pain, including what makes the pain better and worse.

Your doctor may recommend the following:

• Pelvic floor physiotherapy – including techniques to relax and stretch your pelvic floor muscles and other muscles that may irritate the nerve. A TENS machine may be used to relieve your pain. Physiotherapy can also help with posture, management of spinal pain and problems related to weeing and pooing.
• Medicines and nerve creams – to help to reduce the sensitivity of your central nervous system.
• Surgery – to remove lesions or growths, or to insert neurostimulation implants that help to relieve pressure on the nerve and reduce the pain.
• Psychology – to help with mental health issues associated with persistent pain.

What you can do

You can avoid activities such as:

• cycling
• horse riding
• prolonged sitting (or try sitting on a ring cushion to relieve any pain)
• straining when weeing or pooing (see your doctor if constipation persists).

When to see your doctor

If you notice pelvic and vulval pain of any kind, it’s important to see your doctor. Early treatment of pudendal nerve entrapment often leads to better outcomes.

Related resources

Download our fact sheets or visit resources for more information, including translated fact sheets.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at April 2023.