Vulval and vaginal pain

Vulvodynia

‘Vulvodynia’ is the medical term for chronic pain or discomfort in the vulva that lasts for at least 3 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 cause severe pain.

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. You may experience clitoris pain (clitorodynia) or pain around your vaginal and urinary openings (vestibulodynia).

Some women may experience 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 of vulvodynia

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 who have vulvodynia report that sex is painful or impossible.

What causes vulvodynia?

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

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

How is vulvodynia diagnosed?

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 of vulvodynia

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).

With vulvodynia, you might experience:

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

Treatments for vulvodynia

Treatments for vulvodynia aim to reduce pain and improve 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. For example:

• 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 to help with relationship, intimacy and self-esteem issues
• surgery – removal of some skin and tissue inside the inner lips of the vulva to reduce pain (only performed when 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 discuss ways to reduce symptoms so you can start feeling better.

Painful vaginal sex (dyspareunia)

Many women experience painful vaginal sex. ‘Dyspareunia’ is the medical term used to describe pain before, during or after vaginal sex.

Learn more about painful vaginal sex, including the causes, treatments and when to see your doctor.

What you can do

You can try different things to reduce pain during sex.

For example:

• Change sexual positions or techniques. If you experience pain during thrusting, sit on top of your partner so you can control the depth of penetration. You can also try different or longer foreplay to increase your arousal.
• Use water-based lubricants. Personal lubricants can make sex more comfortable.
• Try a vaginal dilator (a tube-shaped device to stretch your vagina). This may help you to relax your pelvic floor muscles.
• Communicate with your partner. Tell them what you like and don’t like.
• Focus on yourself. Try to switch off any worries, tune in to your body and enjoy the moment.
• Be intimate in different ways. If you have a partner, try kissing, cuddling, massage, mutual masturbation and oral sex. This may enhance your sexual desire.

When to see your doctor

If you are experiencing painful sex, see your doctor. They will find and treat the cause or refer you to a specialist. It’s a good idea to seek help as soon as possible so you can resolve the issue and enjoy a healthy sex life.

Vulval and vaginal tears and splits

Childbirth and episiotomy

Over 85% of women experience some form of tear during a vaginal delivery. The tears can happen in and around your vagina, including your labia. Your perineum (the area of skin between your vagina and anus) can also tear.

Tears caused by childbirth are classified as follows:

• First degree – small tears or grazes in and around your vagina, labia and clitoris.
• Second degree – perineal muscle and skin tears that usually require stitches.
• Third or fourth degree – tears that are deep enough to extend towards the anus and may go through the muscle layers of the anus. These tears happen in about 6% of first-time births. Surgery is needed to repair these injuries.

A procedure called an ‘episiotomy’ may be performed during childbirth to prevent a tear. An episiotomy is a cut made in the perineum to widen the vaginal opening during childbirth. This procedure is only done when:

• a baby needs to be delivered quickly
• forceps or suction are used
• you are at risk of serious injuries to your perineum, for example, if your baby’s shoulders are stuck behind your pelvic bone.

Episiotomies are performed by healthcare professionals, such as doctors or midwives, under local anaesthetic. After birth, the cut is stitched together using dissolvable stitches.

It’s normal to feel pain and discomfort for 2 to 3 weeks after an episiotomy. During this time, you can take over-the-counter painkillers and apply a cold pack (wrapped in a cloth) for 10 to 20 minutes at a time to help ease the pain.

Your healthcare provider will give you advice about how to manage daily activities, such as going to the toilet, sitting and walking.

For more information about episiotomy, visit the Pregnancy Birth and Baby website.

Vulval and vaginal splits

Vulval and vaginal splits (fissures) are injuries in and around the vagina. Splits can range from small cuts or grazes that heal on their own to more serious injuries that need medical attention.

If the splitting is on your vulva, it’s important to look at the area (using a mirror) when you first notice symptoms, so you can check if it improves with treatment.

Symptoms of vulval and vaginal splits

Symptoms of vulval and vaginal splits vary depending on the severity of the injury. They may include:

• itching or burning sensations
• stinging pain when weeing
• discomfort with any type of penetration
• spotting or bleeding.

What causes vulval and vaginal splits?

Vulval and vaginal splits may be caused by:

• sex, for example, rough or strong thrusting into the vagina
• drier, thinner and less elastic vaginal tissue (common after menopause and childbirth)
• skin conditions such as lichen sclerosus, lichen planus, psoriasis and eczema
• scarring or tissue damage after surgery
• hair removal, for example, waxing or shaving pubic hair
• childbirth.

Treatments for vulval and vaginal tears and splits

Minor splitting

Most minor splits heal by themselves, but there are ways to reduce discomfort. For example:

• use over-the-counter painkillers
• soak in a warm bath with salt or bicarb of soda (avoid scented soaps)
• gently wash and pat dry the area once or twice a day
• gently wipe your vulva from front to back after going to the toilet
• avoid having sex until the split has healed
• wear cotton or bamboo underwear and loose-fitting clothes.

Severe splitting

See your doctor if:

• any minor splits don’t heal on their own
• the symptoms get worse
• you have a fever
• you notice a smelly or discoloured discharge.

What you can do

If you have sensitive skin that is prone to splits:

• use lubrication during sex
• try different sexual positions
• be careful with any vaginal penetration, including tampons and sex toys
• take extra care if you wax or shave your pubic hair.

When to see your doctor

Vulval and vaginal splits can become infected if not properly looked after. They can also get worse and develop into larger or deeper splits. If your symptoms don’t get better, see your doctor.

Download our fact sheets or visit resources for more information.

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 of pudendal neuralgia

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 (the area between your vagina and anus)
• experience painful sex and find it hard to reach orgasm
• notice the pain is worse after certain types of exercise.

What causes pudendal neuralgia?

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.

It may also be caused by:

• trauma from a fall or broken bone in your pelvis or lower spine
• nerve damage from surgery, for example, 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 blood vessel conditions
• overactive pelvic floor muscles that press on your pudendal nerve
• persistent pelvic pain, even if the pain isn’t associated with physical injury.

How is pudendal neuralgia diagnosed?

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 of pudendal neuralgia

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.

Treatments for pudendal neuralgia

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 different treatments:

• 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.