Common causes of vulval and vaginal pain include vulvodynia, pudendal neuralgia, injuries and painful sex.
It’s common for women to experience vulval and vaginal pain at some stage in their lives.
It’s important to take extra care of your vulva and vagina when managing these conditions.
If you have vulval or vaginal pain, it’s important to see your doctor and ask them to examine you.
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 can cause severe pain. For example:
having sex
inserting a tampon
using toilet paper
sitting for prolonged periods of time.
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.
There are 2 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 experience both types of vulvodynia.
Vulvodynia pain can be caused by pressure or touch (provoked), or it can happen for no reason (unprovoked).
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.
We don’t know what causes different types of vulvodynia. Some studies suggest vulvodynia is associated with:
injury or tissue damage (e.g. childbirth, laser treatment, surgery)
skin conditions (e.g. allergic reactions to soaps and scented toiletry products).
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 may also:
check where the pain is coming from by using a moistened cotton swab to gently apply pressure to different parts of your vulva
check your pelvic floor muscles to see if they are tight, contracted and painful to touch
take samples for testing if you have vaginal discharge or urinary symptoms.
Vulvodynia can have a big impact on your life. It can stop you from doing day-to-day activities and reduce your sex drive.
Fear of sex can also cause spasms in and around your pelvic floor muscles (vaginismus).
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 (labia) to reduce pain (if other treatments haven’t worked).
It may take some time to find the best treatment for you.
It’s important to take extra care of your vulva and vagina when managing this condition.
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 can easily be treated.
Your doctor may refer you to other specialists, for example:
a gynaecologist
a dermatologist
a pelvic floor physiotherapist
a psychologist
a pain specialist
a sexual health physician
a sex therapist.
If you are diagnosed with vulvodynia, your doctor or specialist will discuss ways to reduce symptoms so you can start feeling better.
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. The area of skin between your vagina and anus (perineum) 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 (e.g. if your baby’s shoulders are stuck behind your pelvic bone).
Episiotomies are performed by health care 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 health care provider will give you advice about how to manage daily activities, such as going to the toilet, sitting and walking.
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 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.
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)
hair removal, for example, waxing or shaving pubic hair
childbirth.
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 to manage vulval and vaginal tears and splits
If you have sensitive skin that is prone to splits:
use lubrication during sex
try different sexual positions that may be more comfortable
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 about vulval and vaginal tears and splits
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.
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.
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 (where wee comes out)
anus
rectum
buttocks
thighs
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 the area between your vagina and anus (perineum)
experience painful sex and find it hard to reach orgasm
notice the pain is worse after certain types of exercise.
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.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.
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.
Pudendal neuralgia can cause ongoing pain and discomfort and interfere with daily activities. It can also lead to:
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