Vulvovaginal Pain

Other names for vulvovaginal pain

• Vulvodynia
• Vestibulodynia
• Vaginismus
• Dyspareunia

What is vulvovaginal pain?

You experience pain during intimate relations, a persistent burning sensation, or discomfort from the simple contact of your underwear. Perhaps you've consulted several professionals without getting clear answers. You are not alone: more than one in five women suffer from pain during sexual activity.

Good news: 60 to 70% of women significantly improve with pelvic physiotherapy. It's not "all in your head." Your pain is real, and it can be treated.

What research tells us:

• 90% of women with vestibulodynia have measurable pelvic floor tension.
• Chronic pain changes how the brain interprets signals.
• Pelvic physiotherapy is recommended as a first-line treatment

Vulvovaginal pain refers to all pain felt in the vulva and vagina. This pain can be constant or appear during specific contacts, such as sexual intercourse, tampon insertion, or even wearing tight clothing.

The vulva refers to the external part of the female genitals, while the vagina is the internal canal. Pain can affect either or both of these regions.

This type of pain is more common than people think. Between 8% and 16% of women experience some form of chronic vulvar pain during their lifetime. Unfortunately, only 10% to 25% of patients receive the correct diagnosis during their first consultation.

Women of all ages can be affected, from adolescents to menopausal women. The highest frequency occurs between 20 and 29 years old.

What are the different forms of vulvovaginal pain?

The main forms include vulvodynia, vestibulodynia, vaginismus, and dyspareunia. Each woman may experience one or more of these conditions, and the distinctions between them are not always clear.

Classification by Location

Classification by Onset

We refer to primary pain when it has always been present, from the first attempts at penetration or tampon insertion.

Secondary pain appears after a pain-free period, sometimes following a trigger event such as childbirth, an infection, or a hormonal change.

Classification by Trigger

Provoked pain is triggered by contact, such as sexual intercourse, tampon insertion, a gynecological exam, or even clothing friction.

Spontaneous pain is present without an identifiable trigger.

Associated Conditions

What are the symptoms of vulvovaginal pain?

Symptoms include a burning sensation, itching, throbbing pain, or a tearing sensation. The pain can be constant or appear during contacts such as sexual intercourse, tampon insertion, or wearing tight clothing.

Types of Sensations Experienced

• Burning: the most frequently reported symptom
• Itching: sometimes mistaken for an infection
• Throbbing pain: a "stabbing" sensation
• Tearing sensation: as if the tissues are tearing
• Warmth or persistent irritation

Frequent triggers

Women often report that their pain appears or worsens during:

• Sexual intercourse (penetration)
• Tampon or menstrual cup insertion
• Gynecological exam
• Friction from underwear or tight clothing
• Prolonged sitting
• Cycling or horseback riding

Aggravating factors

Certain factors can worsen symptoms:

• Stress and anxiety
• Repeated infections (yeast infections, urinary tract infections)
• Certain soaps or feminine hygiene products
• Fatigue or lack of sleep

What truly causes vulvovaginal pain?

Vulvovaginal pain is often caused by excessive tension in the pelvic floor muscles. This tension can result from stress, trauma, repeated infections, or hormonal changes. It's not "all in your head"; it's a real and treatable physical problem.

Debunking the myth

Too many women are told that their pain is "psychological" or "all in their head." This is false.

Research shows that 90% of women diagnosed with vestibulodynia have measurable pelvic floor tension. It's a physical problem, not an imaginary one.

The real cause: the pelvic floor

The pelvic floor is a group of muscles located at the bottom of the pelvis. These muscles can become hypertonic, meaning chronically too tense.

Imagine a muscle in your back constantly contracted, day after day. Over time, it becomes painful. This is exactly what happens with the pelvic floor muscles.

This excessive tension compresses the nerves in the area, creates inflammation, and makes the tissues hypersensitive to the slightest touch.

Contributing factors

Several factors can contribute to this tension:

The vicious cycle

Pain creates tension. Tension creates more pain. More pain creates more tension.

This vicious cycle explains why pain can persist even after the initial cause has disappeared.

The liberating message

Your pain is real. It has an identifiable physical cause. And most importantly, it can be treated.

How is vulvovaginal pain diagnosed?

Diagnosis involves a detailed questionnaire and a physical examination. Your healthcare professional will assess the exact location of the pain, what triggers it, and the condition of your pelvic muscles. Medical tests may also be performed to rule out other causes, such as infections.

What your healthcare professional will assess

During your appointment, you will be asked questions about:

• The exact location of your pain
• How long you've had the pain
• What triggers or worsens the pain
• Your medical and gynecological history
• The impact on your daily and intimate life

Physical examination

The examination is always performed with your consent and at your own pace. It includes:

• An external assessment of the vulva
• A cotton swab test to pinpoint the exact painful areas
• An assessment of pelvic floor tension

The examination can be stopped at any time if you wish.

Possible additional tests

Your doctor may prescribe tests to rule out other causes:

• Vaginal culture to detect infection
• Tests for sexually transmitted infections
• Sometimes a biopsy if a visible lesion is present

When to seek physiotherapy for vulvovaginal pain?

Consult a physiotherapist if you experience persistent vulvar or vaginal pain that affects your intimate relationships or limits your daily activities. You do not need a medical prescription to see a physiotherapist specializing in pelvic floor rehabilitation.

Consult if you experience:

• Pain during sexual intercourse
• Pain when inserting a tampon
• Persistent vulvar discomfort
• Chronic burning sensation
• Pain that limits your daily activities

What you do NOT need to do:

• Wait until it's "bad enough"
• Get a medical diagnosis beforehand
• See a doctor before consulting a physiotherapist

Good to know

If your condition requires further medical evaluation, your physiotherapist will be able to tell you and refer you to the appropriate professional.

How does physiotherapy help with vulvovaginal pain?

Pelvic physiotherapy helps by releasing muscle tension in the pelvic floor, desensitizing irritated tissues, and teaching you relaxation techniques. Studies show a success rate of 60-70% with this approach.

The initial assessment

Your pelvic floor physiotherapist will first conduct a complete evaluation:

• Discussion of your symptoms, concerns, and goals
• Assessment of your posture and breathing
• Pelvic floor examination (always with your consent)
• Identification of factors contributing to your pain

The Techniques Used

Depending on the evaluation results, your physiotherapist may use:

What the research shows

Studies are encouraging:

• 60 to 70% of women report significant improvement
• 83% of patients did not require additional treatment after physiotherapy
• 42% become completely pain-free

A personalized approach

Each treatment plan is tailored to your specific needs and pace. You are always in control of what happens during the sessions.

What to do at home to relieve vulvovaginal pain?

At home, practice deep abdominal breathing to relax the pelvic floor, avoid irritating products, use lubricant during intercourse, and explore other forms of intimacy if penetration is painful.

Relaxation Techniques

• Breathe in slowly, allowing your belly to expand
• Imagine your pelvic floor relaxing and opening
• Breathe out gently, allowing everything to return naturally
• Practice for 3 to 5 minutes, 2 to 3 times a day

Other activities that can help include: meditation, gentle yoga, and nature walks.

Hygiene Tips

• Avoid scented soaps and vaginal douches
• Choose cotton underwear
• Avoid overly tight clothing
• Rinse with plain water after intercourse

For Intimate Relationships

• Communicate openly with your partner
• Use a water-based lubricant
• Explore other forms of intimacy that do not cause pain
• Go at your own pace, without pressure

Pain management

• Cold or warm compress, depending on your preference
• Warm bath without scented products
• Stress Management Activities

What is the recovery time for vulvovaginal pain?

Most women see improvement within 8 to 12 weeks of regular treatment. The time frame varies depending on how long you've had symptoms, the underlying cause, and your commitment to home exercises. Gradual improvement indicates that the treatment is working.

Factors that Influence Healing Time

• How long you have had symptoms
• The cause(s) involved
• Your consistency with home exercises
• Your general stress level

What to Expect

Positive Signs to Look For

• Reduced pain during typical activities
• Improved awareness of your pelvic muscles
• Increased ability to relax this area
• Improved quality of life

Patience and progress

Healing is not linear. There can be ups and downs along the way. This is normal and part of the process.

Your vulvovaginal pain is real, has identifiable causes, and can be treated. Pelvic physiotherapy offers an effective and respectful approach that has helped many women regain their quality of life.

You deserve help and support. Do not hesitate to consult a pelvic floor physiotherapist to start your journey towards well-being.

Sources

• Pelvi Life. Vulvovaginal Pain. https://pelvilife.com/problematique/douleur/douleurs-vulvo-vaginales/
• PMC. Long-Term Efficacy of Physical Therapy for Localized Provoked Vulvodynia. https://pmc.ncbi.nlm.nih.gov/articles/PMC7882794/
• Reissing ED, et al. Pelvic floor muscle functioning in women with vulvar vestibulitis syndrome. J Psychosom Obstet Gynaecol. 2005.
• Publications MSSS Quebec. Management Algorithm for Provoked Vestibulodynia. https://publications.msss.gouv.qc.ca/msss/fichiers/2021/21-947-01W.pdf
• Therapeutic Realities in Dermato-Venereology. Vulvodynias. 2017.
• La Revue du Praticien. Vestibulodynia: 1 in 10 women.
• La Revue du Praticien. Epidemiology of Chronic Pelvic-Perineal Pain.
• Bergeron S, et al. Physical therapy for vulvar vestibulitis syndrome: A retrospective study. J Sex Marital Ther. 2002.