Vulvo-vaginal pain

Other names for vulvovaginal pain

• Vulvodynia
• Vestibulodynia
• Vaginismus
• Painful intercourse

What is vulvovaginal pain?

Do you experience pain during intimate relations, persistent burning, or discomfort from simply wearing underwear? Perhaps you have consulted several professionals without getting clear answers. You are not alone: more than one in five women suffer from pain during sexual intercourse.

Good news: 60 to 70% of women experience significant improvement with pelvic physical therapy. 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 first-line treatment.

Vulvovaginal pain refers to any pain felt in the vulva and vagina. This pain may be constant or occur during specific activities, such as sexual intercourse, inserting a tampon, or even wearing tight clothing.

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

These pains are more common than one might think. Between 8 and 16% of women are affected by 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 teenagers to postmenopausal women. The peak incidence is between the ages of 20 and 29.

What are the different types of vulvovaginal pain?

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

Classification by location

Classification by temporality

Primary pain is when the pain has always been present, from the very first attempts at penetration or tampon insertion.

Secondary pain appears after a period without pain, sometimes after a triggering event such as childbirth, infection, or hormonal change.

Classification by trigger

The pain is triggered by contact: sexual intercourse, tampon insertion, gynecological examination, or even rubbing against clothing.

Spontaneous pain is present without any identifiable trigger.

Related conditions

What are the symptoms of vulvovaginal pain?

Symptoms include a burning sensation, itching, stinging pain, or a tearing sensation. The pain may be constant or occur during contact such as sexual intercourse, tampon insertion, or wearing tight clothing.

Types of sensations experienced

• Burning sensation: the most frequently reported symptom
• Itching: sometimes mistaken for an infection
• Stabbing pain: sensation of being "stabbed"
• Tearing sensation: as if the tissues were tearing
• Persistent warmth or irritation

Frequent triggers

Women often report that their pain appears or worsens during:

• Sexual intercourse (penetration)
• Inserting a tampon or menstrual cup
• Gynecological exam
• Rubbing from underwear or tight clothing
• Prolonged sitting position
• Cycling or horseback riding

Aggravating factors

Certain factors can intensify symptoms:

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

What really 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 is not "all in your head"; it is a real, treatable physical problem.

The myth to be deconstructed

Too many women are told that their pain is "psychological" or "all in their head." That's not true.

Research shows that 90% of women diagnosed with vestibulodynia have measurable pelvic floor tension. It is 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 chronically hypertonic, meaning they are too tense.

Imagine a muscle in your back that is constantly tense, 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, causes inflammation, and makes the tissues hypersensitive to even the slightest touch.

Contributing factors

Several factors may contribute to this tension:

The vicious circle

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?

The diagnosis is based on a detailed questionnaire and physical examination. Your healthcare provider will assess the exact location of the pain, triggering factors, and the condition of your pelvic muscles. Medical tests can rule out other causes such as infections.

What your healthcare provider will evaluate

During the consultation, you will be asked questions about:

• The precise location of your pain
• How long has she been here?
• Factors that trigger or aggravate it
• Your medical and gynecological history
• The impact on your daily and intimate life

The physical examination

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

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

The exam may be interrupted at any time if you wish.

Possible additional tests

Your doctor may order 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 should you see a physical therapist for vulvovaginal pain?

Consult a doctor if you experience persistent vulvar or vaginal pain that affects your intimate relationships or limits your daily activities. You do not need a prescription to see a physical therapist specializing in perineal rehabilitation.

Consult if you have:

• 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 "serious enough"
• Obtain a medical diagnosis beforehand
• See a doctor before consulting a physical therapist.

Good to know

If your condition requires further medical evaluation, your physical therapist will be able to advise you and refer you to the appropriate professional.

How does physical therapy help vulvovaginal pain?

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

The initial assessment

Your perineal rehabilitation physical therapist will first conduct a comprehensive assessment:

• Discussion of your symptoms, concerns, and goals
• Assessment of your posture and breathing
• Pelvic floor examination (always with your consent)
• Identifying the factors that contribute to your pain

The techniques used

Based on the results of the assessment, your physical therapist may use:

What the research shows

The studies are encouraging:

• 60 to 70% of women report a significant improvement.
• 83% of patients did not require additional treatment after physical therapy.
• 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 can you 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 that the pelvic floor relaxes and opens up.
• Exhale slowly, letting everything return naturally.
• Practice for 3 to 5 minutes, 2 to 3 times a day.

Other activities can help: meditation, gentle yoga, walking in nature.

Hygiene tips

• Avoid scented soaps and douching.
• Choose cotton underwear
• Avoid wearing clothes that are too tight.
• Rinse with clean 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

How long does it take for vulvovaginal pain to heal?

Most women see improvement within 8 to 12 weeks of regular treatment. The time varies depending on the duration of symptoms, the underlying cause, and your commitment to home exercises. Gradual improvement is a sign that the treatment is working.

Factors that influence healing time

• How long have you had symptoms?
• The cause(s) involved
• Your consistency in exercising at home
• Your overall stress level

What to expect

Positive signs to watch for

• Less pain during usual triggers
• Greater awareness of your pelvic muscles
• Increased ability to relax this area
• Improving your quality of life

Patience and progress

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

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

You deserve help and support. Don't hesitate to consult a physical therapist specializing in perineal rehabilitation to begin your journey toward wellness.

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.
• MSSS Québec publications. Algorithm for the management of provoked vestibulodynia. https://publications.msss.gouv.qc.ca/msss/fichiers/2021/21-947-01W.pdf
• Therapeutic realities in dermatology and venereology. Vulvodynia. 2017.
• The Practitioner's Review. Vestibulodynia: 1 in 10 women.
• The Practitioner's Review. Epidemiology of chronic pelvic and perineal pain.
• Bergeron S, et al. Physical therapy for vulvar vestibulitis syndrome: A retrospective study. J Sex Marital Ther. 2002.