Vulvodynia: Chronic Vulvar Pain Causes, Symptoms, and Treatment

For countless women, vulvar pain is a hidden struggle. It may appear as a constant burning, a sharp sting when inserting a tampon, or pain so intense that sitting, cycling, or intimacy becomes impossible. Sadly, many women go years without answers—misdiagnosed with infections, told “nothing is wrong,” or dismissed as imagining symptoms. Yet, vulvodynia treatment is real, effective, and accessible through specialized care. At Femina Physical Therapy, we understand that chronic vulvar pain isn’t “all in your head.” It has musculoskeletal, neurological, and physiological roots that can be addressed through a targeted, compassionate plan. Our team specializes in vulvodynia physical therapy and pelvic pain therapy, helping patients retrain their bodies, release guarded muscles, desensitize sensitive tissues, and reclaim daily life. This page will explain what vulvodynia is, its types, causes, symptoms, and treatment strategies. We’ll also cover how vulvar pain physical therapy at Femina offers non-surgical, hormone-free, and personalized care to reduce pain and restore comfort.

What Is Vulvodynia?

Vulvodynia is a chronic pain condition of the vulva, the external female genital area, lasting at least three months without an identifiable medical cause such as infection, trauma, or dermatological disease. The hallmark of vulvodynia is pain without visible abnormalities. Unlike yeast infections or dermatitis, the skin may appear normal, but the pain feels very real—burning, raw, stinging, stabbing, or itching. Because vulvodynia is a diagnosis of exclusion, it requires ruling out infections, skin disorders, and other pelvic conditions. Many patients see multiple providers before receiving the correct diagnosis. At Femina, we emphasize comprehensive evaluation and whole-body understanding before recommending vulvodynia physiotherapy.

Types of Vulvodynia

Vulvodynia is not a single uniform condition—it has subtypes, and understanding which type you have can guide more precise therapy. Common types include:

1. Generalized Vulvodynia: Pain affecting much or all of the vulvar region. It may be constant or intermittent, and not always tied to touch or provocation.
   
2. Provoked Vulvodynia / Vestibulodynia: Pain triggered specifically by touch or pressure in the vestibule—the entrance to the vagina. This is sometimes called vestibulodynia. 
   
3. Localized Vulvodynia: Pain restricted to a defined area (e.g. clitoral region, labia minora)
   
4. Unprovoked Vulvodynia: Pain occurring with no external stimulus—constant burning or rawness
   
5. Mixed Type: In some women, symptoms include both provoked and unprovoked elements
   
6. Secondary Vulvodynia: When chronic vulvar pain develops after a previous insult (e.g., recurrent infections, hormonal changes, surgery)
   

Causes of Vulvodynia

The precise cause(s) of vulvodynia often remain unclear and may vary among individuals. However, research and clinical experience point to multiple overlapping factors:

1. Pelvic floor muscle dysfunction/hypertonicity
   Many women with vulvodynia have pelvic floor muscles that hold excessive tension or have difficulty relaxing. Trigger points, shortened muscles, and guarded posture may perpetuate pain. Femina’s website emphasizes that in many pelvic pain syndromes (including vulvodynia), pelvic floor overactivity is a common driver.
   
2. Nerve hypersensitivity / neural proliferation
   Increased nerve fiber density and heightened nerve responsiveness in vestibular tissues can amplify pain signals. In provoked vulvodynia, even minimal stimuli can be perceived as painful.
   
3. Inflammation or microtrauma
   Chronic or repeated low-grade irritation (e.g., friction, infections, or hormonal thinning of tissues) may trigger inflammatory changes and sensitize local tissues.
   
4. Hormonal/mucosal tissue changes
   Low estrogen (especially post-menopause or after hormonal contraceptive use), thinning of vulvar tissues, or changes in local blood flow may reduce tissue tolerance and resilience.
   
5. Psychological/central sensitization factors
   Stress, anxiety, pain catastrophizing, and central nervous system sensitization can amplify or maintain pain once triggered.
   
6. Pelvic anatomical or postural factors
   Imbalances in alignment, connective tissue tightness, or compensatory muscle patterns elsewhere in the pelvis or lower back may contribute to vulvar stress.
   

Symptoms of Vulvodynia

Symptoms vary widely in intensity and pattern, depending on subtype and contributing factors. Common signs and experiences include:

1. Burning, stinging, rawness, or sharp pain in the vulvar area or vestibule: This discomfort can feel constant or intermittent, sometimes described as “razor blade” or “sandpaper-like.” It often interferes with daily activities and significantly impacts the quality of life
   
2. Pain triggered by touch, pressure, or friction (e.g., tampon use, speculum exam, sexual intercourse) — typical of vestibulodynia treatment cases: Provoked pain is one of the hallmarks of localized vulvodynia and can occur even with light contact. This makes routine gynecological exams, tampon insertion, or intimacy very challenging.
   
3. Pain during or after intercourse (dyspareunia): Sexual activity may cause burning, tearing, or aching sensations that linger long after intimacy. This often leads to avoidance, relationship strain, and fear of worsening pain
   
4. Discomfort when sitting or wearing tight clothing: Prolonged sitting—such as during work, driving, or cycling—can aggravate vulvar pain. Tight pants or undergarments may also cause increased irritation due to pressure on sensitive tissues.
   
5. Itching or irritation that resists typical dermatologic treatments: Unlike skin-based conditions, vulvodynia pain does not usually improve with creams or antifungal medication. This can lead to frustration and delays in finding effective pelvic floor–based care.
   
6. Tension, tightness, or cramping of pelvic floor muscles: Overactive or guarded muscles often contribute to persistent vulvar pain. This dysfunction can create a cycle where muscle tension worsens pain, and pain further increases tension.
   
7. Tenderness on palpation in pelvic floor muscles or vestibular tissues: During physical therapy or medical exams, gentle touch may reveal hypersensitive trigger points. These areas often reproduce the burning or sharp pain that patients report daily.
   
8. Functional limitation (avoiding intimacy, cycling, prolonged sitting): Daily routines may be significantly restricted by discomfort. Many women report changes in exercise, clothing choices, and even social or professional activities due to pain.
   
9. Fluctuating pain—sometimes better, sometimes worse, possibly influenced by hormonal cycles, stress, or other conditions: Symptoms may flare around menstrual cycles, stressful periods, or alongside coexisting conditions like endometriosis or interstitial cystitis. Understanding these patterns helps guide individualized treatment.
   

How Pelvic Floor Physical Therapy Can Help 

Vulvodynia can feel isolating, but it is not untreatable. At Femina Physical Therapy, we recognize that this condition is often driven by a combination of muscular, neurological, and emotional factors—not just surface-level irritation. Through compassionate, one-on-one pelvic floor therapy, we help patients address the root causes of pain, restore comfort, and regain confidence in their daily lives.

Here are ways pelvic floor physical therapy helps treat vulvodynia at Femina, based on their approach and published content:

1. Manual release & soft-tissue work—Therapists use gentle internal and external hands-on techniques to reduce tightness, trigger points, and fascial restrictions in pelvic floor muscles associated with vulvar pain. These releases help interrupt vicious cycles of guarding and pain.
   
2. Muscle relaxation and lengthening—Instead of focusing only on strengthening, therapy emphasizes relaxation, stretching, and muscle lengthening to counteract high resting tone in pelvic floor musculature. This helps restore normal resting length and reduce hypersensitivity.  
   
3. Neuromuscular re-education & coordination—Patients learn to “turn off” overactive muscles and retrain proper recruitment patterns, improving control over pelvic floor contraction and release during daily functions. This retraining reduces involuntary guarding that contributes to vulvodynia. 
   
4. Biofeedback and awareness training—When indicated, biofeedback tools help patients sense and modulate pelvic floor activation levels, improving their ability to relax the area and reduce pain responses. This enhances feedback loops between the nervous system and musculature.
   
5. Behavioral education & self‐management tools—Femina therapists teach vulvar hygiene, lifestyle modifications, use of dilators (where appropriate), and strategies for avoiding triggers (e.g., friction, irritants). This empowers patients to manage symptoms outside the clinic.  
   
6. Addressing central & overlapping sensitization — Because vulvodynia often exists in conjunction with other pelvic pain conditions and central sensitization, therapy also works on desensitizing nerve pathways and reducing pain amplification. By treating musculoskeletal and neural contributors, symptom severity can be reduced.
   
7. Integration with holistic methods & mental health support — Recognizing vulvodynia is multifactorial, Femina integrates physical therapy with psychological support (e.g., mindfulness, CBT) to manage fear, anxiety, and stress as part of the pain experience. This biopsychosocial approach supports comprehensive healing.

Treatment Options for Vulvodynia at Femina Physical Therapy

At Femina Physical Therapy, treatment is always one-on-one with licensed physical therapists for extended sessions (55–120 minutes)—no unlicensed staff, no rushed protocols. Our model ensures each client receives personalized attention, tailored progression, and consistent follow-through.

Here are at least six (and up to nine) vulvodynia treatment modalities we routinely use:

1. Manual Internal & External Pelvic Floor Release
   Gentle, precise manual techniques (via vaginal or external approach) target tight muscle fibers, trigger points, and fascial restrictions to ease tension.
   
2. Myofascial / Fascial Release Therapy
   Mobilizing connective tissues around the pelvis, hips, and adjacent regions reduces pull, stiffness, and referred stress to vulvar areas.
   
3. Neuromuscular Retraining & Relaxation Exercises
   Teaching how to release overactive muscles, inhibit guarding patterns, and coordinate relaxation with daily tasks.
   
4. Biofeedback & EMG-Assisted Feedback
   Using real-time feedback to help you become aware of pelvic floor activation and to learn voluntary downregulation or control.
   
5. Desensitization / Graded Exposure with Dilators or Stimuli
   Gradual reintroduction of light touch (e.g., cotton swabs, small dilators) to retrain sensitivity thresholds, especially for vestibulodynia treatment.
   
6. Vulvar Tissue Mobilization & Soft Tissue Stretching
   Gentle stretching or mobilization of vulvar skin, labial junctions, and vestibular rims to improve pliability and reduce hypersensitivity.
   
7. Breathing, Posture, and Core Integration
   Optimizing respiration, alignment, and core support reduces compensatory pelvic floor tension that can exacerbate vulvar pain.
   
8. Pain Education, Cognitive Strategies, and Stress Management
   Teaching pain neuroscience, pacing methods, mindfulness, or cognitive behavioral techniques to reduce central amplification of vulvar discomfort.
   
9. Self-care Programs & Home Exercises
   A tailored home program including gentle stretches, relaxation practices, trigger point self-release, vulvar care, and graded exposure exercises ensures you remain active in your recovery.
   

Each plan is individualized—because no two women experience vulvodynia the same way.

Frequently Asked Questions (FAQs)

1. What distinguishes vulvodynia treatment from standard gynecologic care?
– Vulvodynia therapy focuses on neuromuscular, myofascial, and pelvic floor dysfunction as pain drivers—rather than just prescribing medications or topical creams. Vulvodynia physical therapy and vulvar pain treatment aim to restore function and reduce sensitivity over time rather than just mask symptoms.

2. Is vestibulodynia treatment different from general vulvodynia therapy?
– Yes—vestibulodynia refers to pain localized in the vestibule (entrance). Desensitization methods, precise mapping, and gentle exposure are more emphasized. But much of the same pelvic floor, manual, and neuromuscular approaches apply.

3. What is the timeline for improvement?
– Many patients notice modest relief within weeks; more significant gains often appear over months of consistent therapy, home practice, and desensitization.

4. Can physical therapy cure vulvodynia completely?
– While “cure” is not guaranteed, many patients achieve long-term remission or significant symptom reduction through vulvodynia physiotherapy. The condition is chronic in nature, but proper therapy often offers powerful functional gains and reduced flare-ups.

5. Are exercises or “Kegels” safe?
– In many vulvodynia cases, traditional pelvic floor contractions (Kegels) are contraindicated initially, as the muscles are often already hypertonic. Early therapy emphasizes relaxation and down-regulation, not contraction. Femina specifically cautions against adding strength training to already shortened muscles.  

6. Does vulvodynia come and go with hormonal cycles or menopause?
– Yes—many patients report fluctuations tied to hormonal shifts (e.g., menstrual cycle, perimenopause). Tissue sensitivity may increase when estrogen is low, but therapy still helps during all phases.

7. Is surgery (vestibuloplasty) necessary?
– Surgery is typically considered a last resort after conservative measures (like vulvar pain physical therapy) have failed. In select, severe cases, a vestibuloplasty may be discussed in consultation with gynecology, but many avoid or delay surgery by engaging in skilled therapy.