Vulvodynia is a condition involving persistent and recurring pain or discomfort in the vulva, the external area surrounding the vaginal opening. It is generally diagnosed when vulval pain has been present for three months or longer without an identifiable cause.
Vulvodynia can affect people in different ways and may have significant impact on sleep, concentration, emotional wellbeing, body image, and sexual relationships. With individualised support, symptoms can often be managed and sexual comfort and confidence can improve.
Symptoms:
The pain or discomfort associated with vulvodynia can vary from person to person. It may:
– Feel like burning, throbbing, stinging, stabbing, soreness or aching across some or all of the vulva.
– Be constant or intermittent.
– Be triggered by touch, such as during sexual activity, tampon insertion, or wearing tight clothing.
– Be aggravated by pressure, such as sitting for long periods or during exercising.
– Feel worse during or after urination.
Causal factors:
While vulvodynia has no single, clear cause, it is often influenced by a combination of physical and other contributing factors. These may include hormonal changes, such as a drop in oestrogen during menopause, or irritation and increased sensitivity of the nerves in the vulva.
Previous vaginal infections, allergies, or sensitivities to products such as soaps and lubricants may also contribute. Vulvodynia can also be associated with an overactive or tense pelvic floor, where muscles remain contracted or go into spasm, which can make touch and sexual activity uncomfortable.
How Therapy Helps:
Sex therapy begins by understanding how vulvodynia is affecting daily life, relationships, and intimacy. Education can help make sense of the relationship between pain, fear, tension, and anticipation, while providing strategies to manage pain and reduce shame or unhelpful beliefs around the body and sex.
When ready, sex therapy can support the gradual reintroduction of safe, comfortable touch. This may involve exploring which sensations feel pleasurable, neutral, uncomfortable, or painful, as well as becoming more aware of pelvic floor tension. Vulva mapping and relaxation exercises may be used to support this process.
Sensate Focus exercises can also be introduced to gradually build comfort with touch without pressure or a goal of penetration. These exercises encourage curiosity, body awareness, and pleasure, and can begin individually before involving a partner.
Sex therapy may be undertaken individually or with a partner. Couples therapy can also support communication, reduce pressure around sex, and help partners better understand the experience of sexual pain.