Vulvodynia & Vaginismus: What's the difference?
Dr. Maria Castellas

Dr. Maria Castellas

Mar 11Vaginismus

Vulvodynia & Vaginismus: What's the difference?

What is Vulvodynia?

Vulvodynia is characterised by persistent and unexplained pain in the vulva, another word for the area made up of a person’s external female genitalia. The pain could be localised (just around a single point in the vulva) or generalised (in different locations in the vulva). Vulvodynia is a neurologic condition, where there is an increased sensitivity in the vulvar tissue.

Studies suggest that Provoked Vulvodynia (caused by direct touch of any kind) seems to be the most common cause of pain with sex in women of reproductive age between 20 to 40 years of age.


What are some symptoms of Vulvodynia

Burning and aching pain

Pain could be present in the entire vulva and may even radiate to the thighs, buttocks, and into the abdomen. The pain could be present all of the time and might interfere with daily activities such as wearing clothing, walking, sitting for long periods, and while sleeping. Women who report burning with urination are at increased risk of developing vulvodynia.

Itching and Irritation

The skin at the vulva gets sensitive and irritated due to friction and exposure to things like perfumes, dyes, clothing, or harsh soaps. People experiencing vulvodynia have nerves in the vulva which are very sensitive, and this could lead to itching, burning and/or tingling when exposed to various irritants. Infections in the urinary tract or yeast infections can cause itching, burning, and irritation in the vulva as well, and this sensation can stay on even after the infection has been treated.

Stinging and stabbing

The nerves in the vulva have a tendency to get irritated and sensitive, which leads to an increase in the sensory nerves that eventually cause too much pain. Direct injury to the vulva from childbirth and indirect injury from the back, hip, and pelvic floor muscles could cause a stabbing or stinging type of pain in the vulva.

Rawness and Tenderness

With chronic irritation or itching, a sense of feeling raw or tender at the area can occur. In turn, this can create a burning sensation or the feeling of increased heat around the area. People with vulvodynia who experience these symptoms will report feeling better once they remove any clothes around the area or sit under a fan. Increased sweating with exercise or hot weather might exacerbate this pain.  


What could cause Vulvodynia?

Vulvodynia is a condition in which the cause is still unknown. One thing we do know is that  there are multiple contributing factors which could cause vulvodynia. Chronic vulvar pain can occur without any cause and it’s often linked to women who are experiencing frustration, anxiety, chronic stress, and depression.

One theory is that some women can have an increase in the number of nerve endings in the vulva which could make the area hypersensitive. Pain is then triggered or worsened by touch, pressure, friction (during penetration), sitting for long periods, or wearing tight clothing.

Stress and anxiety are other factors that contribute to the pain in vulvodynia. Chronic stress and anxiety or history of having anxiety and depression can cause a fourfold increased chance of developing vulvodynia in women. 

Hormonal changes that occur during a person’s menstrual cycle, pregnancy, postpartum or during menopause can affect the tissue around the vulva. Fluctuating estrogen levels may affect vaginal lubrication, tissue elasticity, and the vulvar skin that contribute to pain and discomfort.

Vulvodynia can also be caused by infections (such as urinary tract, yeast, or sexually transmitted), inflammatory disorders (such as lichen sclerosus), and neurological conditions like nerve compression or chronic pain.


Difference between vulvodynia and vaginismus

Vaginismus is a psychological condition with physical symptoms. It’s characterised by involuntary muscle spasms in the pelvic floor muscles, specifically the muscles surrounding the vagina. These spasms can make vaginal penetration painful or near impossible, impacting sexual intercourse, inserting a tampon or menstrual cup, or even going through a gynaecological exam. It's often linked to psychological factors like fear or anxiety related to sex or penetration and even traumatic experiences. When we say psychological, we mean that your pelvic muscles are working to protect you from what they think might be  dangerous. 

If a person has previously encountered pain with insertion, has had a strict cultural background around sexuality, or has had a sexual traumatic experience, it’s common for them to anticipate pain or have anxiety around penetration. They expereince a protective reflexive response, causing the muscle to tense and spasm. 

Vulvodynia is a chronic (>3 months duration), persistent pain in the vulva or external female genitelia. The pain is often unexplained or could be caused by various factors. The most common symptoms are: burning, itchiness, soreness, and rawness. The pain could be intermittent or constant and worsened by touch, pressure, friction, sitting for long periods of time, or wearing tight clothing. 


Considered a psychological condition Considered a condition affecting the nerves with a psychological component
Generally caused due to fear and anxiety around penetration No specific cause
People report feeling a “block or wall”, making penetration impossiblePeople report burning and pain around the outer vulva, however penetration is often possible 


Treatment for Vulvodynia and Vaginismus

Although vaginismus and vulvodynia are different, treatment for both conditions are very similar. 

Here are some key components of treatment for both:

Pelvic floor assessment and treatment: Visiting a pelvic health physiotherapist involves assessing the pelvic floor and surrounding muscles for sensation, strength, muscle coordination, and if there are areas of tension which might contribute to the pain and burning. Tension points in the pelvic floor muscles can happen just like in other muscles in the body. They’re released through breathing exercises, gentle massage, and strengthening other areas of the body to offload the pelvic floor muscles.

Relaxation techniques: Various breathing techniques can reduce muscle tension and relax the pelvic floor and surrounding muscles. It’s important that you’re guided by an expert and practise this regularly.

Lifestyle modifications: Sitting for long periods of time and certain postures can decrease the amount of blood flow and oxygen to your pelvic floor muscles, which can then lead to pain. Increasing physical activity throughout your day and maintaining an active lifestyle can help decrease pain around the vulva. 


Mental Health Therapy:  Counsellors help with managing anxiety and depression that is present with vulvodynia and vaginismus.


Vulvodynia and Vaginismus are two different conditions, with similar treatment methods. Both multifactorial causes require a multi-disciplinary approach to treatment. If you feel you have vulvodynia or vaginismus, consult our experts at Proactive for Her for a screening. We offer an evidence based, non-judgementalm and collaborative treatment approach, which involves multidisciplinary care. We offer pelvic health physiotherapy both in person and online. At Proactive for Her we also have a leading an Online Vaginismus Healing Program that encompasses all the aspects of a multicentric treatment approach. Over > 250 women have been healed through the Online Vaginismus Healing Program.