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Women's Health Guide

Vulvodynia & Chronic Pelvic Pain

Real pain that deserves real answers

1 in 6
women experience vulvodynia at some point in their lives
⚠
Medical disclaimer

This page provides general health information. It is not a substitute for personalised medical advice, diagnosis, or treatment. Every person's situation is different. If you have concerns about your health, please speak to your GP or a qualified healthcare professional.

Vulvodynia is chronic pain at the vulva - burning, stinging, rawness, or aching - without an obvious identifiable cause such as infection or skin disease. It affects an estimated 1 in 6 women at some point in their lives, and yet it remains one of the most under-recognised and undertreated conditions in women's health. Many women spend years being told there is nothing wrong, given repeated courses of antifungals that do not work, or made to feel the pain is in their head.

Chronic pelvic pain is a related but broader term - defined as pain in the pelvis lasting more than 6 months, which may or may not include vulval pain, and which may or may not have an identifiable structural cause. Both conditions sit in a space where gynaecology, urology, physiotherapy, pain medicine, and psychology all have a role. That breadth is why care is often fragmented.

These are real, physiological conditions. The pain is not imagined and it is not a reflection of anxiety or relationship problems. The fact that it can be hard to explain on a scan does not make it less real or less treatable.

Symptoms to know

Vulval burning, stinging or rawness
The most commonly reported sensation in vulvodynia. Often described as a constant background burn that worsens with touch, pressure (from clothing, cycling, sitting for long periods), or penetrative sex.
Pain during or after sex (dyspareunia)
One of the most distressing symptoms. Pain may occur at penetration (entry dyspareunia, often associated with vestibulodynia) or on deeper penetration. Many women develop avoidance of sexual activity, which can have significant relational consequences.
Difficulty using tampons or undergoing vaginal examinations
Vestibulodynia (pain specifically at the vaginal entrance) can make tampon use, cervical smears, or any vaginal examination extremely painful. This should always be disclosed to a clinician before examination.
Generalised pelvic aching or pressure
A sense of heaviness, pressure or aching throughout the pelvis, which may radiate to the lower back or inner thighs. May be cyclical (worsening around the period) or constant.
Bladder symptoms
Urgency, frequency, or pain with bladder filling are common co-existing symptoms in women with vulvodynia and chronic pelvic pain. Interstitial cystitis (bladder pain syndrome) frequently co-exists.
Pelvic floor tightness or spasm
Many women with vulvodynia and chronic pelvic pain develop pelvic floor hypertonicity - the muscles become tight and overactive in response to persistent pain. This can itself become a driver of pain, creating a cycle that physiotherapy can break.

What actually helps

Ask for a specialist referral - and know what type of specialist to ask for
Vulvodynia and chronic pelvic pain often fall through the cracks between specialties. NICE guidelines recommends referral to a vulval specialist, which may be a gynaecologist, dermatologist or genito-urinary medicine physician with a specific interest. For chronic pelvic pain, a multidisciplinary pelvic pain clinic is the gold standard. The British Society for the Study of Vulval Disease (BSSVD) can help identify appropriate services.
Pelvic floor physiotherapy is one of the most effective treatments available
A specialist pelvic floor physiotherapist can assess and treat pelvic floor hypertonicity - tight, overactive muscles that contribute significantly to vulvodynia and chronic pelvic pain. This is not the same as standard physiotherapy. It may include internal assessment and treatment, relaxation techniques, and home exercises. NICE guidance on chronic pelvic pain recommends physiotherapy as part of a multidisciplinary approach.
Low-dose topical treatments can reduce nerve hypersensitivity
Low-dose topical anaesthetics (such as lidocaine gel applied before sex) can reduce entry dyspareunia. Topical amitriptyline or gabapentin formulations are also used in specialist centres and can help with nerve hypersensitivity. These are not widely known about but are available on prescription and can make a real difference.
Oral medications targeting nerve pain may help
Vulvodynia involves sensitised nerves - the pain system itself becomes upregulated. Medications used for neuropathic pain, including amitriptyline, nortriptyline, and gabapentin, are used in low doses for vulvodynia. They are not antidepressants in this context - they are nerve pain modulators. They take several weeks to reach effect and require specialist supervision.
Vestibulectomy is an option for localised vestibulodynia in appropriate patients
For women with provoked vestibulodynia (pain specifically at the vaginal entrance) who have not responded to conservative treatment, surgical vestibulectomy - removal of the painful vestibular tissue - has good evidence for significant pain reduction. It should only be considered after conservative measures have been fully explored, and in the hands of an appropriately trained surgeon.
Psychological support is not the same as being told it is all in your head
Pain psychology and cognitive behavioural therapy (CBT) have evidence in chronic pain conditions including vulvodynia. They work by addressing the central sensitisation and psychological impact of living with chronic pain - not by suggesting the pain is imaginary. Pain catastrophising, avoidance behaviours, and relationship impact are all areas where psychological support adds value alongside physical treatments.

Myths worth busting

Myth
“Vulvodynia is caused by thrush”
Vulvodynia has no identifiable infectious cause. It is not thrush. Many women with vulvodynia have had multiple courses of antifungal treatment without benefit before a correct diagnosis is reached. If you have tried multiple courses of antifungals and they have not worked, stop and seek a different diagnosis.
Myth
“The pain is psychological”
Vulvodynia is a real physiological condition involving sensitisation of vulval nerves. Research has identified differences in nerve fibre density, inflammatory markers, and central pain processing in women with vulvodynia. Psychological factors can influence the experience of any chronic pain condition, but they are not the cause. NICE guidelines and the BSSVD are clear on this.
Myth
“You just need to relax”
While pelvic floor hypertonicity is a feature of vulvodynia, telling someone to 'just relax' is not treatment advice - it is a dismissal. Pelvic floor physiotherapy by a specialist is what actually addresses muscle tension, and it is a clinical intervention, not a lifestyle suggestion.
Myth
“Chronic pelvic pain always has an identifiable cause on scan”
Many women with significant chronic pelvic pain have normal ultrasound and MRI findings. The absence of a structural finding does not mean the pain is not real - it may reflect central sensitisation, nerve hypersensitivity, or conditions like interstitial cystitis that are not visible on standard imaging.

Frequently asked questions

What is the difference between vulvodynia and vaginismus?
Vulvodynia is chronic pain at the vulva - burning, stinging, or rawness - that may or may not be triggered by touch. Vaginismus is an involuntary contraction of the pelvic floor muscles that prevents or makes vaginal penetration painful or impossible. The two conditions frequently co-exist and can be difficult to disentangle. Both are real, both are treatable, and both benefit from specialist pelvic floor physiotherapy.
How is vulvodynia diagnosed?
There is no specific test for vulvodynia - it is a clinical diagnosis made by excluding other causes of vulval pain (infection, skin conditions, nerve entrapment, dermatological conditions). A thorough history, examination, and swabs are usually performed. A cotton swab test (pressing gently at different points around the vulval vestibule to map pain) is used to characterise vestibulodynia. Referral to a vulval specialist is recommended if the diagnosis is unclear.
What causes chronic pelvic pain?
Chronic pelvic pain can be caused by or associated with endometriosis, adenomyosis, PMOS (formerly PCOS), pelvic inflammatory disease, interstitial cystitis, irritable bowel syndrome, and pelvic floor dysfunction. In many women, multiple factors contribute. Central sensitisation - where the nervous system itself becomes more reactive to pain signals - is an important mechanism in chronic pelvic pain, regardless of underlying cause.
Can vulvodynia be cured?
Many women with vulvodynia see significant improvement with appropriate treatment, and some achieve complete resolution. Recovery often requires a combination of approaches - physiotherapy, medications, psychological support - rather than a single treatment. It can take time, and setbacks are common. The most important thing is having a specialist team who take the condition seriously and offer a structured management plan.
Is sex possible with vulvodynia?
For many women with vulvodynia, sexual activity is possible with the right support, though it may look different during treatment. Using topical lidocaine before penetration, working with a pelvic physio on muscle relaxation, using lubricants, and exploring non-penetrative intimacy are all part of a management approach. Sex therapy or relationship counselling may also be helpful if the condition has had a significant impact on relationships.
Where can I get help for vulvodynia in the UK?
Ask your GP for referral to a specialist vulval clinic or multidisciplinary pelvic pain service. The British Society for the Study of Vulval Disease (BSSVD) provides a directory of specialists. The Pelvic Pain Support Network and Vulval Pain Society also offer excellent peer support and information for women with these conditions.

Sources & references

All clinical claims on this page are grounded in current evidence and published guidelines. Links open external websites.

  1. NICE CKS: Vulvodynia
  2. NICE CKS: Pelvic pain - chronic
  3. British Society for the Study of Vulval Disease (BSSVD)
  4. Pelvic Pain Support Network
  5. NHS: Vulvodynia

Last reviewed: July 2026. This page will be updated as guidelines change. If you spot an error or an outdated reference, please get in touch.

Dr Hiba Sher Khan
© 2026 Dr Hiba Sher Khan · drhiba.co.uk