Understanding persistent vulval pain
The vulva is the external genital area around the opening of the vagina, including the inner and outer lips (labia) and clitoris. Persistent vulval pain means pain that continues or keeps coming back.
Why do I have these symptoms?
Persistent vulval pain or difficulty with vaginal penetration can be worrying, especially if initial STI tests and thrush swabs keep coming back negative. Negative test results do not mean that your symptoms aren’t real. There are several possible causes that will not show up on an STI or thrush test. These can include skin conditions, irritation or inflammation, hormonal changes and other conditions affecting the vulva.
When we assess you, we may also ask about symptoms elsewhere on your skin or body, including bowel symptoms, swelling, sores, or recurrent painful lumps or boils.
If other causes have been ruled out and the pain has lasted for three months or longer, one possible diagnosis is vulvodynia. If you are having difficulty with vaginal penetration, then a possible diagnosis is vaginismus.
Vulvodynia
What is vulvodynia?
Vulvodynia is persistent vulval pain that has lasted for at least three months when tests and assessment have not found another condition that explains the pain.
What causes vulvodynia?
The exact cause is not fully understood, but vulvodynia is not an STI, is not contagious, and is not caused by poor hygiene.
The nerves in and around the vulva can become over-sensitive, which may cause pain in response to sensations that would not normally be painful. Symptoms can sometimes develop following inflammation or another vulval condition.
What is vaginismus?
Vaginismus causes the vagina to involuntarily tighten up or spasm when penetration is attempted. This can be triggered by one or more of the following: sex (including penetration with sex toys), medical examinations or attempting to insert a tampon into the vagina. It can also be associated with pain or a burning sensation. Some people describe it as if they are hitting a ‘block or brick wall’.
What causes vaginismus?
There are many possible causes of vaginismus, and sometimes the cause is not known. These can include physical symptoms due to infections such as thrush or skin irritation, previous experiences that trigger fear or worry, and the influence of social and cultural beliefs about sex.
These possible causes are explained in more detail in the Vaginismus Workbook.
What are the symptoms of vulvodynia and vaginismus?
The symptoms vary from person to person but may include burning, stinging, soreness, rawness, or pain during sex. Some people have pain with tampon use, discomfort when sitting, or irritation from tight clothing. Pain can affect the vulva, buttocks, or inner thighs, and symptoms may come and go or be constant. The pain may happen without an obvious trigger, or it may be brought on by touch or pressure.
If you experience involuntary contraction of the vagina when penetration is anticipated or attempted, this may or may not be associated with pain. In both cases, the vulval skin often looks normal, even when symptoms are severe.
How are vulvodynia and vaginismus diagnosed?
There is no single test, and we will need to see you in clinic to make an assessment. We will usually talk through your symptoms and perform an examination. The examination may include gently touching different areas of the vulva to see where you experience pain. You will always be offered a chaperone for this examination, and it is important for you to be aware that you are in control and can stop or pause the examination at any time. We will take a trauma informed approach and go at your pace. Usually only one examination is required, but further examinations may be required depending on the goals of treatment. Depending on your symptoms, you may also be offered swabs or STI tests to rule out other causes. Occasionally, a skin biopsy or assessment in a specialist clinic may be recommended.
Treatment and self care
There is no single treatment that works for everyone, but there are several ways to manage these conditions, and many people find that their symptoms improve.
What can I do to help my symptoms?
Many people find symptoms improve by avoiding soaps, shower gels, wipes, and deodorants on the vulva, and using emollients or soap substitutes instead.
Wearing loose cotton underwear, avoiding tight clothing, and using lubricants during sex may also help. Some people find sitting for long periods makes symptoms worse.
Finding ways to manage stress and support your general wellbeing may also help, as stress can make your symptoms feel worse.
What medical treatments are available?
Treatment depends on your symptoms and how they affect you. Options may include pelvic floor physiotherapy, support with managing persistent pain, psychosexual support, and medicines that are used to reduce nerve pain. It is common to use a combination of approaches rather than one treatment on its own.
Getting medical help
When should I make an appointment?
Contact SHAC, your GP or another healthcare professional if vulval pain does not go away, keeps coming back or affects everyday activities, sleep, tampon use or sex. You should also arrange an assessment if you notice skin changes, sores, swelling, bleeding, unusual discharge or recurrent painful lumps.
When should I seek urgent help?
Ask for an urgent GP appointment or contact NHS 111 if the pain is sudden or severe, you have difficulty passing urine, or a lump or swelling becomes larger and more painful over hours or days. You should also seek urgent advice if there is pus, you have a high temperature or you feel unwell.
How can SHAC help in Brighton and Hove?
If you have ongoing vulval pain and previous STI or thrush tests have been negative, SHAC can assess your symptoms and consider other possible causes. You can book an appointment so we can:
- talk through your symptoms and examine the affected area
- offer tests if an infection or STI needs to be ruled out
- discuss ways to manage your symptoms
- refer you to another service for further assessment or treatment if needed.
If you have already seen your GP about your symptoms, they are able to refer directly to our Horizon clinic for you to be seen.
Frequently asked questions about vulval pain and vaginal penetration
Can an infection still be possible after a negative test?
A negative result means that the infection tested for was not found in that sample. It does not rule out every possible infection or other cause of pain. If you have had a new sexual contact, develop new symptoms or had an STI test during its window period, a clinician may recommend different tests or repeat testing.
A window period is the time after possible exposure before a test can reliably detect an infection.
Can vulval pain feel like a UTI?
Burning may sometimes be felt around the urethra or when urine touches sore vulval skin. However, new urinary symptoms should still be assessed because they can have other causes, including a urinary tract infection (UTI).
Can it be vulvodynia even when the skin looks normal?
Yes. Vulvodynia often causes pain without any visible skin changes. An examination is still important because infections and skin conditions can cause similar symptoms.
Can repeated thrush treatment make pain worse?
Yes. Some creams and other treatments can irritate sensitive vulval skin. If thrush tests are negative and symptoms continue, speak to a clinician before using more treatment.
Can vulval pain continue after thrush has cleared?
Yes. Vulval pain can sometimes continue after thrush or another inflammation has cleared. The skin and nerves may remain sensitive, and repeated use of thrush treatments can sometimes cause further irritation. If your thrush tests are negative but pain continues, speak to a clinician so other possible causes can be considered.
Can vaginismus develop if I have previously had no difficulty with penetration?
Yes. Vaginismus can occur when vaginal penetration is first attempted during sex, a medical examination or when inserting a tampon. It can also develop later in life, even if you have previously had no difficulties with penetration.
Do vulvodynia and vaginismus get better?
Yes, symptoms can improve, although this may take time and flare-ups can happen. Treatment usually focuses on reducing pain and improving daily life and may involve a combination of approaches.
Where can I get support if I am not based in Brighton and Hove?
You should be able to get support from your GP, local sexual health clinic or gynaecology services.
The British Society for the Study of Vulval Disease also has a map of publicly funded vulval clinics across the UK and Ireland.