Why does my vulva hurt? Practical tips for people who experience pain around sex  with Dora Pandeloglou

Did you know, when you look down between your legs, at your genitals, you are actually looking at your vulva, not your vagina! 

The vulva is all the things you can see on the outside, basically what touches your underwear, and the vagina is the ‘tunnel’ on the inside. The vulva extends from the pubic bone all the way to the anus. It is a complex area that includes a lot of blood vessels, nerves, skin and muscles. No two look the same and it is normal for vulvas to be different sizes, different colours, with different sized labia… all vulvas are unique and beautiful. 

Never look at porn for a realistic depiction of a vulva, they are heavily edited! It is so empowering to look at your vulva and all its beauty… find a mirror and take a look. Become familiar with what your ‘normal’ is, this way you can detect any changes in appearance, just like checking your breast for lumps every couple of weeks. 

The vulva can become painful for so many reasons including infections such as thrush and bacterial vaginosis, skin conditions such as eczema and dermatitis, and tissue damage related to surgery or childbirth. The vulva can also be painful during sex, especially if you’re not in the mood or your juices aren’t flowing. This is because feeling horny plumps up the vulva and lubricates the vagina, helping to reduce friction and pain.  

Did you know that 15% of vulva owners aged between 20 to 60 will experience ongoing pain, burning or discomfort in the vulva, for no specific reason? If your irritation lingers for longer than three months or your GP can’t tell you exactly what's wrong, you may have something called vulvodynia. This is the number one cause of ongoing pain and discomfort with sex! 

If you are someone that experiences this pain, you may also have pain with external foreplay, inserting a tampon, a pelvic exam, wearing tight pants, sitting for prolonged periods of time, urination and during exercise. Your vulva may also look slightly red or swollen.  

Vulva pain can then cause the muscles in the vagina, known as the pelvic floor, to become tight, causing more pain with sex. This is because when our body suffers pain our brain creates a pathway to respond to the pain by subconsciously bracing the surrounding muscles to ‘protect’ the body from harm. This extra tightening of these muscles can make penetration with a penis or even a finger become impossible. This condition is known as vaginismus, and this can be quite scary when it occurs, especially when you’ve been able to have pleasurable penetration before with no issues… but this is a topic for another day.  

As you can imagine, vulvodynia (or any vulva pain) can cause a lot of anxiety around intimacy and your relationship with your partner. Your partner may also feel fearful of touching you, as the last thing they want to do is cause you distress and pain. Your arousal and libido may also reduce as you associate everything with pain. You may also become more self-conscious and not enjoy your body anymore. Some people feel like their body is ‘failing’ them and this may cause general anxiety, depression, lack of sleep and poorer quality of life.  

It’s important to understand that vulva pain can be treated so you can be pain-free and enjoy pleasurable sex! 

Here are 13 practical tips to manage and treat your vulva pain: 

1. Seek out a good General Practitioner or Gynaecologist. 

They can rule out any physical causes such as thrush, eczema, dermatitis, bacterial vaginosis, sexually transmissible infection, and cancers. This is important, if there is a physical reason to explain your vulva pain, it can be treated promptly. 

2. Maintain good vulva hygiene. 

Avoid washing your vulva with soap, or perfumed bath products – only use water 

Don’t use douches as it disrupts the normal vaginal microbiome, which can cause irritation  

Change out of your workout clothes immediately after you exercise 

Wash your clothes with sensitive washing powder 

Wear natural fibre underwear (like cotton), rather than synthetic (polyester) 

Wear comfy clothing and avoid G-strings and tight jeans if possible 

When urinate, try to lean forward to avoid burning sensation  

3. Apply a cool compress on your vulva.  

This can be a life changer if you experience pain when sitting and can also be helpful before and/or after painful sex. It is recommended to not too have sex if it contributes to pain as this can then cause more pain. 

4. Invest in a good vaginal probiotic.  

Probiotics with lactobacillus strain have been shown to balance your vagina flora and vaginal microbiome and may help with reducing your vulva pain and irritation.  

5. Buy a good quality lubricant.  

Supermarket lubricates are filled with nasties! Invest in a lubricant with all natural ingredients and a neutral pH to assist in vulva pain with sex.  

6. Practise deep breathing exercises.  

This is so important to help your pelvic floor muscles relax! This also helps calm down your nervous system which stops our pelvic floor muscles tightening when your vulva is touched! Aim for 10 deep belly breaths, three times per day, and try it when being intimate (with a relaxed jaw), you’ll be surprised at the change! 

7. Mindfulness, Mediation and Body Scanning.  

Similarly to breathing, learning how to be in the present moment and focus on ‘letting go’ of certain body parts helps your brain and body connect and reduce pain. You can either do this in a quiet room, and focus on scanning your body from head to toe to focus on releasing tension, or you can use some excellent Apps that talk you through mindfulness practice. 5-10 minutes daily is all you need! This can also be helpful to do with your partner and even while being intimate.  

8. Topical cream.   

If the above physical conditions are ruled out, certain creams have been shown to reduce vulva pain. Lignocaine cream (non-medicated) is the first one to try and can be very helpful to achieve pain free sex. Apply this cream 15-20 minutes before being intimate. If this doesn’t work, you may need a prescription cream called amitriptyline cream, a topical antidepressant cream, extremely effective to relieve vulva pain with sex 

9. Retrain and release your pelvic floor muscles.  

As these muscles develop tension with vulva pain, learning how to release these muscles can reduce your sexual pain. This can be done by: 

Down training exercises. Do some deep breathing to begin then gently pull up these muscles by imagining you are ‘pulling up a fart’ just a small amount, then focus and visualise slowly release this tension and gently push down further. You can also think about an elevator and visualise a ‘dropping down feeling’. This is best taught with a Pelvic Health Physiotherapist to guide you. 

Yoga stretches such as child’s pose, pigeon stretch and happy baby can be helpful to relieve vulva discomfort. Try deep breathing while you hold these stretches for 60 seconds 

Massage and trigger points to your pelvic floor. This is done by an experienced Pelvic Health Physiotherapist and they will teach you tips to do this yourself.  

10. Dilator/ vibrator therapy.  

These are silicone dildos that can increase in size and can be very helpful for vulva pain. They can be initially used on the outside to allow the vulva to feel comfortable with touch and then used for insertion in a gradual way to reduce fear and tightening of the pelvic floor muscles. A vibrator can also be used the same way. Once the body experiences no pain, it can feel more comfortable to achieve finger touch and penetration and eventually penis penetration. This is best guided with an experienced Pelvic Health Physiotherapist. 

11. Communication with your partner.  

Have an open and honest conversation with your partner about your vulva pain with sex to help reduce your fears and anxiety and assist your partner to understand what is going on.  

12. Foreplay and outercourse.  

Most vulva owner’s that experience pain are reluctant to have intercourse and therefore may refrain from intimacy with their partner in general as they don’t want penetration. Instead, focus on ways to increase arousal without causing pain and focus on being more pleasure-focused and less goal-oriented. Being intimate doesn’t have to lead to orgasm or penetration. Focus on different things that can bring you pleasure and have some fun with each other to enhance arousal. Improving your arousal is KEY to improving your vulva pain with sex! 

13. Speak to a Sexologist.  

This can be extremely helpful to explore some of these above points, improve your arousal and libido, address the fears associated with vulva pain with sex including trauma, and individualised advice to address these. 

Vulva pain is common but can be treated. It is important to determine what the cause is, if any, and address it! The earlier you address it, the quicker it will go away. Remember that Pelvic Health Physiotherapists and Sexologists are here to help you address your pain, improve your arousal and assist you achieve pain free sex!  

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You can book an appointment with Dora here. 

You can find out more information about the Australian Institute of Sexology and Sexual medicine here. 

Further Research on the Female Orgasm.