Vestibulodynia: causes, symptoms, and how to manage it

Ever get stinging or burning at the entrance of your vagina while sitting, wearing tight clothes, or during sex? You might be experiencing vestibulodynia (previously referred to as vulvar vestibulitis). This is a formal name for pain at the entrance of your vagina, or vestibule.

While experiencing this kind of genital pain can be frustrating, it’s very common. As many as 1 in 4 women experience persistent vulvar pain at some point in their lives, with much of the pain brought on by outside pressure or touch. But there’s a lot you can do to treat this and feel better. Simple at-home approaches, like gentle stretches and lifestyle changes, can help ease symptoms of vestibulodynia.

Read on to learn more about what may contribute to vestibulodynia, common symptoms, and strategies to help ease the pain, including targeted exercises recommended by Hinge Health physical therapists.

What is vestibulodynia?

Vestibulodynia describes persistent pain in the vulvar vestibule. This is the smooth, somewhat flat surface that surrounds the vaginal opening, inside the inner lips of the vulva. 

In many cases, pain occurs when there is pressure on the vulvar vestibule, such as during sexual intercourse or when sitting for a prolonged period.

Vestibulodynia is a specific type of pelvic pain. While vulvodynia is an umbrella term for persistent pain in the vulva, vestibulodynia is distinct because the discomfort is limited specifically to the vestibule — the tissues surrounding the opening of the vagina — rather than affecting the entire vulvar region.

Vestibulodynia that’s “provoked” or triggered by pressure to the vestibule is one of the most common types of vestibulodynia.

Some people feel symptoms the first time they insert anything into the vagina, while others may develop pain with insertional activities later in life. For example, the decrease in estrogen during menopause is a common cause of vestibulodynia.

Symptoms of vestibulodynia

Symptoms can be constant, or they can come and go. In some people, discomfort may be mild; in others, the pain can be intense enough to limit everyday activities. 

Common vestibulodynia symptoms include:

• Burning, stinging, or sharp pain at the vaginal vestibule

• Pain during insertional activities, such as using a tampon or sex

• Pain from pressure (such as sitting, biking, wearing tight pants, touch)

• Painful urination, in some cases

Causes of vestibulodynia

While one specific trigger isn't always clear, researchers believe that pain symptoms may be the result of hypersensitive nerve endings or an increased number of nerve fibers in the vestibule area of the vulva. 

Factors that may contribute to symptoms of vestibulodynia include:

• Pelvic floor muscle tightness or tension, which can impact pelvic nerves

• Recurrent infections (such as chronic yeast infections or bacterial vaginosis)

• Allergies or sensitivities to certain irritants (such as those found in scented soaps, detergents, and some lubricants)

• Hormonal insufficiency, including menopause-related hormone changes and hormone changes due to oral contraceptives

• Previous injury or trauma to the area

• Certain immune-related health conditions

• Genetic factors

• Stress

How movement and pelvic floor therapy can help vestibulodynia

You might feel hesitant to move or exercise when you’re experiencing vestibulodynia, but including gentle activity as part of your treatment plan can help you find relief. Pelvic floor physical therapy and targeted exercises that stretch and balance your pelvic floor muscles may ease pain symptoms.

Your pelvic floor is a group of muscles and connective tissues that stretches like a hammock from your pubic bone in the front to your tailbone in the back. These muscles help support your pelvic organs, and play a role in bladder control, bowel control, and sexual health. 

For a healthy pelvic floor, you need to be able to tighten (contract) the muscles and fully release (relax) them. “Overly tight pelvic floor muscles can put pressure on nerves in the pelvis. Tension can also limit blood flow to the area, which can lead to or worsen pain,” says Ken McGee, PT, DPT, a physical therapist at Hinge Health. “Muscles that aren't strong enough may contribute to nerve irritation as well, by not providing enough support for the pelvis.”

Pelvic floor physical therapy teaches you to coordinate your pelvic floor muscles, which can help improve blood flow to the area and reduce compression on the nerves, explains Dr. McGee. 

Why insertional activities can feel painful

Chronic pain can also lead to muscle guarding. This is when muscles automatically tighten or contract to help protect an area, which can make sexual intercourse or inserting a tampon even more painful. “Pelvic floor physical therapy can help you learn strategies to make insertional activities more comfortable,” adds Dr. McGee.

Practicing these exercises regularly can help manage symptoms of vestibulodynia. Diaphragmatic breathing is essential for reducing pelvic floor muscle tension and calming your nervous system to help manage pain. Reverse Kegels help you become more aware of your pelvic floor muscles so you can learn to relax them when they spasm or tense up. And gentle moves — such as the cat cow, child’s pose, and happy baby — boost mobility and flexibility in the lower back, hips and glutes. 

Together, these exercises can help reduce pelvic floor tension, improve coordination, and make everyday movements like sitting and walking easier.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatments for vestibulodynia

Vestibulodynia treatment options focus on easing pain and discomfort. Your healthcare provider may recommend a combination of physical therapy and targeted exercise, vaginal dilation therapy, biofeedback, relaxation therapies, medications, and in some cases, surgery to remove the affected vulvar tissue. Lifestyle strategies to minimize vulvar irritation and tracking your pain patterns may also help manage symptoms. 

Here’s more about these treatment options:

• Physical therapy and targeted exercise. Physical therapy (PT) and targeted exercises can help ease tension in your pelvic floor, improve flexibility, and build support in this area of your body. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Vaginal dilation therapy. This involves using smooth, tube-shaped tools (dilators) to gently help your body get used to insertion. This can help gradually stretch the vulvar tissue and pelvic floor muscles that may have become tight or tense from persistent irritation, explains Dr. McGee. It can also help reduce fear and muscle guarding during vaginal insertion. “The therapy should not be painful,” adds Dr. McGee. “If you're feeling sharp pain or severe discomfort while dilating, back off to a more manageable level of sensation.”

• Biofeedback. This can help improve pelvic floor muscle control by teaching you how to contract and relax your muscles correctly. Biofeedback uses devices with sensors to provide real-time feedback on muscle activity. It can help you recognize when your pelvic floor muscles are tense so you can relax them. 

• Track your pain patterns. For some people, symptoms may flare after prolonged sitting or exposure to a certain irritant, says Dr. McGee. Noticing your individual patterns can help you understand what is contributing to your pain, and steps you can take to help manage it. 

• Practice relaxation and mindfulness techniques. Strategies such as deep breathing, progressive muscle relaxation, and meditation can help your body relax, reduce muscle tension and lower stress. 

• Topical medications. Your healthcare provider may prescribe a local anesthetic, such as lidocaine ointment, to numb the area and reduce discomfort. If your symptoms are linked to hormonal changes — which can sometimes be triggered by hysterectomy or ovary removal, menopause, or certain oral contraceptives —you may find relief from topical estrogen or testosterone creams. If you are currently on hormonal birth control, it is worth discussing with your provider whether your specific prescription may be contributing to your symptoms.

• Pain medications. Medications often used for other conditions can sometimes be helpful for pain relief. Because pain is processed by your nervous system, medications that help regulate nerve signals can help calm down sensitivity. In these cases, providers may consider options like antidepressants (such as tricyclics) or anticonvulsants (like gabapentin) to help manage nerve pain. Some of these even come in the form of creams that can be applied directly to the skin.

• Surgery. If your pain is severe and symptoms have not improved with other treatments, your healthcare provider may consider a procedure to remove the tissue causing symptoms, which may help relieve pain and improve sexual comfort.

Lifestyle changes to support comfort 

Small daily adjustments can help reduce vestibular irritation and manage pain symptoms. These changes can include:

• Wear loose, breathable clothing and cotton underwear

• Avoid scented feminine products that may act as irritants (including vaginal wipes, pads and pantyliners, deodorant sprays, or bubble bath)

• Use mild soaps for bathing, including washing the vulva

• Use a water-based or silicone lubricant for sexual activity (choose one that is “pH-matched, glycerin-free, and paraben-free,” says Dr. McGee)

• Apply cool gel packs to the vulvar area to reduce pain

• During a pain flare, consider taking a break from exercises that put pressure directly on the vulva, such as bicycling or horseback riding

When to see a doctor

Symptoms of vestibulodynia can be managed with at-home treatments. But if your pain is severe and ongoing, see a healthcare provider. It's also a good idea to get care if you have:

• Burning, stinging, rawness, or intense pain at the vaginal entrance that persists for weeks

• Pain that interferes with your everyday life, mood, and sexual activity

• Unusual discharge, fever, or chills (signs of infection)

Can vestibulodynia be cured?

While there isn't usually a single 'quick fix' for vestibulodynia, effective treatment is available. You can minimize symptoms and achieve long-term pain relief through a variety of approaches — including pelvic floor physical therapy, lifestyle changes, medications, and other therapies. The key is to find the right combination of treatments that works well for you.

PT tip: Find gentle ways to stay active

“When people are in pain, the tendency may be to stop and rest,” says Dr. McGee. “But when it comes to vestibulodynia, decreased movement can contribute to prolonged pain. Gentle activities like walking and yoga help improve blood flow and keep the nerves in the pelvis calm and less sensitive, which can help ease symptoms.” 

Find a level of movement that feels comfortable — enough to challenge you, but not so much that it increases pain. Always listen to your body. It’s okay to feel a little discomfort, but you shouldn’t push through severe pain.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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