top of page

Understanding Vulvodynia: Causes and Symptoms

Vulvodynia is a complex and often misunderstood condition characterized by chronic pain in the vulvar area, without an identifiable cause. It can significantly impact a person's quality of life, affecting both physical and emotional well-being.  This affects up to 15% of women. If you are experiencing vulval pain, it is important to know that you are not alone.

Causes of Vulvodynia:

While the exact cause of vulvodynia remains elusive, researchers believe that it may result from a combination of various factors. Some potential causes and contributing factors include:

Nerve Damage or Irritation: Dysfunction or damage to the nerves in the vulvar region may lead to heightened sensitivity and pain. Trauma, injury, or inflammation could be underlying factors.

Genetic Predisposition: There is evidence to suggest a genetic component in some cases of vulvodynia. Individuals with a family history of chronic pain conditions may be more prone to developing vulvar pain.

Hormonal Changes: Fluctuations in hormonal levels, particularly during puberty, pregnancy, or menopause, can influence vulvar tissues and may contribute to vulvodynia development.

Muscle Spasm or Hypertonic Pelvic Floor Dysfunction: Tension or spasm in the pelvic floor muscles can result in pain and discomfort in the vulvar area. This may be linked to stress, anxiety, or a history of sexual trauma.

Infections or Allergies: Chronic infections, such as recurrent yeast infections, or allergic reactions to certain substances may contribute to vulvar pain.

Symptoms of Vulvodynia:

Vulvodynia manifests differently for each individual, with symptoms ranging from mild to severe. Common symptoms include:

Burning Sensation: A persistent, burning pain in the vulvar area is a hallmark symptom of vulvodynia. This discomfort may be continuous or episodic.

Stinging or Rawness: Some individuals with vulvodynia may experience sensations of stinging or rawness, making daily activities, such as sitting or exercising, challenging.

Itching or Irritation: Vulvodynia can cause persistent itching or irritation, leading to discomfort and distress.

Pain during Intercourse (Dyspareunia): Many individuals with vulvodynia experience pain during sexual intercourse, which can strain relationships and negatively impact sexual well-being.

Throbbing or Aching: Some people may describe the pain as throbbing or aching, which can vary in intensity.

Discomfort with Activities: Activities such as prolonged sitting, exercise, or wearing tight clothing can exacerbate symptoms.

Vulvodynia can affect only the vulval area, or it may spread to the thighs, abdomen, or back. In addition to vulval pain, women with vulvodynia may experience severe menstrual pain, heavy periods, frequent urination, and changes in bowel habits. Before a diagnosis of vulvodynia can be made, other causes of vulvar burning must be ruled out, including fungal, bacterial, and viral infections, inflammatory dermatoses such as lichen sclerosus and lichen planus, contact sensitivity and eczema, and lesions such as surgical scars and recurrent fissuring.

While vulvodynia is not life-threatening, it can have a significant impact on a woman's physical and emotional well-being. The pain associated with vulvodynia can make it difficult to perform daily activities and maintain relationships. Some women with severe vulval pain may be confined to bed during episodes of pain. It can be particularly distressing for women to be told that there is no effective treatment and that they will have to live with the pain for the rest of their lives.

The Muscles Related to Vulvodynia

Vulvodynia, a chronic pain condition affecting the vulvar region, is a multifaceted syndrome with a significant musculoskeletal component. While it is characterized by unexplained vulvar pain, often described as burning, stinging, or irritation, the involvement of pelvic floor muscles plays a crucial role in both the manifestation and management of this condition. Understanding the muscles related to vulvodynia is essential for developing effective treatment strategies and providing relief to those affected.

The Pelvic Floor Muscles and Vulvodynia

The pelvic floor muscles, a group of muscles located at the base of the pelvis, support pelvic organs and contribute to urinary and fecal continence, sexual function, and core stability. These muscles include:

Levator Ani Group: Comprising the pubococcygeus, puborectalis, and iliococcygeus muscles, this group is integral to maintaining pelvic organ support and continence.

Coccygeus Muscle: This muscle assists in supporting the pelvic organs and stabilizing the coccyx.

Obturator Internus: While primarily involved in hip movement, it also contributes to the pelvic floor’s lateral stability.

Piriformis: This muscle is part of the hip’s external rotator group and plays a role in pelvic stability.

Muscle Dysfunction and Pain

In the context of vulvodynia, muscle dysfunction often presents as increased muscle tension, spasms, or myofascial trigger points within the pelvic floor. These issues can exacerbate vulvar pain and lead to a cycle of chronic discomfort and muscle guarding.

Hypertonicity: Pelvic floor muscle hypertonicity refers to the state of increased muscle tone, which can cause significant pain and discomfort in the vulvar region. This heightened muscle tension can lead to compression of nerves, reduced blood flow, and subsequent pain.

Myofascial Trigger Points: These are hyperirritable spots within the muscle fascia that can refer pain to distant areas, including the vulva. Trigger points in the levator ani, obturator internus, or piriformis can mimic or exacerbate vulvodynia symptoms.

Muscle Weakness and Imbalance: Weak or imbalanced pelvic floor muscles can also contribute to the persistence of vulvar pain by failing to adequately support pelvic structures, leading to compensatory muscle tension and discomfort.

Vulvodynia treatment with acupuncture

Recent studies have shown that acupuncture may help in the treatment of vulvodynia.

In 1999, Powell and Wojnarowska published a paper in the Journal of the Royal Society of Medicine on the effectiveness of acupuncture for vulvodynia. They selected 12 patients between the ages of 18 and 68, all of whom had vulval pain and burning without other abnormalities on examination. The patients had experienced severe distress and impairment of sexual function, and many had tried suggested treatments without success. The patients were offered weekly acupuncture for ten weeks, and the results were promising. Two patients declared themselves cured, three believed their symptoms had improved and wished to continue acupuncture, four felt slightly better and judged acupuncture more effective than any other treatment, and three noted no effect at all. No obvious side effects were reported.

A study from Sweden investigated the effect of acupuncture on vulva vestibulitis. After three months of acupuncture treatment, the patients' quality of life improved significantly. More recently, Curran et al. used acupuncture to treat provoked vestibulodynia, another genital pain condition. In this study, 80 patients participated, and after 10 treatments, there were significant decreases in pain with manual genital stimulation and helplessness. There were also strong effects for improved ability to have intercourse and sexual desire. Qualitative analyses were overall more positive and showed an improvement in perceived sexual health, reduced pain, and improved mental well-being in the majority of participants.

A new study from the Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, has shown that acupuncture significantly reduces vulval pain in women with vulvodynia. The study involved 36 women with vulvodynia who were randomly assigned to either the acupuncture group or the wait-list control group. The acupuncture group received ten sessions of acupuncture. Reports of vulval pain and dyspareunia were significantly reduced, whereas changes in the aggregate FSFI scores suggest significant improvement in sexual functioning in those receiving acupuncture versus those who did not. The study concluded that this was the first randomized controlled pilot study to examine the use of acupuncture for the treatment of vulvodynia. The acupuncture protocol was feasible and appeared to reduce vulval pain and dyspareunia with an increase in overall sexual function for women with vulvodynia.

In conclusion, acupuncture has shown promise in the treatment of vulvodynia. Studies have shown that acupuncture can significantly reduce vulval pain and dyspareunia, improve sexual function, and enhance the quality of life in women with this condition. More research is needed to fully understand the mechanisms behind acupuncture's effectiveness in treating vulvodynia, but the evidence so far suggests that acupuncture is a safe and effective alternative for women who do not experience relief from traditional treatments.

Here are some examples of successful acupuncture treatments for vulval pain.

Case 1: A 34-year-old woman had been experiencing vulval pain for three years. The pain was worse during intercourse and she had very painful periods. She also experienced tightness in her thigh and back. Despite being treated with antidepressants and physiotherapy, her pain did not improve. However, she decided to try acupuncture and underwent eight treatments. After the eight sessions, her pain was significantly reduced and she was able to stop taking antidepressants.

Case 2: A 29-year-old woman had been experiencing vulval pain for two years. She felt a burning sensation when passing urine and experienced frequent urination. She found intercourse unbearable and was unable to use tampons. She also had lower back pain and painful periods. Despite being treated with various medications, she found no relief. After hearing that acupuncture could help her condition, she decided to try it. She underwent treatments for three months and her pain completely disappeared. She experienced no pain during urination or intercourse.

Case 3: A 43-year-old woman had been experiencing severe vulval pain for a year. She also experienced pain during intercourse and painful periods. She had irregular periods and experienced frequent urination and urgency. Despite being treated with antidepressants and local injections of steroids, her pain did not improve. She decided to try acupuncture and underwent five treatments. Her pain was lessened after these treatments, and after another ten sessions, her pain completely disappeared.

Acupuncture has been used for thousands of years in Traditional Chinese Medicine to treat various ailments. Acupuncture can help relieve pain, reduce inflammation, improve circulation, and promote relaxation.

In the cases mentioned above, acupuncture proved to be a successful treatment option for vulval pain that had not responded to conventional treatments.

Acupuncture has proven to be an effective treatment option for vulval pain that has not responded to other treatments. Patients with vulval pain may consider acupuncture as a non-invasive alternative to conventional treatments.


Powell and Wojnarowska J R Soc Med (1999) 92:579-81

Curran S et al J Sex Med (2010) 7:981-95

Danielsson L et al Acta Obstet Gynecol Scand (2001) 80:437-41

Schlaeger JM et al J Sex Med (2015) 12: 1019-27

bottom of page