Vulvodynia and Sex

If you have vulvodynia, you already know that pain isn’t just a physical sensation — it affects every part of your life, including intimacy. You might feel frustrated, disconnected from your partner, or even start avoiding sex altogether. And you wouldn’t be alone.

Research shows that people with vulvodynia not only experience pain during sex (dyspareunia), but many also feel isolated, ashamed, or anxious about sex. But here’s the thing: having vulvodynia doesn’t mean you have to give up on a satisfying sex life. With the right treatments, self-care strategies, and communication, many people find ways to reclaim pleasure and intimacy.

Below, we’ll break down what vulvodynia is, how it affects your sex life, and (most importantly) how to find relief and enjoy sex again. You deserve pleasure just as much as anyone else, and there are real, practical ways to get there.

What is vulvodynia?

Vulvodynia is a term used for chronic vulvar pain that lasts for at least three months. The pain can vary from a burning, stinging, or aching feeling. For some, vulvodynia pain is constant, while for others, it may come and go. There are a few different types of vulvodynia:

• Generalized vulvodynia: The pain is spread out across the entire vulva. This type of vulvodynia might feel constant, or it may come and go throughout the day.

• Localized vulvodynia: Pain is focused in one specific spot. The most common is vestibulodynia, pain localized to the opening around the vaginal opening. g. It might hurt during activities like sex or even just wearing tight clothing.

• Provoked vulvodynia: This type of vulvodynia is triggered by sexual intercourse, tampon use, or even sitting for long periods.

• Unprovoked vulvodynia: This is the trickiest type of vulvodynia because the pain comes on its own, without any clear triggers. It can happen even when you’re not doing anything that typically causes discomfort. 

Symptoms 

The main symptom of vulvodynia is pain in the vulvar area. You might feel:

• Burning: This is a common symptom, and it can be constant or come and go.

• Stinging or rawness: This can feel like a sharp, painful sensation.

• Aching or throbbing: This is a duller, more persistent pain.

• Itching: Some experience itching in addition to other symptoms.

• Urinary symptoms: Studies have shown that there is a high incidence of urinary symptoms like urgency, frequency, and pain with urination. 

This pain can make daily activities like sitting, exercising, or even wearing certain clothes uncomfortable. But the most troubling part for many people is how vulvodynia affects their sex life.

Causes 

Vulvodynia often stems from multiple contributing factors, and while the exact cause can vary, most cases are treatable — yet gaps in medical education leave many doctors unprepared to effectively diagnose or manage it. Some potential causes include: 

• Hormonal changes: Changes in hormones (like during menopause or from birth control) may make vulvodynia worse.

• Nerve damage: Sometimes, the nerves in the vulva get injured or irritated, which can lead to pain. This could happen because of an infection, childbirth, or injury.

• Pelvic floor issues: If the muscles in your pelvic floor are tense or not working properly, they could be contributing to vulvodynia pain. Physical therapy to relax and strengthen these muscles can help.

• Infections or allergies: Sometimes, infections or sensitivities to things like soaps or lotions can trigger vulvodynia.

• Genetics: There might be a genetic link, as some may be more likely to develop vulvodynia.

• Stress or trauma: Psychological factors like stress, anxiety, or past trauma can make the symptoms worse, and they can also make it harder to manage the pain.

Vulvodynia and sex

If you’re dealing with vulvodynia, sex can feel like a difficult, frustrating, and even painful experience. When you’re constantly worried about pain, it’s hard to relax and enjoy intimacy. It can also make you feel isolated or even guilty, especially if you feel like you’re letting down your partner.

The good news is that vulvodynia doesn’t mean the end of a healthy sex life. While it might take some time to find the right approach, you can absolutely still have pleasurable and intimate experiences.

Treatment options for vulvodynia

Let’s cut through the noise: vulvodynia is often slapped with labels like “chronic” or “untreatable,” but that’s usually code for “we haven’t found the cause yet.” Most cases of vulvodynia improve — or even resolve — once we play detective and figure out what’s actually driving your pain. 

Effective care starts with a thorough, investigative approach to identify contributing factors (like hormonal imbalances, nerve sensitivity, pelvic floor dysfunction, or infections) so we can treat the source, not just the symptoms. 

Symptom relief medications 

• Topical treatments: One of the most common treatments for vulvodynia is topical numbing creams, like lidocaine. These can be applied directly to the painful area to reduce discomfort, especially before sex. Just be aware that lidocaine can also affect your partner’s sensation, so use it carefully.

• Oral medications: Certain antidepressants and anticonvulsants are also used to treat chronic pain like vulvodynia. These medications work on the nerves and can help reduce the pain signals your brain is receiving. Common ones include amitriptyline and gabapentin.

• Steroid creams: If there’s inflammation in the area, a doctor may recommend steroid creams to calm it down.

• Over-the-counter pain relief: Non-prescription pain relievers like ibuprofen or acetaminophen can help with mild discomfort but won’t usually address more intense vulvodynia pain.

Pelvic floor physical therapy

This isn’t your average workout. A skilled pelvic floor therapist helps you relax, stretch, and strengthen muscles that are stuck in constant clench mode. Think of it as physical therapy for your pelvis. 

Nerve blocks

If your pain feels like burning, stabbing, or electric shocks, it might be nerve-related. Nerve blocks can temporarily calm the chaos and give your body a reset. Bonus tip: make sure you’re seeing a vulvodynia specialist.

Pelvic floor botox

When pelvic floor muscles don’t respond to therapy alone, Botox can be a game-changer. It helps release stubborn tension, giving your muscles a break and allowing other treatments to actually work.

Counseling and therapy

Vulvodynia doesn’t just affect your body — it can impact your mental health, relationships, and sense of self. Therapy helps connect the dots and bring your nervous system out of survival mode.

• Cognitive behavioral therapy (CBT): Helps break the cycle between pain, fear, and stress by rewiring negative thought patterns that amplify discomfort.

• Eye movement desensitization and reprocessing (EMDR): Great for processing trauma that might be fueling physical pain, especially if symptoms started after a difficult experience.

• Sex therapy: Chronic pain can make intimacy feel scary or off-limits. Sex therapy helps you rebuild trust with your body and feel confident navigating pleasure again.

Somatic therapy

Feeling disconnected from your body is common with chronic pelvic pain. Somatic therapies help you reconnect with physical sensation, explore pleasure without pressure, and feel safe in your skin again.

• Sexological bodywork: A hands-on, trauma-informed practice (legal in some places, so check your local laws) that helps you understand your body’s responses and build new, healthy connections with touch and sensation. It's especially helpful for those who feel numb or out of sync with their bodies.

• Breathwork: Breath is a powerful tool. It can regulate your nervous system, release built-up tension, and bring awareness back into your body, no equipment needed.

• Tantra: This isn’t just about sex — it’s about slowing down, tuning in, and learning how to feel again. Tantra encourages a gentle, non-performative approach to intimacy and can be deeply healing for those recovering from pain.

Vulvodynia is real, but it’s also treatable. With the right team and a customized plan, you can combine pelvic floor therapy, nerve support, trauma-informed counseling, and somatic healing to take back control of your body. You don’t have to accept pain as your new normal. If a provider ever tells you “There’s nothing we can do,” that’s your sign to find someone who knows better and does better.

Lifestyle tips for vulvodynia relief

Managing vulvodynia doesn’t stop at the doctor’s office. What you do at home can make a big difference. Here are practical, gentle ways to support your healing every day:

1. Go fragrance-free: Skip the scented soaps, bubble baths, and harsh laundry detergents. Fragrances and dyes can disrupt your natural pH and irritate sensitive skin. Stick with mild, unscented cleansers, and wash with just water when you can. No douches, ever — they do more harm than good.

2. Choose breathable fabrics: Opt for cotton underwear and avoid tight-fitting clothes like skinny jeans or synthetic leggings that trap heat and moisture. Or skip underwear altogether when you're lounging at home. Going commando can reduce friction and keep things aired out.

3. Use lube: Painful penetration? Lube is your new best friend. Look for high-quality water-based or silicone-based lubricants. A few great options include Vella’s Intimate Elixir and Super Slip & Slide, formulated specifically for sensitive tissues and comfort.

4. Soothe with temperature therapy: Feeling inflamed or tender? A cold compress can calm things down. Feeling tight or clenched? A warm compress or heating pad might be more your speed. Trust what your body needs in the moment, both can help ease discomfort.

5. Prioritize rest and regulation: Chronic pain wears down your nervous system. Make space for rest, mindfulness, gentle movement, or anything that helps you shift from “survival mode” to “healing mode.” Even just five minutes of deep breathing can help your body recalibrate.

6. Keep a symptom journal: Track what flares your symptoms and what helps. This can be a game-changer when working with your provider to figure out triggers and patterns (plus, it gives you back some control).

How to have pleasurable sex with vulvodynia

Yes, sex can still feel good — with patience, creativity, and self-trust.

• Go slow and listen to your body. It’s easy to disconnect from your body when you’re in pain, but rebuilding self-trust is key. Let your body set the pace.

• Communication is everything. Be open with your partner about what feels good, what doesn’t, and how they can support you. You don’t have to figure it out alone.

• Penetration isn’t the goal. Explore other forms of pleasure, like touch, oral, cuddling, massage, and mutual masturbation. Intimacy is so much more than intercourse.

• Try new things gently. If penetration is something you want to work toward, tools like vaginal dilators and switching up positions can help (just don’t rush it).

• Get support. Whether it’s a therapist, pelvic floor specialist, or sexual health provider, healing is easier with the right team behind you.

It’s important to remember that vulvodynia is manageable, and with the right care, you can still have a fulfilling sex life. Talk to your healthcare provider, explore treatment options, and be patient with yourself as you work toward finding what works for you. You deserve to feel supported, and you can enjoy intimate moments without letting vulvodynia control your life. 

FAQ

What is the best sex position for vulvodynia? 

The best sex position for vulvodynia is one that minimizes pressure and friction on the vulva while allowing you to stay in control of the depth and speed of penetration. Many people find that being on top is a good option since it lets them control movement and avoid deep penetration that might be painful. Side-lying positions, like spooning, can also help because they reduce friction and allow for a more relaxed experience. Experimenting with different angles, using pillows for support, and prioritizing comfort over performance can make a big difference.

What to avoid when you have vulvodynia? 

When you have vulvodynia, it’s important to avoid anything that increases irritation or discomfort. Harsh soaps, scented feminine hygiene products, and tight clothing can all make symptoms worse by irritating the sensitive skin of the vulva. During sex, avoid rough or deep penetration if it causes pain, and always use a high-quality lube to reduce friction. If a certain sexual position or activity consistently causes pain, don’t force it — intimacy should be enjoyable, not painful (unless that’s what floats your boat).

What aggravates vulvodynia?

Vulvodynia can be aggravated by many factors, and everyone’s triggers may be different. Common culprits include sitting for too long, tight underwear, excessive friction from sex or exercise, and tampon use. Stress and anxiety can also play a big role — when you're tense, your pelvic muscles may tighten, making pain worse. Hormonal changes and infections can sometimes contribute to flare-ups. Keeping track of what worsens your symptoms and making small adjustments can help you manage discomfort and maintain a fulfilling sex life.