Unexplained Pain During Sex? It Might Be Vulvodynia

Illustration by Maria Ines Gul

by Laura Delarato

There are myriad reasons why a person might experience pain before, during, or after sex. Sometimes it’s about not having enough lubrication, other times it’s caused by physical or emotional stress, but non-consensual pain typically signals that something needs to be addressed. But how does one treat and take care of a pain that doesn’t have a tangible, identifiable cause?

Apprehensively introducing: Vulvodynia, a pain disorder without an innate cause that affects approximately 16% of vulva-owners in the U.S. and is often misdiagnosed as yeast infections. Vulvodynia is both easy and difficult to explain: It is pain on the external bits of the vulva that can be subtle as a throb or as jarring as a sharp, knife-like feeling...but there isn’t a specific cause that generated that pain—hence, the misdiagnosis. 

Pain is often associated with a provocation, a stimulant that makes us pull back, sit down, bleed, cry, sometimes laugh as we react to the sliding-scale ache. We apply bandages, wear casts, create spaces where that pain can no longer reverberate throughout our system. Vulvodynia or any kind of genital pain (again, the non-consensual kind) has treatment options, but doesn’t have a true cure outside of communicating with yourself, your doctor, and sexual partners about what you need to feel good. Pain, no matter the area, makes it difficult to feel comfortable, to exude sexiness, to let go and have fun with your partner(s), because your normal activities are restricted and your quality of life suffers, even in non-sexual circumstances.

We’re not here for that. What we are here for is having as much information about your own sexual wellness as possible. So while you need a doctor to officially diagnose you with a condition, here’s a primer on vulvodynia. 

What Exactly Is It? 

Vulvodynia is a chronic vulva pain that can be experiences locally, in specific spots, or in the entirety of the external genital area. It’s frequently described as a burning, itching, stinging, or raw sensation with or without stimulus (i.e. penetrative sex, tampon insertion, or sitting for too long), but vulva owners have also described it as being achy, sore, or a swelling sensation. The most commonly experienced pain point is the tissue surrounding the vaginal opening, but vulvodynia also affects external, vulva-specific organs such as the labia and clitoris. 

There are two main subtypes of vulvodynia: generalized and localized. Generalized vulvodynia is pain that can be experienced at different areas of the vulva at different times, whereas localized vulvodynia refers to vulva pain in one particular area. The distinction depends on how widespread the pain is, but the pain can vary from a repetitive pressure called allodynia to a burning or stinging sensation that encapsulates the vulva area. 

Is It The Same As Dyspareunia?

Nope. Vulvodynia is specifically an external pain affecting the vulva region that has an unknown cause but a lot of possible irritants. Dyspareunia is a deeper pain inside the vaginal canal or pelvis that is caused by sexual intercourse without enough lubrication, communication, or foreplay. 

What Causes Vulvodynia?

There are a lot of possible reasons for vulvodynia but, frustratingly, there isn’t a concrete cause. Vulvodynia is a pain disorder, and not an STI. It is not contagious or transmittable; according to the National Vulvodynia Association, the condition isn’t caused by an active infection or an STI, either. But research continues to show that vulvodynia has been associated with pelvic floor spasms, irritation from the vulva to the spinal cord, and irregular responses from vulvar cell to inflection or trauma. Basically, vulvodynia is a ubiquitous pain that can happen to any vulva-owner and can’t really be prevented.

What Should I Be On The Lookout For? 

While painful, the vulva typically appears to look normal or with a slight inflammation to the painful areas. In these cases, note how the pain feels when presented and speak candidly with your doctor about the rate, pressure, and longevity of the feeling. 

Are There Medical Treatments for Vulvodynia? 

There are ways to manage the symptoms of vulvodynia, but because there isn’t a clear cause it is difficult to treat the root of the issue. The best thing to do is to speak to your doctor about whether the pain is generalized (different areas) or localized (specific areas) of the vulva. From there, local anesthetic, nerve blocks, biofeedback therapy, or pelvic floor therapy are all possible options to lessen the pain. 

Are There Lifestyle Changes I Can Make? 

Absolutely! Depending on the experienced pain and what works best for each person’s individual body, there are a few different ways to alleviate vulvodynia symptoms: Avoid hot tubs and hot baths because the heat can irritate the skin and cause more pain. Switch to non-deodorized menstrual options or silicone-based cups. Find alternates to tight-fitting underwear, nylon, or spandex pieces, as they often increase temperature and moisture to the vulva, causing more irritation. Applying cold compresses to the external affected area will help ease the pain. Use glycerin-free, paraben-free, alcohol-free lubrication during sexual activity to avoid any irritations on the issue surrounding the vaginal canal. 

Can I Still Have Sex Or Masturbate With Vulvodynia?

Yes, but this will always be dependent on the person’s comfort level and the area that’s affected. For example: If the issue surrounding the vaginal canal feels tender, use cold compresses, quality lubrication and condoms, and communication when proceeding! 

How Can I Communicate With My Partner About Vulvodynia?

As strange as it sounds, discussing vulvodynia can actually be an opportune moment to have a candid discussion with your partner about likes, dislikes, boundaries, wants, and needs. Schedule a partnership check-in at a coffee shop (not the bedroom) and talk about your symptoms, sex activities you’d like to try, or maybe a different type of foreplay that would help prepare for a more pleasurable sexual experience (ice cubes, anyone?). You can also suggest kinkier types of play that involve toys, power dynamics, or impact instruments.

Laura Delarato is a creative director, writer, and body image advocate living in Brooklyn. She is the creator of the sex-positive newsletter 1-800-HEYLAURA, is a regular contributor to Condé Nast Traveler, and her essays have appeared Healthyish, Travel + Leisure, NBC Better, BeautyCon, Men’s Health, Huffpost, Ravishly, Salty, and Refinery29. She is currently works as the creative director at Vox Media.