Vulvodynia and Sexual Pain Syndromes

Vulvodynia, also known as vulvar vestibulitis or its newer designation, provoked vestibulodynia (PVD), is a condition of intermittent or constant vulvar pain. It is most often felt in the labia and/or the entrance to the vagina. It may be dull and aching but is often described as stinging or burning. It can range from minor to excruciating, and interfere minimally or severely with activities of daily life as well as with sex and intercourse. Many patients will see several doctors before the correct diagnosis is made, as the symptoms can be confused with vaginitis, STIs or dermatitis. I am sorry to say that some patients will also be told the pain is all in their heads, or that they just need to relax.

Anther common sexual pain syndrome is vaginismus (the involuntary tightening of the muscles surrounding the vaginal opening when there is attempted penetration with a tampon, speculum, finger, toy, or penis). This can be severe enough to prevent heterosexual intercourse completely, thus sometimes providing a barrier to conceiving a wanted child.

Dyspareunia is the term used when sexual penetration is possible, but is painful. Sometimes orgasm is also painful (dysorgasmia). There are many possible causes, and a good evaluation includes a thorough history of where the pain occurs (superficial or deep) and under what circumstances. Sometimes vulvodynia or vaginismus can cause dyspareunia.

Many women (and men!) also expercience chronic pelvic pain, defined as pain lasting more than 3 to 6 months and not relieved by ordinary measures such as rest, heat, massage, and over the counter pain medication. The treatment of chronic pain is becoming a specialty of its own, a welcome development as this kind of pain can be complex to understand and address.


Sexual pain syndromes are not easy to treat, but there are treatments available.  I find the best approach is co-management among a treatment team that may include (in addition to the gynecologist or urogynecologist) a physical therapist, pain specialist and/or counselor. It is a rare patient who doesn't experience some degree of relief with this approach.

See my home page for some suggestions of Denver providers for sexual pain problems.