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Vulvodynia, Vaginismus and Dyspareunia

Vulvodynia, vaginismus and dyspareunia are all medical terms referring to causes of pain that a woman might experience in or around her vagina. When considering the questions, 'what is vulvodynia?', 'what is vaginismus?' and 'what is dyspareunia?', it's important to remember that these conditions are interrelated, but they're not the same.

You may not have heard of any of these words, or maybe you have heard of one or more of them but you're unclear what they mean. Perhaps you're suffering from throbbing 'down there', either inside or outside of your vagina and you don't know why. Or maybe sex is painful or even impossible.

In this article we'll provide a definition of vulvodynia, vaginismus and dyspareunia, outline the specific symptoms of each of these conditions, explain the causes and provide information about routes to get treatment.

What is Dyspareunia?

Dyspareunia is a sexual pain disorder represented by recurrent genital pain that is related to sexual intercourse. It is frequently named when discussing women's vaginal pain, particularly in relation to penetrative sex, but it can also refer to male sexual pain.

In women, although the term dyspareunia is often used to describe vaginal pain on penetration, it can also occur during other forms of sexual stimulation. It can develop either inside the vagina (deep) or externally (superficial).

Causes of Dyspareunia

Research suggests that psychological as well as physical factors can have an impact on dyspareunia. That's not to say—or even to imply—that women with this disorder are imagining their pain. Far from it. But in addition to physiological factors that might trigger this problem, it's thought that women will experience this pain at least partly due to fear of the pain itself or because of previous or ongoing trauma such as domestic abuse or sexual assault.

Physical Causes of Superficial and Deep Dyspareunia

Deep dyspareunia can be caused by a series of physical problems or medical conditions, including:

Infection, for example, herpes
Endometriosis
Ovarian cysts or fibroids
Pelvic inflammatory disease
Gastrointestinal problems, such as Crohn's disease or irritable bowel syndrome
Inadequate lubrication or factors associated with menopause

Superficial dyspareunia can also be caused by some of those issues, or by problems specific to the outer parts of the vagina such as:

Intact hymen
Abscess
Congenital abnormalities of the vagina
Vaginismus
Vulvodynia
Episiotomy, tear

What is Vaginismus?

Medically, vaginismus is known as genito-pelvic pain penetration disorder. But in simple terms, it generally means the pelvic floor muscles are too tight or the muscles of the vagina go into involuntary contraction, like a cramp. As a result of this muscle spasm, it can be painful and difficult or even impossible to achieve sexual intercourse, to submit to a gynaecological exam or even to insert a tampon.

More extreme forms will involve the muscles of the perineum and buttocks too.

Up to 20% of women will experience vaginismus to some extent, so it's not uncommon. Some women have suffered from painful penetration for as long as they have been having sex, while others might have started out able to achieve penetrative intercourse but developed the condition later in life. It has been described as feeling that their partner has 'hit a wall' when trying to penetrate.

Causes of Vaginismus

There is no definitive answer about exactly what causes vaginismus. It's considered to be part of a range of female sexual dysfunction, so it can have complex interdependencies with other problems, such as dyspareunia, childbirth injuries, scarring or anxiety.

What is Vulvodynia?

When there's long-term localised pain in or on the vulva, but there's no apparent cause for it, it's known as vulvodynia. The woman suffering from this might even have sought medical advice and had tests that discovered nothing wrong. Yet, the pain persists.

Pain from vulvodynia can be constant or occasional, and it might occur only when a specific area is stimulated or be more generalised and affect the entire area. The tissue may appear slightly swollen or inflamed but is more likely to look completely normal. Generally the symptoms of vulvodynia present as:

Burning or stinging
Soreness or rawness
Throbbing
Itching
Painful sex (dyspareunia)

The discomfort from this condition can be so extreme that you can't sit for long periods. Because it can be painful and frustrating, it can have a negative impact on your emotional wellbeing too. Not only that, but it can affect your relationship too; it will often cause you to avoid having sex, and that can also trigger vaginismus.

Causes of Vulvodynia

Perhaps because women often find it embarrassing to discuss the problem of pain in and around their vagina with doctors, there is little reliable research, so the precise causes of vulvodynia are not proven. However, it's thought that a number of issues can contribute to the condition, such as nerve injury or aggravation, infection, hormones or sensitive skin. Pelvic floor disorders are thought to potentially provoke it too, whether the muscles are too lax or too tight.

So, not only can vulvodynia cause vaginismus, but vaginismus can also lead to vulvodynia.

Treatment for Vulvodynia, Vaginismus and Dyspareunia

These three conditions have complicated-sounding names and might be unfamiliar to most people. Unfortunately, it's true that there is little depth of knowledge with these problems, but they are actually quite common. A wide range of medical factors can cause vaginal or vulvar pain. Therefore, although women might not want to discuss their symptoms with their doctors, it is the important first step in finding a solution.

Your doctor can rule out or provide treatment for any obvious causes such as infection, vaginal dryness, scarring, menstrual pain, hormonal issues, diabetes and other diseases. After that, there is a variety of methods to resolve or manage the symptoms, which, depending on the precise problem, might include:

Pelvic floor manual therapy
Vaginal and/or perineal massage
Vaginal dilation therapy
Topical medications to ease superficial pain
Hormone replacement therapy
Sex therapy
Cognitive behavioural therapy
INDIBA®Active treatment

Is it Normal for Your Vagina to Hurt?

No, it's not normal. The reasons for these conditions can be complex, but you should be reassured that in the vast majority of cases, the underlying issues that cause the symptoms of dyspareunia, vaginismus and vulvodynia are treatable. If you're wondering why you're having pain 'down there', take the first step and seek treatment. Neither your doctor nor your women's health physiotherapist will be shocked because they've seen it all before, and they can provide relief.

For more information about physiotherapy treatments for vaginal pain or other women's pelvic floor issues, call Magdalena on 07877 017 936 or drop PelviCare an email. Alternatively, you can book an appointment online .

PelviCare Women's Health Physiotherapy is located in Greenwich, London, serving women across South London, East London, Essex, Kent and beyond.