Burning, stinging or rawness of the vulva, sometimes constant, sometimes only on touch, with examination finding nothing wrong. It is a recognised chronic pain condition, it is not caused by infection, and women commonly spend years on repeated thrush treatments before anyone names it.

Where we stand: Menova is an independent publication. We sell no treatments, we are not your doctor, and this is general education, not a diagnosis. Persistent vulval pain needs examining — this article cannot do that.

What it is

Vulvodynia is vulval pain lasting three months or more without an identifiable cause. It is a pain condition — a problem in how pain is generated and processed — rather than a problem with the tissue itself, which is why examination looks normal.

Two patterns:

Provoked vestibulodynia — pain triggered by touch, at the vestibule (the entrance). Tampons, sex, tight clothing, cycling, sitting. Often a sharp, burning or knife-like pain at a specific point, reproducible when touched.

Generalised, unprovoked vulvodynia — burning or rawness present much of the time, not requiring touch, sometimes spreading to the inner thighs or perineum.

Both can coexist, and either can be constant or intermittent.

Why it matters that it is named

Because the alternative is what usually happens: repeated antifungals, repeated antibiotics, and the growing sense that you are imagining it.

You are not. It is described in gynaecology and pain medicine, it has treatment pathways, and the delay to diagnosis is measured in years across multiple studies.

What must be excluded first

Vulvodynia is a diagnosis made once other causes are ruled out, which is why examination matters:

  • Infection — thrush, bacterial vaginosis, herpes. Confirmed by swabs, not assumed
  • Lichen sclerosus or lichen planus, which have visible skin changes and specific treatment; see lichen sclerosus
  • Genitourinary syndrome of menopause — thinning and dryness, which is very common in this age group and is treated with local estrogen; see GSM and urinary changes
  • Contact dermatitis, often from the products being used to treat the itching
  • Vulval intraepithelial neoplasia, or other skin change
  • Pudendal nerve problems
  • Pelvic floor muscle overactivity, which very frequently coexists and is treatable

That last one matters: for many women the pain and the muscle guarding maintain each other, and treating the muscle changes the pain.

The menopause overlap

In midlife, vulval burning is usually assumed to be dryness — and often it is. Local vaginal estrogen is the right first treatment for genitourinary syndrome and helps many women.

But if you have used local estrogen properly for three months and the burning persists, that is the point to ask about vulvodynia rather than to increase the dose or conclude nothing works. See how to use vaginal estrogen.

The two can coexist, and both may need treating.

What treatment involves

There is no single fix, and there is a real toolkit. Most women need a combination.

Remove irritants first. Soap, shower gel, bubble bath, fragranced wipes, intimate washes, laundry detergent residue, and panty liners. Water or a plain emollient on the vulva. This alone helps a proportion of people and costs nothing.

Pelvic floor physiotherapy. One of the better-supported treatments, particularly for provoked pain. Internal release work, breathing, desensitisation, and graded dilator use where appropriate. More Kegels are not the answer when the muscle is already overactive — see when sex hurts after menopause.

Topical treatments — local anaesthetic ointment used before sex or for flares, prescribed and used as directed. Some clinicians use compounded topical preparations.

Neuropathic pain medication — low doses of certain antidepressants or gabapentinoids, used for the pain mechanism rather than for mood. Doses are usually well below antidepressant doses.

Local estrogen, where there is also atrophy.

CBT and psychological pain management, which have evidence in chronic pain generally and in vulvodynia specifically. This is not "it's in your head" — it is the same approach used for any persistent pain condition; see CBT for menopause.

Sex therapy or couples work, where the pain has affected the relationship.

Surgery (vestibulectomy) is used in selected cases of provoked vestibulodynia that have not responded to conservative treatment, in specialist centres.

Living with it while you get treatment

  • Cotton underwear, none at night if comfortable
  • Loose clothing; avoid seams and tight trousers during flares
  • A cool pack, wrapped, for burning
  • Plain emollient as a barrier, including before swimming
  • Avoid prolonged sitting on hard surfaces; a cushion with a cut-out helps some people
  • Urinate before and after sex, and rinse with water rather than wiping hard
  • Adequate lubricant, glycerin-free and fragrance-free — see moisturiser versus lubricant
  • Do not push through painful sex, which reinforces the muscle guarding

Get examined promptly for

  • A lump, ulcer, or non-healing sore
  • A white, thickened, or changed patch of skin
  • Splitting or tearing
  • Any bleeding after menopause — see bleeding after menopause
  • New severe pain, or pain with fever

How to raise it

Naming the condition is what usually changes the appointment:

"I've had burning vulval pain for eight months. Swabs have been negative, thrush treatment doesn't help, and I've used vaginal estrogen properly for three months. I'd like to be assessed for vulvodynia, and referred to pelvic health physiotherapy — and to a vulval clinic if there is one."

If saying it aloud is the obstacle, write it down and hand it over. Our free printable visit prep sheet is designed for exactly that. See also not being dismissed.

The part worth saying

Women with this condition consistently report being disbelieved, and it is one of the more isolating experiences in women's health — because it affects sex, it is hard to describe, and there is nothing to point at.

It is a recognised condition. It has a name and a pathway. And the first step is an examination that rules other things out, which is exactly what repeated antifungal prescriptions prevent.

The free 2-minute Menova self-check organizes your wider symptom picture — no account, not a diagnosis, and your answers never leave your device.

This article is general education, not medical advice or a diagnosis. Persistent vulval pain, skin change, a lump or a non-healing sore requires examination by a licensed clinician. Do not treat repeatedly for thrush without a confirmed diagnosis.

Sources: NICHD — Vulvodynia, ACOG — Disorders of the Vulva, NHS — Vulvodynia, and The Menopause Society.