Understanding Vulvodynia & Pelvic Floor Therapy

Living with vulvar pain can feel confusing, frightening, and isolating. But despite what you might have been told, vulvodynia is not an unresolvable mystery—it is a symptom with identifiable contributors and effective treatments. Research shows that vulvar pain affects a large number of women over the course of their lives, and more clinicians now recognize it and provide targeted care. By understanding what vulvodynia actually is and how it presents, you can move toward treatment and relief.

As pelvic floor physical and occupational therapists, our team at PHRC works closely with individuals who have spent years searching for answers for their pain, often seeing multiple providers before receiving an accurate diagnosis. Through a combination of expertise, evidence-based care, interdisciplinary management with trusted colleagues, and a deep understanding of the pelvic nervous and musculoskeletal system, we help clients find relief, regain function, and feel like themselves again.

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What is Vulvodynia?

The word vulvodynia literally means “pain in the vulva,” which refers to the external female genital area that includes the clitoris, labia, mons pubis, and vaginal opening. It’s best understood as a descriptive term for a symptom rather than a single diagnosis.

So, while vulvodynia sounds like a catch-all label, it actually reflects a variety of underlying and often treatable conditions. Treatment requires identifying the specific contributors—which can be muscular, hormonal, inflammatory, neurological, and psychological—and customizing care to each individual.

What are the Symptoms of Vulvodynia?

Vulvodynia symptoms can vary in type and intensity and can come and go. Some women describe a:

Constant burning or raw sensation
Sharp, stabbing, or itching pain
Pain that is provoked by touch (such as during tampon insertion), sexual activity, or a pelvic exam
Pain that occurs spontaneously without a known trigger the person can identify

The pain can occur in the labia, clitoris, perineum, and/or vestibule.

What Causes Vulvodynia?

Vulvodynia does not typically come from one single source. Instead, it usually develops from several overlapping factors that interact with one another. Among these, dysfunction of the pelvic floor muscles plays a central role (the pelvic floor muscles support the pelvic organs). Many women with vulvodynia have what’s known as a hypertonic or high-tone pelvic floor. This means the muscles remain overly tight throughout the day, which can compress nerves and blood vessels, reduce circulation, and amplify pain signals. This muscular tension also makes sexual activity, tampon use, or even sitting for long periods more uncomfortable.

Aside from pelvic floor dysfunction, additional contributors can include:

Hormonal factors, such as reduced estrogen affecting vulvar and vestibular tissue health
Inflammatory changes in the vulvar or vestibular tissue
Neurological drivers, including nerve irritation or heightened pain signaling
Genetic predisposition that increases sensitivity to pain
Structural issues in the vulvar or vaginal tissues
Psychosocial influences such as stress, anxiety, or past trauma, which can heighten pelvic muscle tension and pain perception

Because these causes often overlap, vulvodynia is best understood through a biopsychosocial lens. That means a thorough evaluation considers the physical, neurological, hormonal, and emotional factors together. Pelvic floor assessment is a very important part of this evaluation, since muscular overactivity is so common in women with vulvodynia. Once contributors are identified, treatment can begin, often involving a team that includes gynecologists, pelvic floor physical and occupational therapists, and sometimes mental health or pain specialists.

What Role Does Pelvic Floor Dysfunction Play in Vulvodynia?

Pelvic floor dysfunction is one of the most significant contributors to vulvodynia, with research suggesting that anywhere from 20 to 90 percent of people with vulvodynia or vestibulodynia (a form of vulvar pain that affects the tissue around the vaginal opening) also experience pelvic floor dysfunction.

The pelvic floor muscles support the pelvic organs, help control bladder and bowel function, and play an important role in sexual activity. When these muscles are in a constant state of overactivity (called hypertonus or high-tone dysfunction), they can cause pain on their own and amplify pain signals coming from the vulvar tissues.

In women with vulvodynia, the pelvic floor muscles are often found to be:

Tight and overactive, creating constant pressure in the pelvis
Tender to the touch, reproducing the same pain felt at the vulva
Poorly coordinated, making penetration painful and sometimes limiting relaxation even outside of sexual activity

This chronic muscle overuse can compress the blood vessels and nerves, restrict healthy circulation, and keep pain pathways activated. It also explains why symptoms often flare with tampon insertion, penetrative sex, pelvic exams, or even prolonged sitting.

While not every case of vulvodynia involves the pelvic floor, it is much more common to see them together than separately. For this reason, a pelvic floor muscle exam is a very important part of evaluating vulvodynia, and treatment frequently includes pelvic floor physical or occupational therapy to restore normal muscle tone, function, and coordination.

By focusing on the pelvic floor, many women experience meaningful relief—not only of vulvar pain, but also of related issues such as painful intercourse, urinary urgency, or bowel discomfort that can accompany muscle overactivity.

How Is Vulvodynia Diagnosed?

Because vulvodynia is a symptom rather than a single disease, diagnosis begins with ruling out other conditions that might explain the pain. At PHRC, your pelvic floor physical and occupational therapist will start with a detailed health history and a pelvic exam. During the exam, they look for visible changes in the vulvar tissue, signs of infection, or skin conditions that could cause discomfort.

With gentle pressure applied to different areas of the vulva and vestibule, they can map out where your pain occurs and how severe it feels. This helps identify if the pain is localized (such as in the vestibule) or more generalized across the vulva.

Diagnosis often involves a team approach. It is important to know that the majority of general OBGYNs likely did not receive training in medical school about vulvovaginal pain disorders. This surprises many people when vulvodynia symptoms arise, your regular doctor may not be able to diagnose and help you. Medical experts with advanced training and interest in vulvaginal pain disorders can help make the diagnosis. If an expert is not available in your area we recommend the Find a Provider List from the International Study for the Society of Women’s Sexual Health and the International Pelvic Pain Society.

What are the Associated Diagnoses?

In addition to pelvic floor dysfunction causing vulvodynia, it can also be associated with:

Dyspareunia (painful intercourse), often related to pelvic floor overactivity
Vaginismus, where pelvic floor muscle contractions make penetration difficult or impossible
Bladder Diagnoses, such as Interstitial Cystitis
Bowel Dysfunction, such as constipation
Other chronic pain conditions, such as irritable bowel syndrome, fibromyalgia, or temporomandibular joint disorder, which reflect a tendency toward central pain sensitization

What is the Treatment for Vulvodynia?

Vulvodynia can sometimes require a combination of treatments. Ultimately, the exact treatments for you will depend on the specific cause of your symptoms and the associated impairments. Below are the most common treatments used by a pelvic floor physical and occupational therapist:

Manual therapy to release trigger points in pelvic muscles
Internal and external techniques to ease tightness and improve mobility
Manual biofeedback to increase awareness and motor control of the pelvic floor muscles
Training in diaphragmatic breathing to lengthen and relax muscles
Guided practice in “dropping” the pelvic floor for pain relief
Gentle stretching positions like child’s pose with coordinated breathing
Neuromuscular re-education to retrain how pelvic muscles respond to movement
Exercises that improve blood flow and reduce nerve irritation
Education on posture and daily habits that can affect pelvic tension
Home program with relaxation and mobility strategies to support progress

Alongside working with a pelvic floor physical and occupational therapist, some people with vulvodynia find temporary relief from warm sitz baths to soothe irritated tissues and using topical creams or other medications that calm nerve sensitivity.

How Pelvic Floor Physical and Occupational Therapy Helps

Pelvic floor physical and occupational therapy can help with vulvodynia in many ways:

Relieves burning, stinging, or aching sensations
Loosens tight pelvic floor muscles
Improves blood flow and tissue health
Restores comfortable movement and mobility
Reduces nerve sensitivity and irritation
Builds strength and support in the pelvic muscles
Improves posture and body alignment
Provides strategies for pain flare management
Supports sexual function and comfort

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What To Expect During a Pelvic Floor Physical and Occupational Therapy Session

At your first visit with PHRC, we take the time to listen to your story. We’ll discuss your symptoms, medical history, past treatments, and how those treatments worked (or didn’t). Many people with vulvodynia come to us after feeling discouraged by multiple appointments and treatments that didn’t help, and we understand how overwhelming that can feel.

During the physical exam, we gently assess your pelvic muscles, connective tissue, nerves, and movement patterns. This hands-on evaluation helps us identify what might be contributing to your pain and discomfort.

After the assessment, we share what we found and explain how these findings connect to vulvodynia. From there, we work with you to create a treatment plan that includes both short-term and long-term goals. Most people benefit from one to two sessions per week for about 12 weeks, along with a home program that supports your progress between visits.

Throughout your care, we also coordinate with your broader medical team to keep your treatment consistent and collaborative. Our goal is to reduce your pain, restore comfort, and help you move forward with more ease in your daily life.

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Tips for Living with Vulvodynia

Always Get Tested If You Suspect an Infection

Burning, itching, or irritation can certainly come from infections, but this isn’t always the case. Treating symptoms as though they are an infection without proper testing can delay the right diagnosis. If cultures come back negative, it’s important to look deeper, as many non-infectious conditions (including vulvodynia) can cause similar symptoms.

Wash Your Vulva with Water

The vulva does not need soap for good health. Many soaps and body washes contain fragrances, dyes, and other ingredients that can irritate sensitive vulvar tissue. Warm water is enough to keep the area clean.

Use Dilators Only When Your Tissues are Ready

Dilators can be helpful tools for reducing pain with penetration, but only when introduced at the right stage of treatment. Using them too early, or without proper guidance, can increase pain and frustration. A pelvic floor physical and occupational therapist can guide you on when and how to use dilators safely.

See a Pelvic Floor Physical and Occupational Therapist

Pelvic floor dysfunction is a major driver of vulvodynia symptoms. Working with a pelvic floor physical and occupational therapist who has advanced training in pelvic pain can make a real difference.

Get Help Today at PHRC

At PHRC, we’re here to listen, assess, and guide you toward meaningful relief. We take a whole-body approach to care, focusing not just on your painful symptoms but on the underlying patterns that contribute to them.

Our team of pelvic floor physical and occupational therapists brings both clinical expertise and genuine compassion to every session. We work with you to build a plan that fits your life and helps you move forward.

If getting to the clinic is a challenge, we offer telehealth appointments following your first in-person visit, so you can keep making progress no matter where you are.

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