Vulvodynia and Vaginal Pain in Menopause: What Can Help

Q: Can menopause cause vulvodynia?

Menopause can play a part. As oestrogen falls, the vulval and vaginal tissues become thinner, drier, and more sensitive, a set of changes known as Genitourinary Syndrome of Menopause (GSM). These changes can trigger vulvodynia or make symptoms you already have worse. If your vulval pain has started or got stronger around menopause, raising it with your GP is a good place to begin.

Q: What does vulvodynia feel like?

Vulvodynia can feel like burning, stinging, soreness, or a throbbing ache in the vulva. The pain may be there all the time, or it may only come on when the area is touched, such as during sex or when you insert a tampon. You might feel it in one spot or across a wider area. There is often nothing visible on the skin, which can make it hard to describe.

Q: What treatments are available for vulvodynia?

Several approaches can help. Pelvic floor physiotherapy can ease muscle tension and calm nerve sensitivity. A clinician may prescribe topical treatments, including local anaesthetics and moisturisers, to help with the pain. Leaving out irritants such as soaps and perfumed products reduces flare-ups. If you are going through menopause, local oestrogen or HRT may be prescribed to address the tissue changes caused by GSM. Your GP can advise on the right combination for you.

Q: How is vulvodynia diagnosed?

Vulvodynia is a diagnosis of exclusion, so a GP first checks for other causes such as infections or skin conditions. Once those are ruled out, they may diagnose vulvodynia directly or refer you to a specialist team, which can include a gynaecologist, dermatologist, pelvic physiotherapist, or pain specialist. The examination may involve gently pressing on areas of the vulva with a cotton bud to find where the pain is.

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The information in this article is for general informational purposes only and does not substitute for professional medical or dietary advice, particularly during pregnancy. If you are outside the UK, please consult your local doctor, midwife, or healthcare provider for guidance that reflects your country's recommendations.

A burning that will not settle, a sting that lingers, or a soreness that sits with you through the day and makes some clothing hard to wear. If you have been living with discomfort in the vulva that you cannot quite explain, you are far from the only one, though it is rarely talked about. Vulval and vaginal pain are among the least raised symptoms of this stage of life. The pain can be hard to put into words, so it often goes unmentioned for months or even years. There are recognised reasons behind it, and practical steps that can help.

What vulvodynia is and how it feels

Vulvodynia is persistent, unexplained pain in the vulva that lasts at least three months. It can feel like burning, stinging, soreness, or a throbbing ache, often with nothing visible on the skin. That lack of anything to see is part of what can make it so hard to explain to other people, and sometimes even to a clinician.¹

The pain can be constant, sitting there without any particular trigger, or it can come on with touch: during sex, when you insert a tampon, or from the pressure of tight clothing. You might feel it in one specific spot, or spread across the whole vulval area.²

What you are feeling comes from the nerve endings in the vulva becoming over-sensitive, which is why vulvodynia is described as a neuropathic pain, a pain that starts in the nerves themselves. The exact cause is not fully understood. Known triggers include nerve irritation, past vaginal infections, hormonal changes, and tightness in the pelvic floor muscles.³

Getting a diagnosis can take time. Vulvodynia is a diagnosis of exclusion, which means a clinician rules out other causes first, such as infections or skin conditions. That process can feel long and frustrating, and you may find your symptoms are not taken seriously straight away.⁴

The link between menopause and vulval pain

If you have noticed new vulval pain around or after menopause, or pain that has got worse, falling oestrogen is likely to be part of the picture. As oestrogen drops, the vaginal and vulval tissues become thinner, drier, and more fragile, a set of changes known as Genitourinary Syndrome of Menopause (GSM). GSM is a separate condition from vulvodynia, but the tissue changes it brings can trigger or worsen vulvodynia symptoms. It is worth raising low oestrogen with your GP.⁵

Woman seated on sofa, covering face with hand. A cozy living room scene.

Vulvodynia vaginal pain menopause: what can help

Pelvic floor physiotherapy

Pelvic floor physiotherapy can be one of the more effective treatments for vulvodynia. A specialist physiotherapist uses techniques that may include manual therapy, guided relaxation exercises, biofeedback (where sensors help you learn to release muscle tension), and vaginal trainers. These work to release tight pelvic floor muscles and calm the sensitivity of the area over time. Your GP can refer you to a pelvic physiotherapist, or you can ask to be referred to a specialist clinic.⁶

Topical treatments

Several treatments can be applied directly to the skin to help with the pain. A GP or clinician may prescribe a local anaesthetic such as lidocaine 5% to numb a specific area. Unperfumed moisturisers can protect the skin and ease irritation. If low oestrogen is part of what is driving your symptoms, a clinician may also prescribe a local oestrogen cream or pessary to improve the health of the tissue in the vulval area.⁷

What to avoid

Some everyday habits and products can make symptoms worse. Soaps and any perfumed products used around the vulva are common irritants, so they are best left out. Loose cotton underwear tends to be gentler on sensitive skin than synthetic fabrics. Anything that puts prolonged pressure on the vulva, like cycling, can also aggravate the pain.⁸

Hormonal options

When vulval pain is linked to GSM, local oestrogen as a cream or pessary can be prescribed to improve the health of the tissue. Systemic hormone replacement therapy (HRT) is another option, and it may help with wider menopausal symptoms too. It is sometimes used alongside local oestrogen for fuller relief of vulval and vaginal symptoms. Both are prescription treatments, so your GP can talk through the options, weigh up anything specific to you, and advise on what suits you.⁹

Seeking assessment and what to expect

If vulval pain has been with you for a while, it is worth raising with your GP. At the appointment, they will ask about your symptoms and may carry out an examination. This can involve gently pressing on different parts of the vulva with a cotton bud to map which areas are painful. It is a brief and straightforward check, and you can ask for it to stop at any point.¹⁰

Once other causes have been ruled out, your GP may diagnose vulvodynia directly or refer you on to a specialist team. Depending on what your symptoms point to, that can include a gynaecologist, a dermatologist, a pelvic physiotherapist, or a pain specialist. Referral routes vary from area to area, so your GP is the right person to guide you through what is available near you.¹¹

Frequently Asked Questions

Can menopause cause vulvodynia?

What does vulvodynia feel like?

What treatments are available for vulvodynia?

How is vulvodynia diagnosed?

Sources

[1] NHS: Vulvodynia

Vulvodynia is persistent, unexplained pain in the vulva lasting at least three months. The pain can feel like burning, stinging, soreness or throbbing, and there are often no visible signs.
[2] NHS: Vulvodynia

The pain can be constant (unprovoked) or triggered by touch (provoked), such as during sex, inserting a tampon, or from tight clothing. It may affect one specific spot (localised) or the entire vulva (generalised).
[3] NHS: Vulvodynia

The condition is considered a neuropathic pain condition, meaning nerve endings in the vulva become over-sensitive. The exact cause is not fully understood, but known triggers include nerve irritation, previous vaginal infections, hormonal changes, and tightness in the pelvic floor muscles.
[4] NHS: Vulvodynia

Vulvodynia is a diagnosis of exclusion, meaning other causes such as infections or skin conditions must be ruled out first. This process can feel long and frustrating, and some people find their symptoms are not taken seriously at first.
[5] Genitourinary Syndrome of Menopause and Female Sexual Dysfunctions

During menopause, falling oestrogen levels lead to Genitourinary Syndrome of Menopause (GSM), where vaginal and vulval tissues become thinner, drier, and more fragile. GSM is a distinct condition from vulvodynia, but the tissue changes it causes can trigger or worsen vulvodynia symptoms.
[6] Female chronic pelvic pain (vulvodynia)

A specialist physiotherapist uses techniques that may include manual therapy, guided relaxation exercises, biofeedback, and vaginal trainers to release tight pelvic floor muscles and reduce the sensitivity of the area over time.
[7] NHS: Vulvodynia

A GP or clinician may prescribe a local anaesthetic such as lidocaine 5% to numb pain. Unperfumed moisturisers can protect the skin and reduce irritation. A clinician may also prescribe local oestrogen cream or pessary to improve tissue health.
[8] NHS: Vulvodynia

Soaps and any perfumed products used in the vulval area are common irritants and are best avoided. Loose-fitting cotton underwear is gentler on sensitive skin. Activities that put prolonged pressure on the vulva, such as cycling, can also aggravate pain.
[9] Medical Management of Vulvodynia

For vulval pain linked to GSM, local oestrogen in the form of creams or pessaries can be prescribed to improve tissue health. Systemic HRT is another option and may be used alongside local oestrogen to achieve fuller relief of vulval and vaginal symptoms. Both are prescription treatments.
[10] NHS: Vulvodynia

If you have persistent vulval pain, it is worth raising with your GP. At your appointment, they will ask about your symptoms and may carry out an examination involving gently pressing on areas of the vulva with a cotton bud to identify where the pain is located.
[11] NHS: Vulvodynia

Once other causes have been ruled out, your GP may diagnose vulvodynia directly or refer you to a specialist team that can include a gynaecologist, a dermatologist, a pelvic physiotherapist, or a pain specialist.