What Causes Vulvodynia? New Research Points to Inflammation
Updated: 5 days ago
The short answer
Vulvodynia is pain in the vulva that lasts at least three months and doesn't have an obvious cause, like an infection or a skin condition. New research suggests that for many people, especially those with pain at the opening of the vagina, the pain comes from inflammation in the skin there. Immune cells pile up in the area and cause extra nerve endings to grow. Those nerves are oversensitive, so touch that shouldn't hurt does.
This changes how we treat it. Calming the nerves and muscles still helps, but finding and removing whatever keeps the skin inflamed matters just as much.
What is vulvodynia?
Vulvodynia means long-lasting pain in the vulva (the outside of the genitals) without a clear cause. "-Dynia" simply means pain.
It can look different from person to person:
Where it hurts: just at the opening of the vagina, at the clitoris, or across the whole vulva.
What sets it off: touch or pressure (sex, tampons, tight pants, sitting), or pain that's there even when nothing is touching.
When it started: from the very first time you tried a tampon or sex, or later on, after things used to feel fine.
The most common type is pain at the opening of the vagina when it's touched or pressed. Doctors call this provoked vestibulodynia. One review estimates it affects somewhere between 8 and 28 out of every 100 women at some point in their lives.
Why researchers think the immune system is involved
Your immune system's job is to fight off threats, and inflammation is one of its tools. Normally, inflammation shows up, does its job and goes away. In many people with vulvodynia, research suggests it never fully switches off.
Here's how researchers think it happens:
Something irritates the skin. Repeated yeast infections, a product you're sensitive to, or another irritation.
The skin overreacts. Skin cells from people with vulvodynia send out more "alarm" signals when they're exposed to yeast than cells from people without pain.
Immune cells move in. Cells called mast cells gather in the area and release a substance that makes nerves grow.
Extra nerves grow. More nerve endings grow closer to the surface, and they're more sensitive.
Light touch starts to hurt. The pelvic floor muscles then tighten to protect the area, which adds muscle pain on top.
What the research shows:
In people: a 2025 study in the journal Brain found more mast cells and more nerve fibers in tissue samples from women with vulvodynia than from women without pain.
In animals: in the same study, repeated inflammation in rats caused pain that lasted long after the inflammation healed. Blocking the nerve-growth signal helped 80% of the rats recover, compared with 25% without it. In mice, an allergy to a preservative found in many wipes and cosmetics caused the same kind of pain.
In large groups of women: frequent yeast infections are linked to a higher chance of vulvodynia. A 2024 study found that women with allergy-type conditions were about 2.5 times as likely to have it.
Some researchers now think vulvodynia belongs in the same family as other inflammatory conditions, like psoriasis and Crohn's disease.
What we don't know yet: most of the studies in people are small, much of the research is in animals, and no immune-based treatment has been proven to work for vulvodynia so far.
Signs your vulvodynia may be caused by inflammation
There's no single test for this yet, but these clues point toward inflammation:
Your pain started after, or gets worse with, yeast infections or lots of rounds of antifungal or antibiotic medicine.
You feel burning or rawness, or see redness, at the opening of the vagina, and it's worse after soaps, wipes, pads, lube or condoms.
You have allergies, eczema, asthma or another immune condition.
Your pain gets a little better when you stop using irritating products, then comes back when you use them again.
Your pain is mostly at the opening of the vagina, not across the whole vulva.
Some skin conditions can look a lot like vulvodynia, such as lichen sclerosus or an allergic skin reaction. A gynecologist or vulvar specialist should check for these first.
What this means for treatment
Treatment works on two things at once: cooling down the inflammation, and calming the nerves and muscles that have learned to overreact.
1. Find and remove what's irritating the skin
Ask for a yeast culture (a lab test) before treating a yeast infection, instead of treating every flare without one.
Use fragrance-free and preservative-free products. Skip wipes and scented pads.
Ask a dermatologist about patch testing to find out whether you're allergic to something you use.
Check your lube, condoms and spermicide for anything that stings or burns.
2. Work with a doctor on the skin itself
A gynecologist or vulvar specialist can confirm what's going on, rule out other conditions and talk with you about medication. Treatments that target the immune system directly are being studied but aren't proven yet. For severe pain that doesn't respond to anything else, a surgery that removes the painful tissue (called a vestibulectomy) has helped most people in small studies.
3. Calm the nerves and muscles
After months of pain, the nerves stay on high alert and the pelvic floor muscles stay tense, even once the irritation is gone. Pelvic floor physical therapy helps by:
Teaching your pelvic floor to relax instead of clench.
Slowly helping the skin get used to touch again, at a pace that feels okay.
Freeing up tight muscles and nerves so they stop pressing on each other.
Breaking habits that add pressure, like always squeezing your butt or belly.
4. Help your whole body calm down
Pain and stress feed off each other. Good sleep, breathing exercises and support from a therapist or sex therapist are part of treatment. That doesn't mean the pain is in your head. It means your whole system needs help settling down.
Other things that can cause vulvar pain
Inflammation isn't the only cause, and many people have more than one thing going on:
Hormones: low estrogen or testosterone in the vulvar skin, which can happen with some birth control pills, while breastfeeding or around menopause.
Extra nerve endings from birth: some people are born with more nerves at the opening of the vagina. They often had pain from their very first tampon.
Tight pelvic floor muscles: muscles that are always tense can press on nerves and make sex painful.
Irritated nerves: such as the pudendal nerve, or nerves coming from the lower back.
An oversensitive nervous system: sometimes the brain and spinal cord turn up the volume on pain signals. This often goes along with IBS, bladder pain or fibromyalgia.
Figuring out which of these apply to you is the first step of a good evaluation.
Vulvodynia vs. vaginismus
These two often get mixed up, and you can have both. But they're different problems.
Vulvodynia | Vaginismus | |
What it is | Pain in the skin of the vulva | The muscles around the vagina tighten on their own |
What it feels like | Burning, stinging, rawness or sharp pain when touched | Like hitting a wall; it's hard or impossible to put anything in |
Can you have sex or use a tampon? | Usually, but it hurts | Often not, or only partway |
What's behind it | Oversensitive nerves, often from inflammation | Muscles bracing to protect you, often with fear of pain |
What treatment focuses on | Calming the inflammation and the nerves | Retraining the muscles and breaking the fear-pain cycle |
Vulvodynia can lead to vaginismus: when touch always hurts, the muscles learn to clamp down. Learn more in How to Treat Vaginismus at Home.
Frequently asked questions
Is vulvodynia an autoimmune disease?
No, not based on what we know now. Autoimmune means your immune system attacks your own body. With vulvodynia, the immune system seems to keep inflammation going in the skin, which keeps the nerves irritated. That's a different problem.
Can yeast infections cause vulvodynia?
Frequent yeast infections are linked to a higher chance of vulvodynia, but that doesn't prove they cause it.
Can vulvodynia be cured?
Many people get a lot better once treatment matches what's causing their pain. Because more than one thing is often involved, the plan usually has a few parts.
Do I need a biopsy?
Usually not. Your doctor might take a small skin sample to rule out other skin conditions.
Can pelvic floor therapy help if my vulvodynia is from inflammation?
Yes. It calms the oversensitive nerves and tight muscles that build up on top of the inflammation. It works best alongside removing irritants and medical care.
Getting help
In Denver? Dr. Caroline Gamwell works one-on-one with people whose vulvar pain hasn't gotten better with other treatment. She looks at inflammation, nerves, muscles and hormones together. Book a free phone consultation or learn more about pelvic floor physical therapy in Denver.
Not in Colorado? Find a pelvic floor physical therapist near you with the APTA Pelvic Health PT Locator.
References
Paavonen J, Brunham RC. Localized provoked vulvodynia as an immune-mediated inflammatory disease: rationale for a new line of research. Front Cell Infect Microbiol. 2024;14:1505845.
Awad-Igbaria Y, Edelman D, Ianshin E, et al. Inflammation-induced mast cell-derived nerve growth factor: a key player in chronic vulvar pain? Brain. 2025;148(1):331-346.
Tonc E, Omwanda GK, Tovar KA, Golden XME, Chatterjea D. Immune mechanisms in vulvodynia: key roles for mast cells and fibroblasts. Front Cell Infect Microbiol. 2023;13:1215380.
Zheng A, Harlow BL, Gereige J. Immune dysregulation, inflammation in characterizing women with vulvodynia, depression, and both. J Womens Health. 2024;33(3):364-370.
Bornstein J, Goldstein AT, Stockdale CK, et al. 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain and vulvodynia. J Sex Med. 2016;13(4):607-612.
Dr. Caroline Gamwell, PT, DPT, PRPC, is a Doctor of Physical Therapy specializing in pelvic health and orthopedics. She earned her doctorate at Northwestern University in Chicago, IL, with a focus on chronic pain rehabilitation. She holds the Pelvic Rehabilitation Practitioner Certification (PRPC) from Herman & Wallace and the APTA's Certificate of Achievement in Pelvic Health (CAPP), as well as a post-graduate certification in treating pregnant and postpartum athletes. She owns Worth It PT, a boutique pelvic health practice in Denver, CO. Her strongest passions lie with helping others conquer their chronic pain and achieve their intimacy goals.
