The outer and inner labia, the opening of the urethra, the entrance to the vagina, and the clitoris together form the vulva.
Many women experience vulvar pain at some point in their lives. The most common symptoms are: a burning or stinging sensation, itching, dryness, irritation, or unusual discharge.

Table of contents

Common causes

One of the most frequent causes of a painful vulva is small tears inside the vagina that occur when penetration takes place before the body is sufficiently ready for it.

A woman's body and vagina prepare for intimacy and penetration when she is adequately aroused. The vagina begins to produce natural lubrication and the labia swell gently, acting as a kind of cushioning.
When a woman is not sufficiently aroused, the body does not prepare itself for intimacy: there is insufficient lubrication and no swelling of the genital tissues. The physical conditions for comfortable, pain-free penetration are simply not in place.
If a penis (or a finger) enters the vagina in this state, friction can occur. This makes it easy for small tears to develop, which can cause a burning sensation or a painful vagina.
As a result of this painful experience, a woman may - often without realising it - tense her pelvic floor muscles during subsequent intimate moments. This reduces natural lubrication further and narrows the vaginal entrance, which in turn intensifies the discomfort.

This type of pain during intimacy is known as "superficial dyspareunia". You can read more about this pain during and after intimacy, its causes and possible solutions here.

Atrophic vulvitis - chafing, itching and pain after the menopause

After the menopause, hormonal changes cause the vaginal wall to become thinner, drier, and more fragile. These changes reduce the elasticity and firmness of the vagina, leaving it drier and more susceptible to irritation and infection.

It is worth noting that after the menopause the vagina does not actually produce less lubrication during arousal than it did before. However, before the menopause, oestrogen kept the vaginal tissues naturally moist at all times, which meant that penetration before full arousal was rarely a problem. After the menopause, this is no longer the case. Because the vagina is generally less moist in everyday life, rapid penetration without sufficient physical arousal can lead to discomfort and pain.

If you continue to experience burning or itching after the menopause despite being sufficiently aroused and lubricated, this may be a sign of atrophic vulvitis. A good lubricant can make a meaningful difference. Creams, tablets, or pessaries containing a low dose of oestrogen may also help.

Vulvodynia (an umbrella term for chronic vulvar complaints) - pain at the vulva

Vulvodynia is an umbrella term for chronic complaints affecting the vulva without any clearly identifiable cause. Symptoms can include a burning sensation, itching, irritation, or persistent pain. In some cases, visible skin changes are also present.

Skin conditions

Skin conditions such as eczema and psoriasis can appear on various parts of the body, including the vulva. In addition, the following skin conditions specifically affecting the vulva may also occur:

Allergy - itching

An allergic reaction can irritate the skin of the vulva, causing itching and redness. This irritation may be triggered by:

  • Scented or coloured toilet paper.
  • Soap.
  • Sanitary towels.
  • Intimate sprays.
  • Panty liners.

Cold compresses can help relieve vulvar itching, while a cream or ointment may soothe irritated skin. Even better is to identify what is causing the irritation and avoid it where possible. Try to resist the urge to scratch, as this can worsen the irritation.

Lichen sclerosus - changes to the skin

Lichen sclerosus often causes itching, and in some cases penetration becomes painful or impossible. With lichen sclerosus, the skin of the vulva may turn white, become shiny, thin, or conversely thicker. In some cases, parts of the vulva may shrink, enlarge, or disappear altogether. Lichen sclerosus does not occur inside the vagina, but it can affect the entire vulva and the area around the anus.

Lichen sclerosus cannot be cured, but creams containing corticosteroids can help relieve the itching. A vibrator may help to stimulate blood circulation in the area.

Because there is approximately a 6% chance that lichen sclerosus may develop into cancer, it is important that you remain under regular medical supervision. If you notice ulcers forming or new thickened areas developing in the vulva, please inform your gynaecologist promptly.

Vulvar intraepithelial neoplasia (VIN) - warts, ulcers or swellings

When new tissue (white, pinkish-red, or brown) develops in the skin of the vulva, this may indicate intraepithelial neoplasia. This can take the form of warts, ulcers, or swellings, and may be accompanied by itching or pain. VIN can be a precursor to vulvar cancer, so it is important to remain under regular medical supervision. The affected tissue is usually removed by laser treatment or surgery.

Paget's disease - red and white patches with itching and burning

With Paget's disease, you may notice red and white marbled patches on the vulva, perineum, or around the anus. These are often accompanied by itching and a burning sensation. The affected areas can be removed surgically. As Paget's disease can be a precursor to vulvar cancer, regular monitoring is essential.

Yeast infection/Candida - an inflamed vagina

With Candida (the most common yeast infection), the vulva appears red and itchy, and the vagina produces a thick, white, crumbly discharge. There may also be a burning sensation when urinating.

You can develop Candida if you have washed your vagina too frequently with soap, or if a tampon has been left in for too long. It can also be passed on through sexual contact. Your risk of developing Candida is higher if you have diabetes, are pregnant, or are taking antibiotics.

Candida can be treated effectively with tablets and/or cream.

Genital warts (HPV) - itching and painful warts

Genital warts are usually white and pointed, though they can sometimes be dark brown. They can cause pain, itching, a burning sensation, or discharge. As well as on the vulva, genital warts may also appear around the anus, inside the vagina, and on the cervix.

Warts often disappear on their own, but this can take a considerable amount of time. If they are causing significant discomfort, they can be treated by applying a cream or liquid directly to the warts. They can also be frozen, cauterised, surgically removed, or treated with laser therapy. There is approximately a 50% chance that the warts will return, as the virus remains present in the body.

STIs

A number of sexually transmitted infections (STIs) can cause symptoms in the vulvar area. The most well known is chlamydia, which is caused by the bacterium Chlamydia trachomatis. Possible symptoms include: discharge, irritation and a burning sensation when urinating, pain during and after intimacy, pain in the lower abdomen, or abnormal bleeding.

Chlamydia can also be present in the anus, where it may cause symptoms such as itching or pain when passing stools. Chlamydia is straightforward to treat with a course of antibiotics.

Herpes - painful blisters on the vagina

A herpes infection causes painful, burning blisters around the entrance to the vagina, the anus, or the mouth. You may also experience itching, pain when urinating, red patches, fever, or swollen glands.

The blisters typically clear up after around three weeks. There is no treatment that eliminates the virus entirely, which means new blisters can recur from time to time. The symptoms can be managed with cream or tablets.

Syphilis - hard ulcers

Syphilis causes hard ulcers that can be up to a centimetre in size. These ulcers can appear in and around the vagina, anus, and mouth, but they are usually painless. In some cases there may also be spots appearing across the skin, swollen glands, eye problems, or flu-like symptoms.

Although the ulcers and spots typically disappear after around three weeks, syphilis must be treated with antibiotics. Without treatment, more serious complications can develop over time.

Provoked vulvodynia (PVD), formerly known as VVS - a burning sensation

With PVD, the skin is chronically irritated. Small red patches and fissures are often visible at the vaginal entrance, which are painful to the touch. There may also be areas within the vulva that are tender under pressure.

PVD causes a burning sensation with any form of touch, and sometimes itching as well. Pain after intimacy is also common and can persist for several days. A diagnosis of PVD is made when these symptoms have been present for at least three months.

Provoked vulvodynia occurs most often in women around the age of 25 and in women approaching the menopause. It frequently develops as a result of persisting with intimate activity despite pain or insufficient arousal. It can also arise following a vaginal infection (such as a yeast infection), or after a distressing sexual or physical experience.

The skin around the vaginal entrance heals slowly, partly because the area is relatively moist. There is often also excessive tension in the pelvic floor muscles, which further hinders recovery. Women with PVD are usually advised to avoid any activity that provokes pain, in order to break the negative cycle. You can find more information in our article on vaginismus exercises and solutions.

Provoked vulvodynia was formerly known as focal vulvitis or vestibulitis syndrome (VVS).

Essential vulvodynia - persistent discomfort of the vulva

Essential vulvodynia refers to chronic vulvar pain that is present outside of intimate activity as well, and for which no physical cause can be identified. This condition is relatively rare and occurs primarily in older women.

Essential vulvodynia is usually approached and treated as a chronic pain condition rather than a sexual health concern.

Aids for pain during intimacy

View all

Sources

  1. https://www.isala.nl/patientenfolders/5643-seksuele-problemen-vrouw/
  2. Sexology (textbook), edited by Luk Gijs, Woet Gianotten, Ine Vanwesenbeeck, Philomeen Weijenborg
  3. Leaflet: Pain during intimacy - Rutgers WPF
  4. Leaflet: Conditions of the vulva - Tergooi
  5. Book: Sex - A Lifelong Journey of Discovery - Rik van Lunsen and Ellen Laan
  6. https://www.soaaids.nl

Veelgestelde vragen

Wat zijn de meest voorkomende oorzaken van vaginale pijn?

De meest voorkomende oorzaak is penetratie terwijl de vagina nog niet voldoende is voorbereid. Dit kan wondjes veroorzaken die branderigheid en pijn geven. Ook hormonale veranderingen na de overgang, infecties, huidaandoeningen en vulvodynie kunnen vaginale pijn veroorzaken.

Hoe kan ik vaginale pijn na de overgang voorkomen?

Na de overgang wordt de vagina droger en kwetsbaarder. Zorg voor voldoende voorspel en opwinding voordat u penetratie heeft. Een goed glijmiddel kan uitkomst bieden. Ook oestrogeenhoudende zalven of tabletten kunnen helpen tegen atrofische vulvitis.

Wanneer moet ik naar de dokter bij vaginale klachten?

Ga naar de huisarts, arts-seksuoloog of gynaecoloog als u langer dan enkele dagen last heeft van pijn, jeuk, branderigheid, afscheiding of andere klachten aan de vulva. Bij nieuwe huidafwijkingen, zweertjes of verharde plekjes is onderzoek altijd nodig.

Wat is het verschil tussen vulvodynie en vaginisme?

Vulvodynie is chronische pijn aan de vulva zonder duidelijke oorzaak. Vaginisme is het onvrijwillig aanspannen van de bekkenbodemspieren waardoor penetratie moeilijk of pijnlijk wordt. Beide aandoeningen kunnen samengaan en hebben professionele behandeling nodig.

Kunnen seksspeeltjes helpen bij vaginale pijn?

Bij sommige aandoeningen zoals lichen sclerosus kan een vibrator helpen de doorbloeding te stimuleren. Dilators kunnen bij vaginisme helpen om geleidelijk te wennen aan penetratie. Overleg altijd eerst met uw zorgverlener voordat u hulpmiddelen gebruikt.

Wat kan ik zelf doen tegen vaginale irritatie?

Vermijd parfums, zeep en andere irriterende stoffen in het intieme gebied. Was alleen met lauw water. Draag katoenen ondergoed en vermijd te strakke kleding. Gebruik een goed glijmiddel tijdens seks en zorg voor voldoende voorspel.

Related articles

Leave a comment

Note: Comments must be approved before they are published.