Vulvodynia vs. Vaginismus: What’s the Difference and How Are They Treated?

Pelvic pain can be a deeply distressing and misunderstood experience, especially when it affects intimacy and daily functioning. Two conditions that often cause confusion, vulvodynia and vaginismus, can present with overlapping symptoms but are, in fact, distinct diagnoses. Understanding the difference is key to getting appropriate treatment and relief. Here's a clear breakdown of these two conditions and how pelvic floor therapy can help.

What Is Vulvodynia?

Vulvodynia is defined as chronic vulvar pain lasting at least three months without an identifiable cause. It can be generalized or localized (such as vestibulodynia, which affects the vaginal entrance), and may be provoked (e.g., by touch or pressure) or unprovoked (occurring spontaneously).

Symptoms of vulvodynia may include:

• Burning, stinging, or irritation around the vulva

• Pain during or after intercourse

• Discomfort when sitting or wearing tight clothing

• Increased sensitivity to touch or pressure

  
  

The exact cause remains unclear, but potential contributing factors include nerve hypersensitivity, pelvic floor muscle dysfunction, past infections, hormonal influences, and central sensitization.

What Is Vaginismus?

Vaginismus is a condition characterized by involuntary contraction of the pelvic floor muscles, particularly the muscles surrounding the vaginal opening, making penetration difficult or painful.

Common symptoms include:

• Burning, tightness, or pressure during attempted penetration

• Inability to tolerate tampons or undergo pelvic exams

• Anxiety or fear associated with vaginal insertion

• A sensation of “hitting a wall” during intercourse

  
  

Vaginismus is a reflexive muscle response, often with both physical and psychological components. It can be lifelong (primary) or develop after a period of pain-free intercourse (secondary).

Key Differences Between Vulvodynia and Vaginismus

Feature	Vulvodynia	Vaginismus
Location of pain	External (vulva)	Internal (vaginal entrance and walls)
Pain triggers	Touch, pressure, friction	Penetration attempts
Pain quality	Burning, stinging, rawness	Tightness, burning, resistance
Muscle involvement	Often secondary overactivity	Primary involuntary muscle contraction
Emotional response	Frustration, confusion	Fear, anxiety, avoidance

Some individuals may experience both conditions simultaneously, further complicating diagnosis and treatment.

vulvodynia

Vaginismus

How Are These Conditions Treated?

Pelvic floor physical therapy is a first-line treatment for both vulvodynia and vaginismus, often used in conjunction with medical or mental health therapy when needed.

Treatment for Vulvodynia

• Pelvic floor muscle downtraining: Many patients with vulvodynia have tight or hypertonic pelvic floor muscles. Gentle manual therapy, internal release techniques, and neuromuscular retraining are used to reduce tension and pain.

• Soft tissue mobilization: Therapy may include work on surrounding tissues like the hips, glutes, and lower abdomen to improve blood flow and reduce referred pain.

• Desensitization strategies: Gradual exposure to touch using wands, soft brushes, or guided self-treatment can help retrain the nervous system to respond to non-threatening stimuli appropriately.

• Education and lifestyle adjustments: Therapists provide guidance on avoiding common irritants (e.g., synthetic underwear, harsh soaps) and improving posture and movement patterns that contribute to pelvic strain.

Treatment for Vaginismus

• Internal muscle retraining: Physical therapists work on relaxing and coordinating the pelvic floor muscles using internal manual therapy and guided exercises.

• Vaginal dilator therapy: A graded dilator program helps desensitize the pelvic muscles to penetration, gradually increasing tolerance in a safe, non-threatening way (4).

• Breathing and nervous system regulation: Diaphragmatic breathing, progressive relaxation, and trauma-informed care are often incorporated to reduce anxiety and reestablish trust in the body.

• Multidisciplinary care: Collaboration with sex therapists, gynecologists, or counselors may enhance outcomes, especially when emotional or relational factors are involved.

The Importance of Individualized Care

No two cases of vulvodynia or vaginismus are the same. A skilled pelvic floor therapist will conduct a thorough evaluation—including a review of medical history, pelvic floor muscle assessment, posture, and functional movement screening—to design a tailored treatment plan that addresses both physical and emotional needs.

Final Thoughts

Pelvic pain and painful intimacy is not "just in your head," and it's not something anyone should feel ashamed to talk about. Whether it’s vulvodynia, vaginismus, or both, effective, evidence-based treatments exist—and pelvic floor therapy plays a central role in restoring comfort, function, and confidence.

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References:

1. Bornstein J, et al. (2016). 2015 ISSVD, ISSWSH and IPPS Consensus Terminology and Classification of Persistent Vulvar Pain and Vulvodynia. Journal of Lower Genital Tract Disease, 20(2), 126–130. https://doi.org/10.1097/LGT.0000000000000194

2. Reissing, E. D., et al. (2004). Vaginismus: A Review of the Literature on the Classification/Diagnosis, Etiology, and Treatment. Archives of Sexual Behavior, 33(5), 515–530. https://doi.org/10.1023/B:ASEB.0000044734.20049.5a

3. Goldstein AT, Pukall CF, Brown C, et al. (2016). Vulvodynia: Assessment and Treatment. Journal of Sexual Medicine, 13(4), 572–590. https://doi.org/10.1016/j.jsxm.2016.01.020

4. Brotto LA, Basson R. (2014). Group mindfulness-based therapy significantly improves sexual desire in women. Behavior Research and Therapy, 57, 43–54. https://doi.org/10.1016/j.brat.2014.04.001