Pain with Sex Is Not Something You Just Have to Live With
Vestibulodynia is one of the most common — and most under-recognised causes of intimate pain in women. Here’s what it is, what the latest research tells us, and how women’s health physiotherapy can help.
If you've ever experienced burning, stinging or sharp pain at the entrance to the vagina — during sex, when inserting a tampon, or even just from wearing tight clothing — you are not alone, and you are not imagining it.
For many women, this pain goes unnamed for years. It gets dismissed, minimised, or attributed to stress. Some women quietly stop having sex. Others simply endure. Many don't even know there's a name for what they're experiencing.
There is. It's called vestibulodynia — and it is both common and treatable.
At Ivoryrose, we support women with vestibulodynia regularly. In this post, we want to share what the evidence tells us — including insights from a recent randomised controlled trial by Murina et al. (2023) — and explain exactly how women's health physiotherapy fits into the picture.
What is vestibulodynia?
Vestibulodynia (VBD) is the most common form of vulvodynia — chronic vulvar pain — and is characterised by tenderness and pain at the vulvar vestibule, the tissue at the entrance to the vagina. Research suggests it affects approximately 8–15% of women during their lifetime.
The pain is typically provoked — meaning it occurs in response to touch or pressure, such as during sex, tampon insertion, a gynaecological examination, or even tight clothing. Women most commonly describe it as burning, stinging, rawness or a pricking sensation.
VBD can occur at any age. It is not a sign of how relaxed you are, how much you want sex, or how hard you're trying. It is a real, documented pain condition — and it deserves real, evidence-based care.
What causes it?
This is perhaps the most important thing to understand: vestibulodynia is not a single condition with a single cause. Current research confirms it is multifactorial — meaning it arises from a complex overlap of contributing factors that look different for every woman.
These can include:
Inflammation — neuroinflammatory responses in the vestibular tissue
Hormonal changes — including oral contraceptive use, perimenopause, menopause, or the postpartum period
Genetic predisposition
Nerve sensitivity — biopsy studies have shown increased nerve fibre density in the vestibular tissue, contributing to heightened pain perception
Pelvic floor muscle overactivity — chronic muscular tension in the pelvic floor
What these factors share is a common endpoint: vestibular hypersensitivity and pelvic floor dysfunction. Understanding this overlap is exactly why treatment needs to address more than one system at once.
The pelvic floor: a central piece of the puzzle
One of the most consistent findings in the VBD literature is the role of pelvic floor muscle dysfunction. Chronic muscular tension in the pelvic floor creates a self-reinforcing cycle:
Pain → muscular guarding → reduced blood flow and increased sensitivity → more pain.
This cycle also produces myofascial trigger points — areas of heightened sensitivity within the muscle tissue that can cause localised or radiating pain and significant tenderness.
The good news? This cycle can be interrupted. The pelvic floor doesn't hold tension because you're anxious or not trying hard enough — it responds to pain. And with the right treatment, it can learn to let go.
There is also a clear neurological connection between the pelvic floor muscles and the vulvar vestibule — their sensory and motor nerve fibres are deeply interconnected. This means that treating the vestibular pain can reduce muscle dysfunction, and treating the pelvic floor can reduce vestibular sensitivity. The two systems talk to each other, which is exactly why a whole-person approach works.
What does the research say?
The 2023 randomised controlled trial by Murina et al., published in Medical Sciences (Basel), investigated the effectiveness of intravaginal TENS (Transcutaneous Electrical Nerve Stimulation) in women with vestibulodynia — and the results are worth knowing about.
The study: 78 women with confirmed VBD were divided into two groups, both using a home-based TENS device with an intravaginal probe over 120 days. The groups differed in the electrical stimulation parameters used.
Group 1 used an alternating approach — cycling between high frequency (100 Hz) and low frequency (5 Hz) stimulation in each session, targeting two different pain pathways simultaneously.
Group 2 used a less varied parameter set.
The results for Group 1 by day 120:
38.2% reduction in burning and pain scores
52.1% reduction in pain during sex
44.2% reduction in vestibular sensitivity
22.9% improvement in Female Sexual Function Index scores
23% improvement in pelvic floor muscle function
Improvements continued to build progressively from day 60 through to day 120, with no adverse effects reported. The alternating parameters in Group 1 were more effective because they engaged two neurological pathways at once — reducing pain both at the spinal level and through the release of the body's natural pain-relieving compounds. Put simply: a more comprehensive approach produced better results.
Why one treatment is rarely enough
One of the most important conclusions of the Murina 2023 paper is straightforward: because VBD involves multiple overlapping factors, a single-approach treatment plan is rarely sufficient.
Current best practice consistently identifies a multidisciplinary approach as the gold standard — addressing all the systems involved so that treatment actually works and the results last. This typically includes:
Women's health physiotherapy — for pelvic floor dysfunction, tissue sensitivity and pain education
TENS therapy — as an evidence-based adjunct within a physiotherapy programme
Medical assessment — for hormonal contributors or pharmacological options where relevant
Psychological support — particularly for the fear-avoidance cycle that can develop when sex consistently hurts
Pain education — understanding why pain is occurring is itself a validated part of treatment
This isn't about adding more to your plate. It's about addressing the full picture — so that the care you receive is actually matched to the complexity of what you're experiencing.
How we support vestibulodynia at Ivoryrose
Our approach to VBD is grounded in this multidisciplinary, evidence-based model. We understand that seeking help for intimate pain takes courage — and we take that trust seriously.
An assessment and treatment plan with our team is highly individualised and may include:
A comprehensive history — understanding your symptoms, triggers, hormonal context and how pain is affecting your daily life and relationships
Pelvic floor assessment — evaluating resting tone, trigger points, coordination and endurance
Manual therapy — hands-on techniques to address muscle tension and tissue sensitivity
TENS therapy — applied using evidence-based parameters
Biofeedback training — building conscious awareness and control of your pelvic floor, including the skill of relaxation
Graded desensitisation — gentle, progressive techniques to reduce vestibular reactivity over time
Pain neuroscience education — understanding your nervous system's role in pain, which itself changes the pain experience
Breathing and nervous system regulation — essential tools for downregulating the pain response
A home programme — so you feel supported and empowered between sessions
We also know when additional support is needed — whether that's referral for hormonal assessment, collaboration with a psychologist, or liaison with your GP or gynaecologist. VBD rarely benefits from a siloed approach.
Why vestibulodynia is so often missed
Many women live with VBD for years without a diagnosis. They may have been told everything "looks normal", that they need to relax, or that pain during sex is just something their body does.
The gap between symptom onset and diagnosis in VBD is well documented, and it reflects a broader pattern of women's intimate pain being under-investigated and undertreated. The silence around vulvar and sexual pain also means many women feel too embarrassed to raise it, or assume their experience isn't significant enough to warrant help.
We want to be unambiguous: this pain is real, it has a name, it has a mechanism, and there is evidence-based treatment available. You do not have to keep living with it.
You deserve to feel comfortable in your own body
Living with vestibulodynia can be isolating. It can affect your relationship with your partner, with your own body, and with your sense of self. The silence around it makes that harder.
At Ivoryrose, our goal is to be a place where women can speak openly about their pelvic and sexual health — where pain is met with clinical curiosity, not dismissal, and where care is always individualised, evidence-based, and delivered with warmth.
If any of what we've described resonates with your experience, please reach out. You don't need to have everything figured out before you book. A conversation is always the right place to begin.
Book an appointment with our women's health physiotherapy team, or visit our Women's Health and Perimenopause & Menopause pages to learn more about the full scope of care we offer.