Vaginismus, Vulvodynia, Dyspareunia… What’s the Difference?

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Chances are, a gynecologist has never asked if you’re experiencing vaginal pain, despite the fact that it’s surprisingly common. Research shows that 1 out of 5 women have painful sex. And as many as 1 in 4 experience some kind of chronic pelvic pain. If you’re lucky enough to have a doctor who brings up vaginal pain, they may use confusing terminology that they don’t have time to explain during a packed, 15-minute visit.

As a woman or individual with vaginal anatomy, knowing the vocabulary of vaginal pain will help you communicate clearly and confidently with health care providers. Check out the various names for vaginal pain below, plus advice on when to see a pelvic floor physical therapist.

The Vocabulary of Vaginal Pain

Dysmenorrhea

Dysmenorrhea basically describes menstrual cramps. Dysmenorrhea can be debilitating and can occur on its own, or it can occur as a result of another condition, such as endometriosis.

Endometriosis

Endometriosis occurs when tissue similar to the lining of your uterus (your endometrium), grows outside of your uterus. A lot of complicated symptoms can occur with endometriosis, including pelvic and low back pain, digestive problems, pain with bowel movements, and even pain with intercourse.

Dyspareunia

Dyspareunia is pain with sex. You may have pain before, during, or after sex, and pain can be felt anywhere in the vagina or pelvic/abdominal areas.

Vaginismus

Vaginismus used to have a very specific definition: The involuntary contraction of the outer third of the pelvic floor muscles in response to attempted vaginal penetration (by a penis, tampon, toy, etc). Now it’s being used more generally to describe pain and anxiety with penetration. Both vaginismus and dyspareunia are considered genito-pelvic pain and penetration disorders.

Vulvodynia

The suffix ‘dynia’ means ‘pain,’ and vulvodynia refers to pain that comes from tissues of the vulva. Quick anatomy review: The vulva is the external female anatomy that includes the outer and inner labias, the vaginal entrance (introitus), the tissue surrounding the vaginal entrance (vestibule), plus the urethral opening and the clitoris.

If pain is coming from any of these tissues (whether the pain is provoked by touch or always there), it may be vulvodynia. It’s also common to experience pain with intercourse and even experience bladder symptoms such as urinary urgency and frequency.

Vulvodynia can be further classified into vestibulodynia and clitorodynia, which more specifically describe where the pain is coming from.

Pudendal Neuralgia

The pudendal nerve is the main nerve that provides sensation and function to the pelvic floor muscles, including the structures of the vulva, pelvic floor muscles, and anus. With pudendal neuralgia, you may experience “nervey” symptoms such as burning, discomfort, or itching in any of the areas that the nerve provides sensation.

If you have pudendal neuralgia, you may also have pain with sex and bowel or bladder dysfunction. Simple things like sitting can irritate the nerve even further, making symptoms worse.

When to See a Pelvic Floor PT

There are a wide range of reasons why you might have pain in and around your vagina. It could be due to a medical condition like the ones listed here, or it may be its own thing. If you have pelvic pain that’s widespread and difficult to localize, or is associated with a fever, blood in your urine, unusual discharge, a foul smell, or a sudden change in your bowel or bladder function, check in with your physician immediately. They can ensure that you don’t have any immediate health concerns that are causing your pain.

If there isn’t a medical cause to explain your pain, reach out directly to a pelvic floor physical therapist. No matter what the cause, they can probably help. Musculoskeletal pain and dysfunction are seen in up to 90% of those with pelvic pain.

PT-Loved Products To Help Ease Pain With Sex

Living with pain during intimacy can be frustrating and isolating, but there are helpful tools designed specifically to address this issue. These products can be used as part of your overall treatment plan and may provide significant relief:

‍1. Vaginal Dilators: Trainers (aka dilators) can help you break the vaginismus pain cycle or maintain a neovagina. Consult with your pelvic floor PT to find out the best size/type dilator to start with and how to progress slowly to prevent setbacks.

2. Ohnut: This soft, wearable device acts as a buffer during penetrative sex, allowing you to customize penetration depth. It's an excellent solution for deep penetration pain related to endometriosis, pelvic floor tension, or other conditions where depth control makes a difference.

Remember that these products work best as part of a comprehensive approach to addressing painful sex. Using them in conjunction with guidance from your pelvic physical therapist can help maximize their effectiveness and your comfort.

The bottom line: It’s important not to ignore and endure pelvic pain! Chronic pain is tricky and will stick around — and likely get worse — if not addressed. A pelvic floor physical therapist will work with you to investigate causes and contributing factors, and build a treatment plan that helps you start feeling better, as fast as possible.