Burning, stinging, rawness, or pain at the vaginal opening that doesn’t go away. Sex hurts, tampons hurt, and sometimes sitting down hurts. You’ve maybe been treated for a yeast infection or a UTI (or three), and nothing changed.
That pattern has a name, and it’s treatable. At Below The Belt, we figure out what’s driving your pain and build a plan to calm it down.
Vulvodynia is vulvar pain that lasts three months or longer without an obvious cause like an infection or a skin condition. It’s usually described as burning, stinging, rawness, or a feeling like a paper cut.
The most common form is vestibulodynia: pain right at the vaginal opening that’s triggered by touch, like sex, tampons, or a speculum. Other women have pain that’s more widespread or that shows up on its own without being touched. It’s common, affecting an estimated 8% of women by age 40.
“No obvious cause” doesn’t mean no cause. It usually means several things are feeding the pain at once:
Figuring out which of these apply to you is what decides treatment. If you’re not sure your pain is vulvodynia, start with our page on painful sex.
When the pain started, what triggers it, what it feels like, and what you’ve already tried. Your birth control history matters a lot here, including pills you stopped years ago.
A list of medications and supplements, any past test results, the treatments you’ve tried (and whether they helped), and the products you use down there: soaps, wipes, lubricants, and laundry detergent all count.
An exam is part of every evaluation. We rule out infections, skin conditions, and tissue changes, then use a cotton swab to map exactly where it hurts. It’s slow, we explain everything as we go, and you can pause or stop at any time.
Most women do best with a combination, matched to what’s driving their pain. Depending on what we find, options include:
Vulvodynia rarely has a single fix. Treatment usually works in layers: calm the tissue, treat the hormones, relax the muscles, quiet the nerves. Each layer builds on the last.
If penetration hurts, it’s smart to take it off the table for a while. That’s not the same as giving up sex, and we’re happy to talk about what still feels good.
Progress is gradual and easy to miss. A simple 0-to-10 pain score after triggers like sex or tampons helps us see what’s working.
Most women get substantial relief. Flares can still happen, especially during stress or hormonal shifts, but they get easier to recognize and manage, and they don’t mean you’re back at square one.
Topical anesthetics may help right away. Nerve-calming medications usually take several weeks. Hormonal treatment at the vestibule usually takes two to three months to show its full effect, and sometimes longer when birth control was the driver. Pelvic floor therapy typically takes a few months of consistent work. Regenerative treatments take weeks to months as tissue responds.
This is a months-long project, not a quick fix, and we’ll adjust as we go. If something isn’t helping, we change course.
Results vary. Your plan and expectations will be based on your own evaluation.
Vulvodynia is a real pain condition with measurable changes in the nerves, tissue, and muscles. Because the skin often looks normal, it’s easy to miss, and research has found that many women see several providers before getting a diagnosis. If that’s been your experience, you’re far from alone.
The good news: once it’s recognized, there’s a lot we can do. And because vulvodynia often travels with other conditions like IBS and bladder pain, treating it well means looking at the whole picture, which is exactly what Below The Belt is built for.
We’re a cash-pay clinic, so there are no surprise insurance bills. What you pay depends on your plan:
You’ll get a clear quote after your first visit, before anything starts.
Your care is led by Dr. Jake Shank, a board-certified physician and Menopause Society Certified Practitioner. Vulvar pain, hormones, and pelvic health are what we focus on, not a side menu.
We’ll take the time to find what’s driving your pain, explain it in plain language, and use everything from simple topicals to advanced regenerative options to treat it.
No, though it’s often mistaken for one, or for a UTI. If you’ve been treated for yeast or urinary infections repeatedly without relief, or your tests keep coming back negative, vulvodynia is worth considering. Repeated antifungal treatments can even make the tissue more sensitive.
It can contribute. Some pills lower the hormones the tissue at the vaginal opening depends on, and pain can start months or years after you begin taking them. We’ll look at your history and talk through options.
Maybe for a while, if penetration is a trigger. That’s about letting tissue and muscles calm down, not giving up sex. We’ll talk about what still works.
No. It involves real changes in nerves, tissue, and muscles. Stress can make any pain louder, and that’s worth addressing, but it’s not the cause.
For most women, it gets substantially better with the right combination of treatments. Some find it resolves; others manage occasional flares. Either way, the goal is getting your life back.
Book a consultation and bring your questions, even the awkward ones. Especially the awkward ones.
