Any of the causes of vulval itching may cause actual pain if they are severe (see section on vulval itching). Thrush or trichomonas, for example, can both make the vulva very sore. However, other causes of pain include genital herpes, gonorrhoea, ulcers, and syphilis. Vulvodynia and vulval vestibulitis are other pain syndromes affecting the area discussed below.

Genital Herpes

Genital herpes results from infection with the herpes simplex virus. Small blisters form on the genital area and these burst to form small ulcers that take about 10 days to heal. If you think that you have herpes, you should speak to a genitourinary medicine (GUM) clinic for tests and treatment (take a look at the section on genital herpes to find out what you should do).

Vulval Pain Syndrome

Vulval pain syndrome (sometimes called vulvodynia) is a very unpleasant burning or aching feeling. The sensation is unremitting and is often worse at night. It is more common around the menopause or in older women. It is diagnosed when other causes of pain, such as a skin disease, have been ruled out. The vulva looks perfectly normal, but the pain is real. No-one knows what causes it.

What Can Be Done about Vulval Pain Syndrome?

• Topical treatments such as hormonal replacement creams (containing oestrogen) can be helpful when symptoms are related to oestrogen deficiency (e.g., during the menopause).
• Topical anaesthetics can also be beneficial, such as a lidocaine gel or ointment.
• Aloe vera gel, Calendula and Dr Bach Rescue Cream are remedies for sore and painful skin. You can buy them from health food stores. Try each separately. You may also be able to soothe the area by applying vitamin E oil (which you can squeeze out from capsules of vitamin E).
• Aqueous cream is a plain, soothing, perfume-free cream that you can buy from pharmacies. Many women with vulvodynia find that aqueous cream helps by soothing and rehydrating the skin. Use it cold, by storing it in the fridge. Unlike steroid creams, you can use it as often and for as long as you like.
• Oatmeal baths are a useful treatment for severe attacks of pain. You can buy sachets (e.g. Aveeno) from health shops. Put a sachet in the bath and bathe for 20 minutes. Repeat up to four times.
• Tricyclic antidepressant medication such as amitriptyline often helps. This is not because you are depressed (or imagining the condition), but because these drugs suppress transmission in nerves of the skin.
• Other “neuropathic” (meaning works on the nerves) medications may also help, such as antidepressants or anticonvulsants and pain-relieving opioids such as oxycodone.
• Pelvic floor physiotherapy can be helpful if there is spasm or weakness in the muscles of the pelvis that can cause pain.
• Psychosexual counselling can be really effective for treating vulval pain, especially when the condition affects sexual relationships or is associated with mental health conditions such as anxiety or depression.
• Your local hospital may have a vulval clinic that your family doctor/GP could refer you to. Vulval clinics are usually part of the hospital dermatology or gynaecology department, and doctors at these clinics are experts in looking after people with painful vulvas.
• You could also look at the advice in the sections on vulval itching and dry vagina.

Vulval Vestibulitis Syndrome

With vulval vestibulitis syndrome, you experience severe pain when the opening of the vagina (the vestibule) is touched. The syndrome usually comes on quite suddenly, and is most common in women in their 20s or 30s. It is very distressing because, as well having to cope with the pain, it can significantly impact your sex life and it can even prevent you using tampons, wearing jeans or riding a bike. It may affect 1 in 20 women at some time (British Medical Journal 2004;328:1214–1215).The cause of vulval vestibulitis is not known, but some experts think the nerves of the genital skin become oversensitive.

What Can Be Done about Vulval Vestibulitis Syndrome?

• Do not feel too discouraged, because the problem often improves with time.
• Teabags (Indian tea) or Earl Grey contain tannic acid, which is a local anaesthetic and can calm the burning sensation of vulval vestibulitis. Put teabags in the bath, or put a cold, damp teabag on the sore area at night.
• You may be able to soothe the area by applying vitamin E oil (which you can squeeze out from capsules of vitamin E).
• Aqueous cream is a plain, soothing, perfume-free cream that you can buy from pharmacies. Many women with vulval vestibulitis find that aqueous cream helps by soothing and rehydrating the skin. Use it cold, by storing it in the fridge. Unlike steroid creams, you can use it as often and for as long as you like.
• 5% lignocaine ointment contains a weak amount of the local anaesthetic lignocaine. It numbs the nerves in the skin and can be used safely on a regular basis. Although it does not cure the problem, it will allow you to have sexual intercourse comfortably if you apply it 15 minutes beforehand.
• You could try a diet that is low in oxalate, a plant chemical. The evidence that this works is scanty, but some women find it helpful. This means avoiding beetroot, chocolate, cola drinks, cranberries, nuts, rhubarb, soya foods, spinach, strawberries, tea and wheat bran.
• As with vulvodynia, tricyclic antidepressant, anticonvulsant or opioid medication for 3–6 months often helps. This is not because you are depressed (or imagining the condition), but because these drugs suppress transmission in nerves of the skin. So talk to your family doctor.
• As with vulvodynia, ask your family doctor if your local hospital has a vulval clinic that you could be referred to. Some clinics use a technique called electromyographic feedback from pelvic floor muscles, which is a method of training your nervous system to stop sending the pain signals.
• You may also find the section on things to do to help with vulvodynia, itchy vulva or dry vagina helpful.

First published on embarrassingproblems.com
Reviewed and edited by Dr Laura Gush
Last updated: June 2025 by Dr David Rook