To improve difficulties with vulval pain, it is important to:

  • Have sex only when you want to
  • Meet your own conditions for good sex (for example having privacy, feeling relaxed, not feeling rushed, pressured, tired or distracted, feeling able to trust a partner)
  • Learn to recognise when you are tense and identify techniques and ways to relax and overcome this
  • Use self-exploration to identify the kind of stimulation you like and focus on this stimulation during partnered sexual activity
  • Be able to enjoy having sex rather than worrying about your performance
  • Feel confident to communicate and negotiate about sex with your sexual partners

Lifestyle factors

A healthy lifestyle helps to reduce stress levels and improve cardiovascular health. In turn, this can enhance arousal and support sexual functioning. A healthy lifestyle can be supported by:

  • Getting enough sleep
  • Eating well
  • Exercising regularly
  • Stopping smoking
  • Limiting the use of alcohol and recreational drugs

Visit www.nhs.uk/live-well for help and advice around maintaining a healthy lifestyle.

We know that there are three key elements that enable sex to go as well as possible: psychological arousal, physical touch, and being in the moment. These are known as the Conditions for Good Sex (Gurney, 2020). 

Psychological arousal refers to how much of what is happening you find sexually arousing and turns you on. This can include how attracted you feel to your sexual partner(s), things in the environment (like lighting, sounds), the context (time of day, your role in the sexual experience), and also sexual fantasy and types of porn. 

Physical touch refers to the types of physical stimulation that your body needs to feel sexually aroused. This can include the types of pressures your body needs, the speed and location of touch, the types of sex you enjoy and whether you enjoy using sex toys and/or lubricant (‘lube’). 

Being in the moment refers to how much you are able to be in the present moment (rather than caught up in other thoughts or worries) and how much you’re able to focus on the physical sensations and psychologically arousing stimulation. This also includes how much you’re able to feel relaxed. Later in this booklet we have included suggestions about using mindfulness to increase being in the present moment.

The closer each of these elements are to our ideal conditions, the better the sexual experience will be. If we have high psychological arousal (are aroused and turned on), are receiving the types of physical touch we find pleasurable and are able to be in the present moment (and not distracted by other thoughts or worries) we have met the conditions we need in order for sex to go well.

Knowing your own conditions for good sex can help you to:

  • understand what you need for sex to be its most enjoyable
  • understand what might be disrupting the arousal process
  • understand how these conditions might have changed or been impacted by sexual difficulties

It is not usually necessary for all of your conditions for good sex to be met throughout every sexual experience for the experience to be enjoyable. However, understanding your own conditions, and talking about them with sexual partners, can help to include more of your conditions more of the time. 

Our pelvic floor muscles are like ‘a bowl of muscle’ underneath the pelvis. They provide support for the pelvic organs and help control when we go to the toilet. They also help to increase blood flow to your genitals which aids arousal and increases pleasure. Contractions of these muscles also help produce sensations at orgasm.

The image below shows where your pelvic floor muscles are on your body. You can feel your pelvic floor muscles by contracting your anus as though you’re trying to stop a bowel movement, then imagine a zip closing forwards an upwards as if you’re trying to stop the flow of urine at the same time.

Medical Diagram – internal and external diagram of genitalia including: vaginal opening, tip of clitoris, pelvic floor muscles, cervix, uterus, anus and rectum.

Sometimes, the muscles of the pelvic floor can become tight or tense. There are many reasons why this happens, for example injury during surgery or childbirth, a history of sexual trauma, feeling anxious about sex for any reason, or just the anticipation of penetration. This tension can cause pain or discomfort during sexual activity, and reduce pleasure. 

Pelvic floor relaxation exercises improve your awareness of when these muscles are tense or relaxed. Ensuring our pelvic floor muscles are relaxed helps sex to be enjoyable and not uncomfortable or painful.

To practise pelvic floor relaxation, you can use a technique called ‘Sniff, Flop and Drop’. 

  • Sniff - take a soft and deep breath in through the nose over three seconds. Keep your shoulders relaxed and your chest still.
  • Flop - keep your stomach soft while breathing in. This should mean that the abdomen ‘flops’ or fills all the way out on the in-breath.
  • Drop – allow your pelvic floor to drop or release also during the in-breath. 

You might find it easier to close your eyes while doing the exercises to really focus on the sensation of the pelvic floor relaxing, of ‘dropping away’. You can then take this skill into sexual situations, consciously relaxing your muscles in the sexual moment.

Earlier in this booklet we explained the importance of being in the present moment to fully enjoy sex. ‘Mindfulness’ has its roots within a wider set of Buddhist spiritual teachings and practices, the benefits of which have been known to Asian communities for centuries. More recently, a secular version of mindfulness practice has been adopted by Western cultures. Mindfulness practice can enhance our connection to the present moment, which can help improve a range of difficulties, including sexual ones.

When we get caught up with critical thoughts or trying to change things, this takes us away from the present. An important part of mindfulness is paying attention to your present experience without evaluating it. This means not judging the experience that you are having, just noticing it with curiosity and openness. 

There are many ways to practise mindfulness. For example you could:

  • Go on a walk and use all your senses to notice your present moment experience – the different things (like colours and textures) you can see, the smells and the sounds. Rather than ‘listing’ the things you notice, this is about really experiencing them in depth and detail. 
  • Sit in comfortable position, with your feet on the floor and your back straight but relaxed. Spend some time focusing on your breath as you inhale and exhale, focusing your awareness on the natural rhythm of your breathing.

It is completely normal for your mind to wander. When you notice this has happened, gently bring the focus of your attention back to the present moment. 

It can take time to increase your ability to be mindful. You can start by practising for 10 minutes each day as you get more confident. Building up your day to day mindfulness skills can help you stay more present during sexual situations. Everyone responds differently to mindfulness practice, however. As with all suggestions in this booklet, only do what feels right for you and stop if anything causes you pain or feels distressing.

If the pain you are experiencing is associated with a medical cause, a doctor may suggest medical treatment, for example antifungal medication for a yeast infection, antibiotics for a urinary tract infection, or antivirals for herpes infection. There are also local anaesthetic preparations that can be used to reduce sensitivity and pain in the vulva area. Oral medications, such as some types of antidepressants and anti-epilepsy medicines, can be helpful for some people with persistent vulval pain. Your doctor can also advise about your general vulval and vaginal health and alternatives to products you might be sensitive to.

Sometimes a specialist referral may be required, for example to a dermatologist or gynaecologist, which your GP will be able to make for you. Pelvic floor exercises can help you to relax the muscles around your vagina if they are too tense, however if you find you need more specialist help with this than you can ask your doctor for a referral to a pelvic floor physiotherapist. A physiotherapist might also suggest trying a TENS (transcutaneous electrical nerve stimulation) machine, which some people find reduces their pain. They might also recommend vulval massage techniques.

The vagina’s production of natural lubricant can be affected by a range of factors (for example: the menopause and certain medications). If your vagina feels dry, you can try to make sex more comfortable by getting more turned on before sex and/or by using a lubricant (lube), which you can buy at any chemist, sex shop or online. Lots of people find that lube makes intimate touching more pleasurable. Over the counter emollient creams can also help with vaginal dryness. 

Painkillers such as paracetamol do not usually help with this kind of pain. Applying an anaesthetic cream or gel around 20 minutes before sex can help make things more comfortable. If having sex with a partner, you can wipe the product off beforehand to avoid it transferring to their body. You can buy anaesthetic gel, such as lidocaine, over the counter from a pharmacy. Before trying this, get advice from you doctor and make sure it is a product suitable for the genital area. If you use latex condoms you will need to switch to latex-free, as these products can damage latex.