Do you have Vulval Pain? Could the Pill be involved? Let’s Talk About It

Let’s be honest—most of us were handed the Pill as a rite of passage. Bad periods? Here’s the Pill. Don’t want to get pregnant? Here’s the Pill. Irregular cycles? The Pill will regulate it. (Ah, no. It won’t – it actually can’t). There are many things we were not/are not told when it comes to potential impacts of the Pill – even just the basics of how it actually works. One thing I certainly wasn’t told when I started the Pill was that for some women, hormonal contraceptives might be linked to a lesser-known but incredibly disruptive condition: vulval pain, specifically a type called vestibulodynia. And I’m pretty sure I’m not alone in this.

If you’ve ever felt burning, stinging, or irritation at the entrance to your vagina—especially during sex, using a tampon, or even while sitting—you’re not alone. And it’s not all in your head.

So, What Is Vestibulodynia?

Vestibulodynia is a form of vulvodynia (which is the umbrella term for chronic vulval pain without a clear cause). The key difference here is that vestibulodynia is localised to the vestibule—the area just inside the vaginal opening—and is usually provoked by touch or pressure. Think: sex, speculum exams, or even tight clothing.

The pain can feel like rawness, burning, or a constant sting, and for many women, it seriously affects their sense of self, relationships, and daily life.

Is There a Connection With the Pill?

Increasingly, research is saying yes—at least for some women.

Here’s why:

• Hormonal birth control changes your hormone levels. In particular, the combined oral contraceptive pill (COCP) reduces testosterone by increasing a protein called sex hormone-binding globulin (SHBG). Testosterone helps maintain the thickness, elasticity, and sensitivity of your vulval tissues. When your testosterone drops too low, those tissues can become thin, fragile, and more prone to pain. YES – testosterone is important for us too! We actually need testosterone to make oestrogen.

• The vestibule might suffer. With less testosterone and estrogen available to the local tissues, the vestibular glands (which provide natural lubrication) can shrink or become less active—making things drier and more sensitive.

• Younger users may be more at risk. One study found that women who started the Pill under the age of 17 were at increased risk of developing vestibulodynia later on (Reed et al., 2013).

  
  

To put it simply: for some women, the Pill might be setting up the perfect storm for pain.

How Would You Know?

The symptoms might include:

• Pain during sex (sometimes from the first attempt)

• Burning or stinging with tampon use

• Pain even during gentle washing or wearing tight underwear

• A sense of frustration or “brokenness” (you are not broken, by the way)

  
  

Many women go years before getting a diagnosis, often being told it's “just in their head,” “anxiety,” or “vaginismus” which can be exhausting, invalidating, and very frustrating.

What Can You Do?

The good news is: this is not a dead end road. There are treatment options, and avenues of support to explore.

Here’s what some women find helpful:

• Coming off hormonal contraceptives. Some women experience a reduction in pain once they stop the Pill, especially when it’s identified early.

• Topical hormone treatments. Vulval estrogen or testosterone creams prescribed by a knowledgeable GP or women’s health specialist can help restore tissue health. We have some amazing options available today in both practitioners and treatments – make sure you do your research and get recommendations/referrals if possible.

• Pelvic floor physiotherapy. A trained women’s health physio can support you with relaxation, muscle release, and restoring healthy function. They may support you to use a dilator, to guide proper function in these muscles.

• Women’s Health Informed Counsellor. A trained Counsellor can support to deal with any underlying psychological factors that may be contributing to the condition. And to assist in helping restore a healthy connection to this very delicate area of the body.

• Professional therapeutic support. Working with a multidisciplinary team—a GP, pelvic physio, counsellor—can make a big difference.

  
  

You’re Not Alone

This topic is still not talked about enough. Many women suffer in silence, thinking they're the only ones. But once you start speaking to others or reading personal stories you’ll realise this is more common than we’ve been led to believe.

Your pain is valid and your body isn’t broken. And there are options available to you.

As with all communication from our bodies, this condition is an opportunity to acknowledge the depth of sensitivity in a woman’s body. We need to listen to the sensitivity and honour it deeply. Our sensitivity is not something to be frustrated by, but rather to embrace and adjust accordingly.

I wonder what medicine would be like if women were to honour their depth of sensitivity and let the world adjust, rather than adjusting their sensitivity for the world? Perhaps there wouldn’t be such a thing as the Pill??

References:

Aerts, L., & Pluchino, N. (2021). Hormonal contraception and vulvodynia: An update. Gynecological and Reproductive Endocrinology & Metabolism, 2(3), 145–152.

Kiesner, J., & Bittoni, C. (2024). (050) vulvodynia: Risk associated with vulvar/vaginal, psychological and physical side effects of oral contraceptive use. The Journal of Sexual Medicine, 21(Supplement_2). https://doi.org/10.1093/jsxmed/qdae002.046 

Reed, B., Harlow, S., Legocki, L., Helmuth, M., Haefner, H., Gillespie, B., & Sen, A. (2013). Oral contraceptive use and risk of vulvodynia: A population‐based Longitudinal Study. BJOG: An International Journal of Obstetrics & Gynaecology, 120(13), 1678–1684. https://doi.org/10.1111/1471-0528.12407