Understanding Hormonal Vulvar Pain

If you’ve ever experienced unexplained burning, irritation, or discomfort in your vulva, you’re not alone. These symptoms are often dismissed or misdiagnosed as infections—but for many people, the real cause is a hormone imbalance.

Your hormones play a crucial role in maintaining vulvar tissue health. When they’re out of balance, it can lead to vulvar pain, dryness, and discomfort during sex or exercise. In this post, we’ll break down:

• How hormones affect your vulva
  
  

• Common causes of hormonal imbalance
  
  

• Signs your vulvar pain is hormone-related
  
  

• Evidence-based treatments to help you feel better
  
  
  

The Link Between Hormones and Vulvar Health

Hormones like estrogen and testosterone help keep the vulva healthy, resilient, and pain-free:

• Estrogen maintains moisture, elasticity, and thickness of vulvar tissue
  
  

• Testosterone supports sensitivity, blood flow, and tissue strength
  
  
  

When hormone levels drop or become imbalanced, it can result in:

• Vaginal and vulvar dryness
  
  

• Burning or stinging sensations
  
  

• Pain with penetration or exercise
  
  

• Increased inflammation and sensitivity
  
  
  

Common Causes of Hormonal Imbalance and Vulvar Pain

1. Menopause and Perimenopause

Lower estrogen during menopause leads to thin, dry, and fragile tissue. This can cause burning, itching, and painful sex—a condition known as genitourinary syndrome of menopause (GSM).

2. Hormonal Birth Control

Combined oral contraceptives (e.g., Yaz, Lo Loestrin) reduce free testosterone by up to 60%. This affects vulvar resilience, leading to mechanical irritation and discomfort during sex or tampon use.

3. Postpartum and Breastfeeding

Estrogen levels plummet after giving birth, especially while breastfeeding. Many new moms experience vulvar dryness, irritation, and even sharp pain due to this hormonal drop.

4. Polycystic Ovary Syndrome (PCOS)

PCOS causes hormone dysregulation, often resulting in low estrogen or fluctuating testosterone levels that can contribute to vulvar discomfort.

5. Medications and Medical Treatments

Hormone-modifying treatments for endometriosis, breast cancer, or certain antidepressants can cause vulvar thinning and dryness.

How Hormone Imbalance Causes Vulvar Discomfort

Let’s break down what’s happening physiologically:

• Thinning Tissue: Less estrogen = less moisture and elasticity
  
  

• Decreased Blood Flow: Low hormones reduce circulation to the vulva, which can affect sensitivity
  
  

• Inflammation: Fragile tissue is more likely to become irritated or inflamed
  
  

• Increased Sensitivity: Low testosterone can make the vestibule hypersensitive to touch or pressure
  
  
  

Could It Be Hormonally Mediated Vestibulodynia (HMV)?

If your pain is concentrated at the vestibule (the area around the vaginal opening), and it worsens with penetration, tampons, or tight clothes, you might be experiencing Hormonally Mediated Vestibulodynia (HMV).

This condition is often misdiagnosed as chronic yeast or recurrent UTIs—but it won’t improve with antifungals or antibiotics. Instead, it requires hormone-aware treatment.

Signs Your Vulvar Pain Might Be Hormone-Related

Wondering if hormones are the culprit? Look for these common signs:

• Persistent vaginal or vulvar dryness

  
  

• Burning or stinging after sex, even with lube

  
  

• Pain that worsens during hormonal transitions (e.g., starting birth control, postpartum, menopause)

  
  

• Negative tests for yeast or bacterial infections

  
  

• Discomfort with tampons, leggings, or biking
  
  
  

How to Treat Hormone-Related Vulvar Pain

1. Topical Hormone Therapy

• Estrogen creams, gels, or suppositories help restore moisture and thickness
  
  

• Testosterone creams may be used to strengthen tissue and improve resilience
  
  
  

2. Lifestyle and Nutrition

• Stress management, regular movement, and hormone-supportive foods (like flaxseed and soy) can help
  
  

• Stay hydrated and avoid harsh soaps or products near the vulva
  
  
  

3. Pelvic Floor Physical Therapy

• Tight or protective pelvic muscles can worsen pain
  
  

• A pelvic PT can help release tension, improve blood flow, and restore comfort
  
  
  

4. Vulvar Moisturizers and Lubricants

• Daily vulvar moisturizers (e.g., coconut oil or specialized products)
  
  

• Use pH-balanced lubricants like Uberlube or My Personal Fav for sex or internal exams
  
  
  

5. Switching Contraception

• If birth control is contributing to your symptoms, consider non-hormonal options (e.g., copper IUD, condoms) or speak to your provider about supplementing with topical testosterone.
  
  
  

You Don’t Have to Live with Vulvar Pain

Hormonal vulvar pain is real, common—and treatable. You don’t have to wait for a provider to “figure it out,” and you don’t have to suffer in silence