Hormones and Your Vulva: How Imbalance Can Cause Pain and Discomfort
Experiencing burning, irritation, or dryness in your vulva? Learn how hormone imbalances—like low estrogen or testosterone—can cause vulvar pain and what you can do to treat it.
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
Take the First Step Toward Relief
VULVAi is the first AI-powered platform designed to help you understand what’s causing your pain and what to do about it. Whether it’s vestibulodynia, HMV, or hormonal imbalance—we give you evidence-based insights and language to advocate for your care.