Do Your Symptoms Feel Like a UTI or Yeast Infection—but Never Go Away?

If you’ve been dealing with persistent burning, itching, or sensitivity around the vaginal opening, and treatments like antibiotics or antifungals aren’t helping, it might not be an infection at all.
It could be Hormonally Mediated Vestibulodynia (HMV)—a condition where hormonal imbalances make the tissue around your vaginal opening (the vestibule) hypersensitive and painful.

What Is HMV?

Hormonally Mediated Vestibulodynia (HMV) is a type of vestibulodynia—a chronic pain condition that affects the vestibule, the sensitive area just outside the vaginal opening.

Common HMV Symptoms Include:

• Burning or rawness during or after sex

• Pain inserting tampons

• Discomfort from tight clothing

• Irritation with wiping or touch

If these symptoms persist—but your test results are always negative—hormones might be the hidden cause.

What Causes Hormonally Mediated Vestibulodynia?

HMV is typically triggered by hormonal shifts that lead to thinning, drying, or inflammation of the vestibular tissue. Here’s what could be behind it:

1. Hormonal Birth Control
Low-dose oral contraceptives (like Yaz or Lo Loestrin) can reduce free testosterone by up to 60%. This drop affects the health of your vulvar tissue—causing dryness, pain, and hypersensitivity.
Pro Tip: If your pain started after switching birth control, it might be HMV.

2. Menopause
During menopause, estrogen levels decline, which thins the vestibular tissue and reduces natural lubrication—often triggering HMV-like symptoms.
Hot Take: HMV isn’t just a menopause issue. It can affect people of any age with hormonal shifts.

3. Postpartum & Breastfeeding
After giving birth, estrogen drops—especially if you're breastfeeding. This can cause dryness and pain around the vestibule, especially during sex or physical activity.
Quick Tip: Stay hydrated and use vulvar moisturizers or lubricants during this time.

4. Medications That Lower Hormones
Medications used for endometriosis, PCOS, or acne—especially anti-androgens—can suppress testosterone, worsening HMV symptoms.
Reminder: If your symptoms started after a medication change, ask your doctor about hormonal effects.

5. Genetics
Some people may be genetically more sensitive to hormone shifts, making them more prone to HMV.
Real Talk: You can’t change your genes, but you can tailor your treatment.

How to Know If It’s HMV—Not a UTI or Yeast Infection

HMV Can Be Mistaken For:

• Recurrent yeast infections

• Chronic UTIs

• Vulvar dermatitis or allergic reactions

If you've had multiple negative cultures, tried all the creams, and still feel burning or pain—HMV is worth investigating.

How to Get a Proper HMV Diagnosis

Getting diagnosed with HMV requires a knowledgeable provider and the right approach.

Steps to Take:

• Track your symptoms: When they occur, what triggers them, how they feel

• Ask for hormone labs: Test estrogen, free testosterone, and SHBG

• See a vulvovaginal specialist: Not all providers are trained in HMV diagnosis and care

Use this language:
“Could this be hormonally mediated vestibulodynia? I’ve had negative cultures but persistent pain.”

HMV Treatment Options That Actually Work

Good news: HMV is treatable, especially when diagnosed early. Common treatment options include:

1. Topical Hormone Therapy

• Vaginal estrogen creams

• Testosterone ointments applied to the vestibule
  These help restore tissue strength, moisture, and comfort.

2. Pelvic Floor Physical Therapy

• Tight or overactive muscles can worsen vestibular pain. A trained PT can help release tension and reduce hypersensitivity.

3. Lifestyle Adjustments

• Use only water or fragrance-free gentle cleansers

• Wear breathable cotton underwear

• Use water-based lubricants (like Uberlube or My Personal Fav)

• Avoid douches, wipes, and scented products

Living with HMV: What You Need to Know

Untreated HMV can affect:

• Your sex life

• Your confidence

• Your ability to exercise, wear certain clothes, or feel present in your body

But once diagnosed, most people find relief through hormone support, physical therapy, and lifestyle changes.

You Deserve Real Answers—Not More Guesswork

If you’ve been told “it’s just another UTI” or “you’re fine,” but the pain keeps coming back—trust your instincts.

HMV is real.Your pain is real. And you deserve treatment that sees the full picture—not just a lab result.