Provoked vulvodynia is pain felt in the vulva for at least three months without a known cause. This can be triggered by touch or pressure in the vulva, possibly from both sexual and non-sexual stimuli. According to a 2019 study, about 10% of individuals across Europe are affected by provoked vulvodynia, which often results in pain during intercourse.

While not completely understood, common theories for what causes provoked vulvodynia may include hormones (medications, menopause, or breastfeeding), genetics, maladaptive pain processes (due to nervous system dysfunction), and hyperinnervation (having an excessive amount of nerves in the area). It is also widely believed that other psychological, biomedical, and social factors contribute to the development of provoked vulvodynia. For example, the condition is often associated with irritable bowel syndrome, fibromyalgia, post-traumatic stress disorder, anxiety, and depression. Current treatments, which are seen as beneficial, include a combination of medical, psychological, and physical therapies. Psychological treatments may include cognitive behavioral therapy, which helps people work to change unhelpful or negative thought patterns, and acceptance-based treatments (involving mindfulness practices) for vulvar pain and sexual function.

A newer treatment, Acceptance and Commitment Therapy (ACT), which aims to help people adapt to challenges by accepting their feelings and committing to their values and has been used for a variety of psychological ailments, could improve the experience of sexual pleasure and decrease pain interference in everyday life when applied to individuals experiencing provoked vulvodynia symptoms. It focuses around six main pillars: acceptance (learning to live with pain), cognitive defusion (changing the way you react to distressing thoughts), being present, self as context (recognizing thoughts and feelings as separate from yourself), values, and committed action (taking steps that align with your values).

To see if this new treatment could be beneficial in the long run, a 2025 study investigated the effects of internet-based ACT treatment on individuals suffering from provoked vulvodynia. Ninety-one women from Sweden diagnosed with provoked vulvodynia and experiencing symptoms for at least six months were asked to complete a program centered around the pillars of ACT. The program promoted non-judgmental acceptance of experiences and engagement in meaningful activities, both sexual and non-sexual in nature, that were aligned with participants’ personal values and goals. These activities included mindfulness practice, pelvic floor exercises, and exposure exercises, as well as educational content.

While the study was ultimately inconclusive, preliminary results suggest that those who had logged more hours of participation in internet-based treatment or had previous experience with violence or sexual assault showed better outcomes toward vulvar pain acceptance, while those with gastrointestinal issues or who were previously exposed to physical violence showed better outcomes toward activity engagement. This is likely because some comorbidities (two or more medical conditions existing simultaneously in the same person) may be more suitable for psychological treatments in general. Additionally, younger participants showed better outcomes regarding pain willingness (a part of pain acceptance - the amount of pain they allowed themselves to endure before stopping), which may be linked to some more general thoughts about age and receptiveness to treatments. With further study, researchers believe internet-based ACT could prove to be extremely beneficial to those experiencing provoked vulvodynia, potentially decreasing the effects of pain during sexual intercourse and increasing the ability to manage painful symptoms.

References:

• Hess Engström, A., Flink, I., Kero, V., Bohm-Starke, N., & Skalkidou, A. (2024). Internet-based treatment for provoked vulvodynia: Factors associated with treatment outcomes. The Journal of Sexual Medicine, 22(1), 107–113. https://doi.org/10.1093/jsxmed/qdae158
• Rubin, R., & W., C. (2022). Hormonally mediated vestibulodynia. Prosayla. https://www.prosayla.com/articles/hormonally-mediated-vestibulodynia