Painful spasms of the pelvic floor muscles -Levator ani-, is often the presenting symptom of patients with vulvodynia. This condition has been called several names including levator ani syndrome and myofascial dysfunction.

Myalgias of the pelvic floor are often the result of trauma and/or inflammation of the perineal branch of the pudendal nerve. The pudendal nerve originates from the S2-S4 region of the spinal cord, and serves to transmit both sensory input to the vulva and perineum, as well as motor function to the muscles of the pelvic floor and external sphincters of the urethra and rectum.

Inflammation of the pudendal nerve -Pudendal Neuralgia- could result from a number of factors. These include: stretching or injury during labor, vaginal delivery or episiotomy repair; accidental trauma to the pelvis and vulvar-vaginal procedures or infections. This in turn causes painful spasms of the affected muscles and fascia that become knotted and unable to relax. The surrounding muscles try to compensate, often resulting in "overloading" of the muscles and the development of painful trigger points (fibromyalgia).

Treatment of pelvic muscle myalgias may require pudendal block and/or pelvic physiotherapy and biofeedback.