Part of vaginal health is understanding vaginal pain. Vaginal pain is common, and people with vaginas experience it for several reasons. Pain in or around the vagina can have several possible causes, including infection, injury, medical conditions, menopause, childbirth, pelvic floor problems, or allergies. Usually, vaginal pain will go away on its own with time.
An important distinction is that vaginal pain and vulvar pain are different. Pain in the outer tissues of your genitals, such as the labia, is vulvar pain. Internal pain is vaginal pain. However, it is not uncommon for all of this to be classified as vaginal pain.
Health compiled a list of some of the most common sources of vaginal pain and what you should know about them.
Adenomyosis occurs when the lining of the uterus, known as the endometrium, grows into the muscular layers of the uterus. Symptoms of adenomyosis include:
- Pelvic pain
- Vaginal pain
- Painful sex
- Heavy or irregular periods
A hysterectomy, a procedure that removes the uterus, can cure adenomyosis, but may not be an option for people who want to get pregnant later. Hormonal contraceptives can help relieve symptoms for those who want to preserve their fertility but are not trying to get pregnant.
Endometriosis is an inflammatory condition where tissue similar to that lining the uterus is found on structures outside the uterus, such as the fallopian tubes, bladder, or ovaries. Symptoms of endometriosis include, but are not limited to:
- Digestive problems
- Fatigue
- Infertility
- Pelvic pain
Some people experience pain associated with endometriosis only during menstruation, while others experience symptoms consistently throughout the month. The pain commonly associated with endometriosis can spread to the nerves in the vulva and vagina, which can cause discomfort. Less often, endometriosis lesions can also appear on the vagina and vulva.
The gold standard for endometriosis care is excision surgery, where a surgeon removes visible lesions. Hormonal treatments, such as oral contraceptives and intrauterine devices (IUDs), can prevent the growth of lesions and reduce symptoms, but do not eliminate the lesions.
A fibroid is a non-cancerous growth in the uterus. You may have one or several, and depending on its size and location, the growth can cause chronic pelvic pain that some describe as a constant feeling of pressure rather than a sharp pain.
Fibroids are very common and are more likely to develop with age. A health care provider can diagnose fibroids with a pelvic exam, but they’ll likely confirm the diagnosis and get a better sense of exactly where they are and how big they are with tests like ultrasound.
Although some fibroids may require removal, this is not always true. Sometimes fibroids shrink as one approaches menopause.
Vaginal pain can be the result of painful intercourse. Genital pain before, during or after sex is medically known as dyspareunia. Specifically, deep dyspareunia is pain deep in the lower pelvis or vagina.
Deep dyspareunia can also be associated with deep penetration during sex. Penetrative sex without sufficient lubrication can also lead to vaginal pain and discomfort. It can even cause small tears or scratches inside the vagina or vaginal opening, which can cause the pain to persist after sex.
The most common cause of vaginal pain is infection. For example, pain in the pelvis, vulva, and vagina are symptoms of many sexually transmitted infections (STIs). Chlamydia and gonorrhea, two bacterial STIs, can cause pelvic or lower abdominal pain.
If left untreated, either can lead to a much more serious infection called pelvic inflammatory disease (PID), which happens when bacteria reach the uterus and other parts of the upper reproductive tract. Signs include pelvic pain and pain during sex. PID requires immediate medical attention, leading to infertility if not caught in time.
Vaginal dryness is one of the most common causes of vaginal pain during and after sex. One of the most common reasons for vaginal dryness is low estrogen, which can be caused by hormonal birth control and perimenopause.
Perimenopause, which occurs five to ten years before menopause, is often also marked by vaginal dryness. When the body goes into perimenopause, your estrogen levels drop, which can cause vaginal dryness and lead to painful penetration.
If you can’t pinpoint your vaginal dryness to hormonal birth control or other hormonal changes in your body, look into allergy medications. Antihistamines, such as Zyrtec or Claritin, work by drying out the mucous membranes in your body, including the vagina.
If you have a painful bump on your vulva, it could be a vulvar cyst, also known as a Bartholin’s cyst. This happens when the Bartholin’s gland in your vulva becomes blocked with fluid. If the Bartholin’s cyst is large and annoying enough, it will need drainage.
The most important thing is not to choose it. A sitz bath – soaked in warm water to several inches – with Epsom or sitz salt can be helpful for cyst rupture and drainage.
If your vulva experiences chronic pain or swelling, you may have vulvodynia. If you have vaginal pain that makes penetration painful — including tampon insertion — you may have a similar condition called vaginismus.
Experts don’t know for sure what causes vulvodynia and vaginismus, but they can be caused by:
- Abnormal responses to infection or trauma
- Allergies to chemicals
- Hormonal changes
- Medicines
- Nerve injury
- Stress or anxiety
If you have any of these conditions, talk to your healthcare provider about pelvic floor physical therapy (PT). A physical therapist can teach you how to perform exercises and use other treatments, such as vaginal dilators (prosthetics of varying sizes), to improve your symptoms.
If you have pain in your pelvis, vulva, or vagina and you think the cause could be any of the above or something else, talk to your gynecologist. They can help determine what the problem might be and treat it accordingly.
For example, if vaginal dryness is a problem because of birth control, a health care provider may be able to switch you to a different pill or type of birth control that won’t have that effect.
You’ll also want to seek immediate medical attention if you experience vaginal pain and:
Vaginal pain is common, but that doesn’t mean it’s normal. This type of pain may indicate an underlying condition, such as endometriosis, an STI, or vaginal cysts. Regardless of the cause of vaginal pain, see a gynecologist for diagnosis and appropriate treatment.