Vaginal Pain: Causes, Symptoms, Types and Treatment

Vaginal or vulvar pain is broadly classified into 3 types, depending on its occurrence. These types and their characteristics are discussed in this section.

Vulvar pain during periods

• Intense, gripping vaginal pain
• The pain may be constantly occurring or may be perceived as occasional cramps
• Pain in the lower abdomen, which may refer to the back or the legs
• This pain starts at the beginning of menstruation
• It is the most severe during initial 24 hours or the first day of menstruation
• Presence of clots in menstrual blood
• Other symptoms such as nausea, vomiting, bloating, diarrhoea and other digestive problems are often experienced.

Vulvar pain before periods

Premenstrual syndrome may be responsible for vulvar pain occurring before the beginning of the menstrual cycle. It is accompanied by the following symptoms:

• Abdominal pain
• Breast tenderness
  Read more: Benign fibrocystic breasts
• Anxiety
• Pain in joints
• Headache
• Mood swings
• Irritability
• Bloating

Vaginal pain during sex

• Sharp vaginal pain often experienced during the entry of penis, which may last until later
• It may last even after the end of sex
• It may be experienced during the entire duration of sexual intercourse or may arise with specific types of stimulation
• Deep thrusting pain at the cervix
• Deep and extreme pain, which can cause burning sensations in the vagina
• Muscle spasms
  Read more: Treatment of muscle cramps
• Abdominal cramps
• Pelvic cramps
• Tightening of pelvic muscles
• Dryness of the vagina

Vaginal pain during pregnancy

• Deep and sharp vaginal pain
• Burning sensations
• Itching, backache and vaginal discharge, if associated with an infection

Read more; Vaginal discharge during pregnancy

• Sharp pain and sore breasts when associated with ectopic pregnancy
• Common symptoms of pregnancy like nausea, vomiting and fatigue are experienced

Vaginal pain due to endometriosis

• Severe pain and abdominal cramping during menstruation or during or after sexual intercourse
• This may radiate to the back or the legs
  Read more: Leg pain causes
• Nausea, vomiting, diarrhoea and severe cramping
• Painful micturition (urination)
• Difficulty in bowel movements (excretion)
• Troubles getting pregnant (fertility problems)

Vaginal pain due to fibroids

• Heavy menstruation
• Prolonged menstrual cycle
• Pain during sexual intercourse
• Pelvic pain
• Lower back pain
• Frequent urination
• Presence of a firm mass
  Read more: Cancer symptoms

Vaginal pain due to pelvic inflammatory disease

Pelvic inflammatory disease causes inflammation in the female reproductive system and is caused due to sexually transmitted infection. Following are the symptoms:

• Vaginal pain, especially during sex
• Long-term pelvic pain
• Smelly, whitish vaginal discharge
• Burning, redness and swelling of the vagina
• Abdominal pain
• Fever
• Irregular menstrual cycles
• Painful micturition

Vaginal pain due to adenomyosis

Adenomyosis is a condition in which the endometrial tissue moves to the outer wall of the uterus. It is characterised by:

• Mild vaginal pain during intercourse
• Heavy and painful menstrual bleeding
• Vaginal pain due to ectopic pregnancy
• Pelvic pain
• Abnormal vaginal bleeding
• Severe, sharp and sudden pain in the abdomen
• Pain in the shoulder area
• Fatigue or feeling of faintness

Vaginal pain due to gestational trophoblastic disease

In this condition, abnormal trophoblast cells grow inside the uterus, which may have the following symptoms:

• Pain or pressure in the pelvis
• A larger size of the uterus
• Abnormal vaginal bleeding that continues after pregnancy
• Fatigue and shortness of breath
• High blood pressure

As you may by now understand that vaginal pain is a broader symptom rather than being a disease in itself. It can have several causes, which are enlisted below:

• Heavy menstrual bleeding
• Family history of dysmenorrhoea
• Vaginal dryness
• Allergy to latex, spermicide, condoms
• Allergy to clothing
• Early menarche
• Irregular menstrual cycle
• Smoking
• Premenstrual syndrome
• Inflammation of the vaginal area or vulvar vestibulitis
• Adenomyosis
• Endometriosis
• Ectopic pregnancy
• Gestational trophoblastic disease
• Late pregnancy
• Psychological pain during sex
• Fungal infection
• Sexually transmitted diseases
• Vaginal yeast infection
• Urinary tract infection (UTI)
• Use of intrauterine devices for contraception
• Sexual abuse
• Atrophic vaginitis in postmenopausal women
• Lichen planus infection
• Side effects of certain medications

Since vaginal pain is caused due to several causes, its prevention can be done in many ways. Vaginal pain occurring during menstruation is inevitable if you have a family history. However, if disturbed menstruation is associated with an underlying disorder like polycystic ovarian syndrome (PCOS), you can get yourself treated. Maintaining a healthy lifestyle and weight will help you in the management of PCOD. You must, however, consult your gynaecologist for the best advice.

Vaginal pain during sexual intercourse can be prevented by using a lubricant, which will help to counteract vaginal dryness. Avoiding deep penetration during sex may help. Use of latex-free condoms can also help to avoid pain in allergics. Use of condom during sex will further help to avoid STI and eventually vaginal pain. Other ways in which vulvar infection can be avoided are:

• Maintaining proper hygiene of the intimate area
• Avoiding wearing tight synthetic clothing since bacterial growth occurs in warm, moist environment (this will also help in avoiding allergy to clothings)
• Drinking enough water to prevent UTI

Read more: How much water to drink in a day

• Avoiding the use of cleansers and other scented products on the vagina
• Avoiding washing too often, since it will wash away the good bacteria
• Changing underwears every day

Avoiding the use of uterine contraceptives can also help in preventing vaginal pain.

During pregnancy, vaginal pain can be prevented by avoiding smoking, which increases the risk of ectopic pregnancies. Taking care of general health and hygiene is also important to avoid vaginal infections.

Read more: Treatment of vaginal bleeding

Your doctor will form a diagnosis of either of the conditions discussed above, based on your symptoms and diagnostic tests. The various methods of diagnosis are:

• Medical history: This will help to know if the individual has an underlying cause of vaginal pain, like vaginal infection or PCOD
• Family history: To determine if there is a family history of dysmenorrhea
• Drug history: Certain drugs like antihistamines can cause vulvar pain in women, especially during sex
• Physical examination: This will help to diagnose infections or inflammation of the vaginal area
• Urinalysis: To detect the presence of blood, protein, etc in the urine
• Ultrasound of the pelvic area: To confirm and establish the underlying disorder causing pain

Read more: Pregnancy test

• Mild vaginal pain during menstruation can be managed by abdominal massages and hot packs, along with the use of anti-inflammatory and analgesic drugs, as prescribed to you. Premenstrual syndrome can be managed by taking adequate rest and meditation, to avoid anxiety and mood swings. Anti-anxiety drugs may also help.
• In case of vaginal pain due to yeast or fungal infections, antifungal medications are indicated. Steroid creams and other topical agents are used for the management of other vaginal infections or inflammation.
• Treatment of vaginal pain due to urinary tract infections involves the use of antibiotics.
• A warm bath and use of painkillers will help in resolving pain after sexual intercourse.
• For the management of atrophic vaginitis, oral or vaginal estrogen is indicated in women.
• In case of vaginal pain of unknown aetiology during sex, it is recommended to seek psychological help to determine and cure the cause.
• Treatment of vaginal pain during pregnancy involves slight lifting of the legs and pelvic area, along with pelvic massages and hot packs. Support belts can also be worn but gynaecologist’s consult must be taken. Topically applied anaesthetics may be helpful for the management of vaginal pain postpartum (after childbirth)
• Other than this, specific treatment measures like drug treatment or surgical removal, as in case of fibroids may be needed. You are recommended to seek medical help if you experience severe vaginal pain due to any known/unknown cause.
  
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Vaginal pain is often unrelated to serious causes and is mostly self-limiting. Rarely, it may be related to vaginal fibroids or endometriosis, which may cause difficulty in the process of fertilisation and conception in the woman. In case of an ectopic pregnancy, a miscarriage is highly likely.

Risk of fatality due to vaginal pain is very low, and it holds an overall good prognosis. However, the quality of sex life of the woman is likely to be affected until pain lasts.