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Any pain occurring in the area of the vagina, that is, the opening below the opening of the urethra from where the menstrual fluid leaves the body, is called as vaginal pain. It may be a symptom of a severe underlying cause, like uterine fibroids (benign growths) or vaginal infection or inflammation or it may simply occur during sexual intercourse in some women.

More often, vaginal pain is associated with the menstrual cycle, particularly in younger girls. Pain during menstrual cycles or dysmenorrhoea is known to occur in more than half of the menstruating women. This pain is known to last for 1 to 2 days at the beginning of the cycle. Vaginal pain is often associated with vulvar pain in women. Vulva refers to the entire female genitalia including the clitoris, vagina and labia minora and labia majora.

This article will discuss the types, symptoms, causes and diagnostic methods of vaginal pain along with its treatment and prognosis.

  1. Symptoms of vaginal pain
  2. Vulvar pain causes
  3. Prevention of vaginal pain
  4. Diagnosis of vaginal pain
  5. Treatment of vaginal pain
  6. Types of vaginal pain
  7. Prognosis and complications

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:

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
  • 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 treatment)
  • 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 (pain in the pelvic area)
  • 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.
(Read more: AIDS symptoms)
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:

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 multifold. 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
  • 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.

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

  1. Vulvar pain during periods
  2. Vaginal pain during sexual intercourse
  3. Vaginal pain during pregnancy

Vulvar pain during periods

Periodic discharge of blood from the vagina, occurring at every 28 days is known as menstruation or the periods. Some women may experience pain during menstruation, which may be regarded as normal. However, intense pain may have a severe underlying cause.

Vaginal pain usually occurs in women with a heavy menstruation, due to excessive flow of blood occurring from the disruption of the uterine lining. Women who have experienced menarche early (before the age of 11 years) and those who have not yet experienced childbirth have a greater predilection for vaginal pain. Usually, women with a family history of painful periods may experience this pain in their teenage years and during young adulthood, which is known to diminish after the age of 20 years.

When associated with uterine contractions responsible for shedding of the uterine lining during periods, vaginal or vulvar pain can either be either primary or secondary. It is regarded as primary when it is caused due to these contractions alone, and secondary, when additional factors are involved. When termed secondary, it is a matter of concern and may be caused due to benign growths in the uterus, such as fibroids or polyps. Placement of intrauterine devices in the uterus for the purpose of contraception (birth control) is also often associated with vulvar pain during menstruation.

Vaginal pain during sexual intercourse

Some women may experience pain during or after the act of sexual intercourse, which is called as dyspareunia. This pain may occur either in the vagina, clitoris or the labia and may vary in type and intensity. It is often associated with vaginal dryness (causing sharp shooting pain) or may be an allergic reaction to the latex of condoms or spermicides. History of sexual abuse in the past or the fear of sexual intercourse is likely to aggravate this pain. Vulvar pain is more commonly observed in older women as the vaginal lining thins out or atrophies. More severe causes of pain during sexual intercourse can be vaginal inflammation or infection, particularly a yeast infection, or certain sexually transmitted diseases (STDs).

(Read more: Home remedies for Vaginal Yeast Infection)

As with pain associated with menstruation, this type of vulvar pain is also divided into primary and secondary types, wherein primary pain lasts for the entire sexual lifetime of the woman, and the secondary begins after a certain period.

Dyspareunia is also a common symptom of endometriosis, that is, the growth of endometrial tissue (tissue lining the uterus) in areas other than the uterus. This is characterised by intense pain in the vulva during sexual intercourse and menstruation, and is likely to cause fertility problems. This condition often remains undiagnosed in women, which is a matter of concern. Endometriosis will be discussed ahead along with other causes.

(Read more: Treatment of infertility)

Vaginal pain during pregnancy

Pregnancy is often a difficult phase in every woman's life, where her health is affected in more than one ways due to the changing hormones. Vaginal or vulvar pain is one such matter of concern, which is considered to be a side-effect of excessive pelvic pressure. However, mild vaginal pain may be considered normal during pregnancy.

It has been noted that vaginal pain is more common and severe during later stages of pregnancy due to excessive uterine contractions in that phase. The release of relaxin (hormone) causes loosening of pelvic ligaments during pregnancy, which eases the movements of the child.

But, excessive movements of the baby are likely to cause weakening and stretching of these muscles raising the pelvic pressure. It can be due to dilation of the cervix at the end of the pregnancy, which is a physiological (related to normal functioning) process to facilitate childbirth. Rarely, it can be associated with infections or ectopic pregnancy or gestational trophoblastic disease. These conditions will be discussed ahead.

(Read more: How to get pregnant)

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.

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References

  1. American College of Obstetricians and Gynecologists [Internet] Washington, DC; Dysmenorrhea: Painful Periods
  2. American Pregnancy Association. [Internet]; Stages Of Childbirth: Stage I.
  3. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Period pain: Overview. 2008 Feb 22 [Updated 2016 Jul 1].
  4. Better health channel. Department of Health and Human Services [internet]. State government of Victoria; Menstruation - pain (dysmenorrhoea)
  5. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Diary: Premenstrual syndrome (PMS). 2017 Jun 14.
  6. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Endometriosis: Overview. 2008 Feb 25 [Updated 2017 Oct 19].
  7. UCLA Health. What are Fibroids. California, United States [Internet]
  8. Office on Women's Health [Internet] U.S. Department of Health and Human Services; Pelvic inflammatory disease.
  9. National Center for Advancing and Translational Sciences. Adenomyosis. Genetic and Rare Diseases Information Center
  10. Government of Western Australia. Ectopic pregnancy. Department of Health
  11. MedlinePlus Medical Encyclopedia: US National Library of Medicine; Ectopic pregnancy
  12. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Gestational Trophoblastic Disease Treatment
  13. Office on Women's Health [Internet] U.S. Department of Health and Human Services; Vaginal infections.
  14. F. A. Taran, E. A. Stewart, S. Brucker. Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy. Geburtshilfe Frauenheilkd. 2013 Sep; 73(9): 924–931. PMID: 24771944
  15. Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Dyspareunia and quality of sex life after surgical excision of endometriosis: a systematic review.
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