The vagina is the passage from the cervix to the vulva. Pain or discomfort in the vagina is often the result of a medical or psychological issue. Early treatment and intervention can help a patient get pain relief.
Vaginal pain can be confined to the vaginal area. It can also radiate down from the pelvis or cervix. The most common cause of vaginal pain is infection (UNC School of Medicine).
Other causes include:
- cervical traumas caused by childbirth, cone treatments, or the LEEP procedure
- nerve malfunctions from scarring
- post-hysterectomy pain
- vulvovaginal atrophy due to a drop in estrogen following menopause
- vulvar vestibulitis
- vulvodynia, or chronic vaginal pain with no known cause
Vaginal pain can also stem from a condition called dyspareunia. This is when intercourse is painful to a woman. Insufficient lubrication during sex or a lack of sexual arousal can lead to vaginal pain. An estimated 60 percent of women experience dyspareunia in their lifetimes (Heim, 2001).
Vaginal pain can also stem from psychological conditions, such as a history of physical or sexual abuse.
Women of all ages can experience vaginal pain.
Past medical conditions may increase risk in some cases. Examples include hormonal changes brought on by pregnancy or menopause or a hysterectomy. Women with a history of breast cancer are at a higher risk.
Medications known to cause vaginal dryness include statins, which help lower cholesterol. Patients should not discontinue medications without a doctor’s permission. This is true even if the medications cause vaginal dryness.
Advancing age is also a risk factor. Menopause causes a reduction in hormones and a thinning of vaginal tissue. This affects vaginal lubrication and can contribute to vaginal pain.
Symptoms of vaginal pain depend on the medical conditions that cause it. For example, vulvar vestibulitis causes pain only when there is pressure on the vagina. In contrast, vulvodynia patients experience constant, chronic pain.
General symptoms related to vaginal pain include:
- pain when having intercourse
Patients with vaginal infections may experience vaginal discharge. This can indicate a yeast and/or bacterial infection.
A medical provider diagnoses the cause of vaginal pain with tests, a physical exam, and the patient’s medical history.
A medical history takes into account past procedures and surgeries. A provider may also ask questions about sexual health, including frequency and pain.
A physical exam of the vaginal area will check for any signs of redness and inflammation. Visible scarring can also indicate causes of vaginal pain. A physician will try to identify where the painful sensations come from. Some women with vulvodynia experience pain so severe that touching the vagina with a cotton-tipped applicator is too painful.
A doctor can take a discharge sample from the vagina and test it for bacteria. A high number of bacteria may indicate that infection is the cause of pain.
If the pain is severe or the physician suspects a more serious condition, such as cancerous tissue, he or she may recommend a laparoscopy. This is a surgical investigation of the vagina and/or cervical area to view the inside of the body and take tissue samples for biopsy.
A medical provider will treat the underlying disorder to address vaginal pain. Doctors may prescribe a multi-step approach. This can include topical anesthetics or oral medications.
A doctor may prescribe antibiotics to treat an infection. A patient should take all the antibiotics prescribed, even if the infection is getting better. This reduces the chance that the infection will return.
Topical ointments such as lidocaine gel can help to numb the vaginal area. This can relieve discomfort or numb the vagina prior to intercourse to reduce painful symptoms.
Topical steroid creams also reduce irritation, swelling, and burning.
Both tricyclic antidepressants and/or anticonvulsants can help to reduce chronic pain.
Witch hazel pads applied to the vaginal area may soothe irritation. This can help patients who experience pain during intercourse or when urinating. Patients can purchase pre-treated witch hazel pads at a drugstore or dip their own cotton pads in witch hazel.
Women can relieve painful urination by pouring clean, lukewarm water over the vulva after urinating. This helps to cleanse the area.
Use of lubricant during sexual intercourse can also reduce pain. Over-the-counter antihistamines can lessen vaginal itching.
Doctors may recommend anesthetic injections or nerve blocks. These help to deaden or numb painful nerves.
In rare instances, a doctor may recommend surgery to treat vulvodynia or vulvar vestibulitis.
If vaginal pain stems from chronic urinary tract infections (UTIs), calcium citrate tablets of between 1,200 to 1,800 milligrams per day may help to reduce urinary tract symptoms that contribute to vaginal pain.
Avoiding foods high in oxalates can also help to reduce kidney stones and UTIs. These foods include leeks, okra, rhubarb, wheat brain, almonds, peanuts, pecans and pistachios.
Discuss supplements and dietary changes with your doctor or healthcare provider.
The outcome for vaginal pain treatments depends upon the condition causing it. However, with care and adherence to treatment recommendations, patients can often find relief from vaginal pain.