VAGINAL HEALTH
10 CAUSES OF VAGINAL PAIN AND WHAT TO DO ABOUT IT
May 06, 2024
Quick Answer
The most common causes of vaginal pain are infections like yeast infections and bacterial vaginosis, hormonal changes that lead to dryness, nerve conditions like vulvodynia, and pelvic floor dysfunction. Most of these are treatable once you know the cause. A few, like a ruptured ovarian cyst or a severe pelvic infection, need care right away. I want you to know the difference before you read further.
Key Takeaways
- Vaginal pain has many possible causes, from common infections to nerve conditions like vulvodynia and vaginismus.
- Sudden, severe pain paired with fever, fainting, or nausea is different from chronic, recurring pain, and needs same-day care.
- A yeast infection affects about 75% of women at some point, but not every symptom means yeast, so do not guess if you are unsure.
- Vaginal dryness from low estrogen is treatable with vaginal estrogen or moisturizers, not something you have to just live with.
- A fever of 100.4°F or higher, sudden one-sided pain, or fainting alongside pelvic pain means it is time to go to the ER.
When to Seek Care Right Away
Most causes of vaginal pain are not emergencies, but a few genuinely are. I always lead with this because it matters more than any single cause on this list.
Pain that comes on suddenly and severely is different from pain that builds gradually or keeps coming back. Sudden, severe, one-sided pelvic pain can mean a twisted ovary or a ruptured cyst. Chronic or recurring pain, like pain during sex or pain that shows up before your period, more often points to a hormonal cause, a nerve condition, or pelvic floor dysfunction. Both deserve attention, but they call for a different response.
Go to the emergency room or call 911 if you have
- A fever of 100.4°F or higher along with pelvic pain, which can signal a serious pelvic infection
- Sudden, severe, one-sided pelvic pain, which can mean a twisted ovary or a ruptured ovarian cyst
- Fainting, dizziness, a racing heart, or rapid breathing along with pelvic pain
- Heavy vaginal bleeding along with severe pain
- Confusion, chills, or a very low body temperature along with pain, which can be signs of sepsis
Book a same-week appointment if you have
- Pain that has lasted more than a few days without improving
- Pain during sex that keeps happening, not just once
- Discharge that smells unusual or has changed color alongside the pain
- Pain that is getting worse instead of better despite home care
An untreated pelvic infection can progress quickly, and a twisted ovary can lose its blood supply within hours if it is not treated. This is not meant to scare you, sis. It is meant to help you know exactly when speed matters.
Vaginal Yeast Infections
A vaginal yeast infection is a type of vaginitis, a condition where the vagina is painful, swollen, and possibly infected. At least 75% of all women will get a yeast infection caused by a common fungus called Candida at some point in their life. Candida naturally lives on the skin and inside the body including the mouth, gut, and vagina. Occasionally, the delicate balance of naturally good bacteria and yeast can be disrupted for many reasons, such as the use of certain antibiotics, leading to infections in the vagina. These infections do not usually spread through sexual intercourse. Symptoms of vaginal yeast infection can include itching, abnormal discharge, burning, pain during sex, and discomfort when urinating.
Even though a mild yeast infection may sometimes go away without treatment, your doctor may recommend the use of over-the-counter vaginal antifungal medication to reduce worsening of symptoms and give you some relief. Persistent or complicated yeast infection may require prescription vaginal creams/suppositories or oral medications from your healthcare provider. You can also help yourself with taking probiotics. You’ll find some of my favorites in this blog post. If this is your first yeast infection or you are not sure if you have a yeast infection, you should see your healthcare provider. A few ways to reduce the risk of yeast infection include wearing cotton or cotton-crotch underwear to keep the vaginal area dry; avoiding douching to maintain normal vaginal pH level; and, not wearing damp clothes or uncomfortable pants, or sitting around in a wet bathing suit. Also, limit the use of antibiotics to when necessary as antibiotics can upset the balance of our vaginal flora.
Dyspareunia
Dyspareunia is genital pain that can be experienced before, during, or after penetrative sexual intercourse. Between 10 and 20% of women have dyspareunia. Deep dyspareunia can also cause bladder pain. There are several potential causes including hormonal changes, inadequate vaginal lubrication, uterine prolapse, uterine fibroids, endometriosis, ovarian cysts, irritable bowel syndrome, and pelvic floor dysfunction.
Some effective treatments of dyspareunia include water-based vaginal lubricants, pelvic floor therapy, and topically applied vaginal estrogen. Vaginal dilator therapy, which uses movement-based vaginal dilators to gently increase the pliability of vaginal tissues over time, can also significantly reduce pain experienced with dyspareunia.
Vulvodynia
Vulvodynia is a chronic pain or discomfort around the vulva without any identifiable cause. The vulva is the outer parts of female genitals. Some people might experience pain in one area of the vulva while others feel the pain in multiple areas. Although there is no known cause for vulvodynia, past injuries or infections to the vulva, allergies, genetic disorders, hormonal changes, or pelvic floor dysfunction can increase the risk of developing vulvodynia. Although often misdiagnosed and underreported, up to 16% of women will experience symptoms of vulvodynia at some point in their lives.
Vulvodynia symptoms can be treated using topical medications such as estrogen cream or the pain-blocker lidocaine. Antidepressants, specifically tricyclic antidepressants (TCAs), as well as anticonvulsants can help lower neuronal sensitivity and decrease pain. Pelvic floor therapy and transcutaneous electrical nerve stimulation (TENS), or nerve stimulating equipment, have also been proven effective at relaxing pelvic floor muscles and improving vulvodynia symptoms.
Vaginismus is a closely related but different condition. Instead of ongoing pain like vulvodynia, vaginismus is an involuntary tightening of the vaginal muscles whenever penetration is attempted, whether during sex, a pelvic exam, or inserting a tampon. Your body reacts as if it needs to protect you, even when there is no danger. It often develops after a painful first sexual experience, a medical procedure, or with no clear trigger at all, and it responds well to pelvic floor physical therapy, often alongside vaginal dilators used gradually at home. If you have been avoiding intercourse or exams because of this, I want you to know it is treatable, and you do not have to figure it out on your own.
Bartholin’s Cyst
Bartholin’s glands are located on either side of the vaginal opening and secrete fluids that lubricate the vagina. A backup of fluid in a Bartholin’s gland can lead to a Bartholin’s cyst or Bartholin’s duct cyst, a small fluid-filled sac just outside the opening of the vagina. If a Bartholin’s duct cyst remains small, and does not become infected, it can remain asymptomatic, and you may not notice it. If the cyst continues to grow, you may feel a mass near your vaginal opening. This mass is normally tender but painless.
In some cases, Bartholin’s cysts can become infected and turn into abscesses after exposure to E.coli, staphylococcus, streptococcus, or some sexually transmitted bacteria like those that cause gonorrhea and chlamydia. Practicing safe sex and using condoms can lower your risk of developing a Bartholin’s cyst or abscess. Bartholin’s cyst and abscess can lead to pelvic pain, dyspareunia (genital pain before, during, and after sex), discomfort while walking, sitting, and standing, and fever. Bartholin’s cyst is commonly diagnosed in women of reproductive age and affects about 2% of women at some point in their lives. If you suspect you have a Bartholin’s cyst without improving symptoms, consult with your health provider as you may need surgical drainage and/or antibiotics.
Bacterial Vaginosis
A balanced level of our natural bacteria is important for vaginal health, but sometimes, the bacteria can overgrow, leading to bacterial vaginosis (BV). Bacterial vaginosis is estimated to affect about 21 million women in the United States yearly, but is more common in women of childbearing age and people who are sexually active. Although BV is not yet considered a sexually transmitted disease (STI), it can increase the risk of contracting STIs. BV is also more common in people with multiple sex partners, people whose sex partners have BV, and people that do not use condoms. BV can be spread through sharing of sex toys and oral-genital contact. Pregnant women with untreated BV are more likely to have premature birth and low birthweight babies.
BV can be asymptomatic in some people while some others can experience symptoms including vaginal pain, itching, and burning. BV is often associated with a thin grey discharge and a strong fishy smell, especially after sex. Male partners of women with bacterial vaginosis are not at risk of infection; however, female partners are and should also be treated. BV is typically treated with antibiotics. Prevention of BV includes limiting your number of sexual partners, using condoms when having sex, and avoiding douches or other feminine hygiene products that can cause an imbalance in your healthy vaginal flora.
Read about some of the best probiotics for BV in this blog post.
If odor is your main concern rather than pain, I break down what is normal and what is not in this guide to vaginal odor, and you can check what your discharge is telling you in this breakdown of discharge colors.
Vaginal Dryness
Vaginal dryness (VD) is a painful symptom that many people will experience at some point in their lives. It often causes pain and discomfort during penetrative sex. The most common cause of vaginal dryness is a decrease in hormone (estrogen) levels that can occur with childbirth, breastfeeding, perimenopause and menopause. Over 50% of post-menopausal women aged between 51-60 experience symptoms of vaginal dryness. Vaginal dryness can result from chemotherapy, ovarian surgery, stress, depression, smoking, antihistamines, and use of vaginal douches. Rarely, VD can be a result of Sjögren’s syndrome, an autoimmune disorder that causes drying of mucous membranes.
Treatment for vaginal dryness includes the use of vaginal moisturizers to maintain a moist vaginal environment. If VD causes painful sex, water-based lubricants can increase pleasure and decrease discomfort or irritation from vaginal dryness. Your doctor may also suggest using a vaginal estrogen cream or suppository to help maintain vaginal moisture levels. Some natural ways to relieve VD include following a hormone-balancing diet, boosting your water intake, avoiding perfumed soaps, and doing pelvic floor exercises.
I put together more natural, at-home strategies in this guide to dry vagina home remedies if you want to go deeper on what actually helps.
Pelvic Floor Dysfunction
The muscles of the pelvic floor support the pelvic organs (bladder, vagina, uterus, anus, rectum, and intra-abdominal contents), contribute to urine and feces continence, and support sexual functions of arousal and orgasm. Pelvic floor dysfunction refers to a broad spectrum of symptoms and changes related to the abnormal functioning of the pelvic floor. This can affect up to 50% of childbearing women. In PFD, the muscles and supporting structures of the pelvic floor might be too weak or too inflexible. This can lead to numerous kinds of PFDs affecting the pelvic organs.
Some symptoms of PFDs include pelvic pain, heaviness or aching in the vagina, and pain after sex. Current treatment options for pelvic floor dysfunctions include massage therapy, pain medications, pelvic floor muscle training (PFMT), and surgery. You can also help prevent developing PFD by maintaining a healthy weight, eating healthy, preventing constipation, exercising regularly, and quitting smoking.
Pelvic floor dysfunction shows up in other conditions too. I go deeper on the overlap with bladder pain in this piece on interstitial cystitis and pelvic floor exercises.
Sexually Transmitted Infections (STIs)
STIs are common worldwide with hundreds of millions of new cases reported each year. The World Health Organization (WHO) estimates that about 1 million STIs are acquired every day worldwide. According to the Center for Disease Control and Prevention (CDC), there are about 20 million new cases of STIs in the United States alone, yearly. Sexually transmitted illnesses cause a wide range of symptoms that include sores/warts in the genital areas, unusual vaginal discharge, pain/burning on urination, unusual vaginal bleeding, pain during sex, swollen lymph nodes, warts in the mouth/throat, and much more. The three most common STIs, however, that lead to pelvic and vaginal pain, include chlamydia, gonorrhea, and trichomoniasis.
Chlamydia can cause vaginal discharge, pelvic pain, and vaginal pain during sexual intercourse. Gonorrhea can cause abnormally painful menstrual periods and a thick, bloody vaginal discharge. While bacteria cause chlamydia and gonorrhea, trichomoniasis is caused by a one-celled parasite called Trichomonas vaginalis. Trichomoniasis can lead to mild to severe itching and irritation in the vagina, and pain during sexual intercourse. Fortunately, when uncomplicated, all three of these STIs can quickly and effectively be treated with antibiotics. Practicing safe sex with diligent condom use is the best way to avoid contracting any of these STIs if sexually active.
Vaginal pain from an STI can look a lot like a UTI at first, before other symptoms show up. I walk through the chlamydia vs UTI symptoms that actually tell the two apart in this comparison.
Endometriosis
It is well-known that endometriosis can cause severe pelvic pain and menstrual pain. However, less known is the fact that endometriosis can also cause vaginal pain. Endometriosis affects about 10% of women of reproductive age (190 million women) globally and is the leading cause of infertility and chronic pelvic pain.
Vaginal pain during sex is the third most common symptom associated with endometriosis. This is because endometriosis can cause adhesions that fuse the rectum to the back wall of the vagina and the movements of sex can stretch and irritate the tissue, leading to extreme pain during sex. Different sexual positions may be less painful than others, but if endometriosis is widespread, all positions may cause pain. Some people find that open communication and timing sex around different phases of their menstrual cycle can improve pain. There is currently no cure for endometriosis and treatment is aimed at controlling symptoms. If your vaginal pain is persistent, your healthcare provider may recommend surgical excision by laparoscopy to free the vagina from the rectum wall.
Vaginal Folliculitis
Vaginal or genital folliculitis is a condition characterized by inflammation and infecting of the hair follicles in the genital area, including the vagina. It is not contagious; however, due to the proximity of hair follicles to each other in that part of the body, infection can spread quickly from one follicle to the other. Factors that increase the risk of folliculitis include shaving or waxing the genital area, wearing tight clothes, and a weakened immune system. When the follicle is compromised, microorganisms such as bacteria, fungus, or viruses can penetrate the hair follicle and cause an infection.
The most common bacteria involved in vaginal folliculitis is staphylococcus aureus; however, candida (yeast) and herpes simplex virus (HSV) can also cause folliculitis. Symptoms of folliculitis include redness, itching, small bumps/pimples, tenderness, and sometimes, pus-filled lesions. Good hygiene practices such as keeping the vaginal area clean and dry can help to reduce the risk of folliculitis. Treatment options include applying a clean, warm compress to affected areas and avoiding shaving or waxing until healed. In a situation where folliculitis is caused by a microorganism, your healthcare provider may recommend appropriate antibiotics, antifungals, and antiviral medications for treatment.
Frequently Asked Questions
When should I see a doctor for vaginal pain?
See your doctor within a few days if the pain lasts more than a couple of days, keeps happening, or comes with unusual discharge. Go to the emergency room right away if you have a fever, sudden severe one-sided pain, fainting, or heavy bleeding along with the pain. I always tell my patients that pain lasting longer than expected is reason enough to be seen, you do not need to wait for it to become unbearable first.
Is sharp vaginal pain normal?
Occasional sharp pain, like a quick twinge during ovulation or ligament stretching, can be normal. Sharp pain that is sudden, severe, or lasts more than a few minutes is not something to brush off. It can point to a Bartholin’s cyst, a twisted ovary, or a pelvic infection, all of which need medical attention rather than waiting it out.
Can vaginal pain be a sign of something serious?
In most cases, no. Vaginal pain is usually caused by a treatable infection, hormonal change, or nerve condition. In a smaller number of cases, it can signal something more serious, like a ruptured ovarian cyst, a severe pelvic infection, or in rare cases a gynecologic cancer. This is exactly why persistent or unusual pain deserves an evaluation instead of a guess.
What's the difference between vaginal pain and a UTI?
A urinary tract infection (UTI) causes burning with urination, urgency, and pain centered around the bladder and urethra, the tube urine passes through. Vaginal pain involves the vaginal tissue itself, and can happen with or without urination. The two can overlap, since some vaginal infections also cause burning when you pee, so if you are not sure which one you have, it is worth getting checked rather than guessing.
Can an ovarian cyst cause vaginal pain?
Yes. Most ovarian cysts are small and cause no symptoms, but a larger cyst can cause pelvic and vaginal pain, especially if it twists or ruptures. Sudden, severe pain on one side, especially with fainting or vomiting, is not something to wait out. That combination means you should be seen right away.
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