10 Causes of Vaginal Pain and What to Do About It

Temporary or chronic pain in and around the vagina is common and caused by several factors including hormonal imbalances, infections, childbirth, menopause, allergies, surgery, cervical cancer, sexual abuse, medications, and injury. Sometimes, the cause of the pain is unknown (idiopathic). Depending on your specific condition, other symptoms like burning, itching, throbbing, soreness, rawness, pain during intercourse, vaginal discharge, and stinging can also accompany vaginal pain. Usually, vaginal pain will go away with time, but sometimes, it could persist depending on why you have the pain.

 Here are the ten most common causes of vaginal pain and what you can do about them.

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.

 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. 

 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.

 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.

 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.

 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.