Aug 14, 2020
Pain with menstruation is common, and to some extent expected- but what about vaginal or pelvic discomfort that is not related to your cycle? Even if your symptoms are mild, you shouldn’t ignore them. It could be an infection, a cyst or another condition that requires treatment by a board-certified gynecologist.
Be Specific
It is important to be able to describe the location of your symptoms. The pelvis encompasses the abdominal area from below your umbilical area down to your pubic bone, and between your hip bones. The vagina is the internal organ and the vulva is the outer genitalia that includes the opening of the vagina and the labia. It’s important to be specific because different conditions cause discomfort in different areas.
COMMON CAUSES
Aging
The most common cause of vaginal discomfort is decreased lubrication, simply a natural occurrence of getting older. Post-menopausal women experience vaginal atrophy, caused by the waning supply of estrogen at this stage of life. The vaginal walls often become dry and which may cause inflammation, itching, and tenderness. Urinary symptoms may accompany vaginal pain and discomfort.
Infections
In premenopausal women, the most common cause of vaginal discomfort is infection: either yeast infection, bacterial vaginosis, or a sexually transmitted disease (STD).
Yeast infections and bacterial vaginosis are very common, affecting up to 75% of all women at some point in their lives. Severity of symptoms ranges from mild to moderate, and may include swelling, redness, pain, itching, a burning sensation (usually with urination or intercourse) and a change in vaginal discharge or odor.
Many yeast infections can be treated with over-the-counter medications, but it is very important to see a doctor if the symptoms do not resolve. Complicated yeast infections and bacterial vaginosis require medical intervention, especially if you are pregnant, have uncontrolled diabetes, or a compromised immune system.
Sexually transmitted diseases (STDs) may also cause vaginal or pelvic discomfort. Genital herpes is marked by painful sores on the genitals, while other STDs, such as HPV (genital warts), gonorrhea, chlamydia and trichomoniasis, may result in other symptoms such as vaginal spotting or pain with intercourse.
Pelvic Floor Issues
This is a broad category because pelvic floor pain has many causes.
Pelvic floor myalgia, also called vaginismus, is pain or soreness caused by tightness in the pelvic floor muscles. A woman may not even be aware of the involuntary clenching of these muscles until there is vaginal penetration, either through intercourse, inserting a tampon, or during a pelvic exam.
Another common pelvic floor issue is levator spasm, in which the pelvic floor muscles have a spasm reflex to pain. Other causes include irritation or damage of the pudendal nerve (pudendal neuralgia) and pelvic congestion syndrome, which is analogous to having varicose veins in the pelvis.
It’s important to have a physical examination to determine the cause of your symptoms, so your physician can determine how to treat it. Untreated pelvic floor problems can cause urinary and bowel issues, as well as painful intercourse.
LESS COMMON CAUSES
Interstitial Cystitis
Often initially misdiagnosed as a urinary tract infection, interstitial cystitis (IC) is chronic bladder inflammation that is usually very painful. Patients with IC often present with urinary urgency, frequency, and pain over the bladder region. While the cause is unknown, we know that IC can be triggered by certain foods or fluids. A diagnosis of interstitial cystitis is usually made once infection and other causes are ruled out.
Vulvodynia
Defined as chronic pain or discomfort in the vulvar region with no discernable cause, vulvodynia can be very disruptive to a patient’s quality of life.
The pain, which is described as burning, stinging, throbbing or itching can make it extremely uncomfortable to have intercourse or even to sit for an extended period of time. Symptoms usually last for at least three months, but can be present for years. Examination is important so your doctor can rule out any known conditions that could be causing your symptoms, as well as offer you relief from your discomfort.
Treatments often include a multidisciplinary approach with pelvic floor therapy, topical or vaginal medications, personal lubricants, antidepressant/anti-anxiety medications, and cognitive behavioral therapy.
Wearing seamless cotton underwear or loose-fitting clothing on the bottom half of your body and avoiding scented soaps or fragrances in the affected area may also help alleviate some irritation or discomfort.
Endometriosis
The lining of the uterus (endometrium) can sometimes grow outside the uterus, causing many problems.
In addition to significant pain during their periods, endometriosis sufferers may also experience heavy bleeding with periods, pain during sex, fatigue, nausea, painful urination, and bowel issues, including constipation and diarrhea. The condition can also cause infertility.
While some women with endometriosis can manage their pain and discomfort with over-the-counter medications, many may require prescription medication and should be under a doctor’s care. Treatment options range from over the counter nonsteroidal anti-inflammatory medications, to hormone therapy, or surgery.
Bartholin’s Cysts
Bartholin glands are responsible for vaginal lubrication. When they become blocked, it can cause painful, pus-filled cysts at the opening to the vagina. In addition to pain during sex, the condition can make it painful to simply walk or sit.
Soaking in a warm bath may provide some relief, but be sure to see your doctor, as well. You may need antibiotics or the cysts may need to drained surgically.
Consult an Expert
A double board-certified specialist in two areas of women’s health, Dr. Robison has decades of experience treating a wide range of gynecological conditions. He is also know for his extraordinary compassion, and for treating women with dignity and respect, no matter how sensitive the issues.
If you are experiencing vaginal or pelvic pain, please call our office at 910.509.0103 for an appointment.