Vaginal pain: Causes and how to treat it

Persistent vaginal pain with no clear cause is called vulvodynia. It is a common gynecological condition that affects up to 16% of females in the United States.

Fear or embarrassment may keep a person from seeking professional treatment for vaginal pain. Anecdotal evidence suggests that some doctors can be quick to dismiss this symptom.

However, the right healthcare provider will work diligently to diagnose and treat the problem.

Read on to learn about the symptoms and causes of vaginal pain, as well as the treatment options.

Causes of vaginal pain

Infection

Yeast infections are among the most common causes of vaginal pain. About 75% of females develop a vaginal yeast infection at some point during their life.

A yeast infection can cause itching, burning, and, sometimes, a cottage cheese-like discharge from the vagina.

These infections do not usually spread through sexual intercourse, and most experts do not recommend treating sexual partners.

Bacterial vaginosis (BV) is also a common infection, particularly among people who are sexually active.

Although BV does not always cause symptoms, some people may experience the following symptoms in the vagina:

pain
itching
burning
a fishy odor
discomfort during sex

Many people mistake the symptoms of BV for those of a yeast infection. However, the two have different causes and require different treatments.

Some other infections, especially chlamydia and gonorrhea — both of which are sexually transmitted infections (STIs) — can also cause pain and unusual discharge.

Physical trauma

Physical injury to the vagina or vulva can cause vaginal pain. Relatively minor injuries, such as cuts from shaving, may sometimes be responsible, but one of the most common causes of injury and pain is childbirth.

Giving birth causes vaginal tearing in most people during their first vaginal delivery. The tear usually extends into the perineum, which is the area between the vagina and anus. Doctors refer to this as a perineal tear. It is also possible for the clitoris or labia to tear during childbirth.

A doctor or midwife may need to stitch up serious tears. The stitches that they use will dissolve over time and do not require removal.

Pelvic floor dysfunction or injury

Damage to the muscles of the pelvic floor can cause pain in the vagina, stomach, and back, as well as affecting muscles in other areas.

Some factors that can increase the risk of pelvic floor problems include:

age
pregnancy
injury from childbirth

episiotomy, which is a surgical incision to enlarge the vaginal opening into the perineum during labor
Some people with pelvic floor dysfunction also experience incontinence, especially when sneezing or jumping. A person may also experience fecal incontinence, pain when passing stool, or both symptoms.

Vulvodynia

Vulvodynia is a type of chronic pain in the vulva, vagina, or both. The pain varies from person to person, but many report a burning pain that is fairly continuous, though sexual intercourse can trigger or worsen it.

Doctors do not fully understand vulvodynia and why it occurs. The diagnostic process can be lengthy because it involves excluding other causes of vaginal pain.

Anyone who suspects that they have vulvodynia should see a doctor, as various treatments are available.

Bartholin’s cyst

The Bartholin’s glands sit on either side of the entrance to the vagina and help lubricate it.

A blockage in one of these glands can give rise to a cyst, which may feel like a hard lump or look like a pimple. The cyst can cause pain, usually on one side of the vagina.

Bartholin’s cysts may get larger over several days before disappearing or rupturing. Sometimes, they become infected, causing intense pain.

Symptoms

Vaginal pain can have many different characteristics. Describing the pain in detail can help a healthcare provider correctly diagnose the problem.

Below are the most common types of vaginal pain:

Burning

Vaginal yeast infections, BV, and other types of infection often cause a burning sensation, especially during or after intercourse.

Vulvodynia also often causes burning pain, though this typically occurs alongside other symptoms.

Itching

Itchiness is a classic sign of an infection, such as a yeast infection, BV, or an STI.

Less frequently, a pelvic floor injury causes nerve dysfunction that feels like itchiness or another unusual sensation.

Some people experience vaginal itchiness specifically during intercourse. Some possible causes of this include:

vulvodynia

the rupture of a Bartholin’s cyst
healing following a physical injury
Tension or muscle spasms

Tightness, soreness, and muscle spasms in the vagina may indicate pelvic floor dysfunction. Some people also experience pain with different characteristics or in other areas — for example, they may have lower back pain or hip discomfort.

Vulvodynia can cause the vaginal muscles to tense before or during intercourse. Some people report that their muscles tense so forcefully that they are unable to have intercourse.

Tenderness or sensitivity

If the skin around the vagina and vulva feels painful, tender, or sensitive, this may be a symptom of a Bartholin’s cyst.

The area may also be discolored, and there may be a hard lump or visible swelling. If an infection develops, the pain may become intense.

Trauma to the vagina or vulva can also cause tenderness and sensitivity. Many people report soreness after giving birth, especially following a perineal tear.

Pain during intercourse

Intercourse can make any type of vaginal pain worse because friction causes irritation.

However, if a person only experiences vaginal pain during intercourse, vulvodynia may be the cause.

If a fishy odor follows painful intercourse, this could indicate BV.

Diagnosis

A doctor can usually diagnose a vaginal yeast infection based on a person’s symptoms alone, though they may need to test a sample of discharge. This test will help the doctor rule out bacterial infections and STIs, such as gonorrhea and chlamydia.

The diagnostic process may also involve the doctor:

performing a physical examination of the area to check for recent injuries

carrying out an internal vaginal exam to check for muscle abnormalities, swelling, and irritation

taking a comprehensive medical history, during which they are likely to ask about risk factors for specific vaginal health issues

People with vulvodynia do not typically have detectable symptoms of a physical disorder. Therefore, the doctor will need to rule out other causes of vaginal pain to arrive at this diagnosis.

Treatments

The cause of the pain will determine the treatment options.

Antibiotics can treat gonorrhea, BV, chlamydia, and some other bacterial infections. Physical injuries, such as deep or infected wounds, may also require antibiotics.

As yeast is a fungus rather than a bacterium, antibiotics will not treat a yeast infection, and they may make it worse. Instead, the doctor may recommend an over-the-counter treatment or prescribe oral antifungal medication.

Bartholin’s cysts typically go away on their own, although warm compresses can speed this process. If a cyst grows very large, a doctor may surgically drain it. If a cyst becomes infected, it may require antibiotics.

Physical therapy may help with pelvic floor injuries, and the physical therapist can work with the person to develop a plan for strengthening the pelvic floor at home. Physical therapy may also help with vulvodynia.

Vulvodynia is notoriously difficult to treat. The right treatment varies from person to person, but it often includes a combination of:

oral and topical pain medications
nerve stimulation
drugs called nerve blocks
pelvic floor exercises
sex therapy
avoiding known triggers, where possible

Home remedies

Home remedies cannot treat bacterial vaginal infections, and trying these methods may give an infection time to get worse.

Anyone who suspects that they have a bacterial infection should see a doctor for a diagnosis and treatment.

However, certain home remedies may help with symptoms of other conditions. People may find that applying warm compresses to a Bartholin’s cyst several times a day reduces the time it takes to resolve.

Those with a vaginal tear can often ease the pain using a sitz bath, ice packs, numbing sprays, or a combination of these remedies.

Prevention

• Strategies for preventing some forms of vaginal pain include:
• wearing a condom during sex
• undergoing regular STI testing and asking all partners about their STI status
• changing out of clothes as soon as possible if they become wet or sweaty, as moisture provides an ideal environment for yeast
• asking a doctor or midwife about methods of preventing tears during childbirth, if pregnant