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September 15, 2021/Living Healthy/Women's Health

Pain Down There? 5 Reasons Your Pelvis and Vagina Hurt

Vaginal pain can be caused by infections, cysts or other conditions

A person sitting on the edge of a bed holding their stomach in pain

Menstrual pain is no picnic, but pain and discomfort down there that’s not related to your monthly cycle can be even more upsetting. It might leave you wondering what the heck is causing it and what you should do about it.

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Whether your vagina hurts a little or a lot, you shouldn’t just ignore it. The pain could be coming from your actual vagina (the internal organ) or from the labia and skin that form your vulva (your outside genitalia).

“Many women think it’s all the same thing,” says women’s health specialist, Jessica Strasburg, MD. “To a lot of people, your vagina includes the vagina and the vulva,” she says. “But the cause of these types of pain are very different.”

“While your mind may go straight to cancer, that’s rarely a cause,” she says. So where does that leave you?

1. Vulvar infections

Both yeast and genital herpes infections are vulvar conditions that can cause the kind of vagina pain we’re talking about.

Yeast infections cause swelling, itching and pain, especially during sex or urination. Yeast infections can be triggered by antibiotics. Herpes is considered a sexually transmitted disease. A herpes infection causes raw, painful sores that lasts from 3 to 14 days. Contact with urine exacerbates the discomfort.

Other sexually transmitted infections (STIs), including gonorrheachlamydia and trichomoniasis, can also cause vaginal pain, itching and burning.

In many cases, you can treat a yeast infection with over-the-counter medication. But see your doctor if the problem persists. STIs require prescription drugs. If you are diagnosed with an STI, your partner will also need testing and treatment to prevent reinfection.

2. Vulvodynia

This condition can make you miserable. Your doctor may diagnose vulvodynia if you have vulvar pain that lasts for at least three months.

The underlying cause is unknown, but the condition prompts painful intercourse and sensations of rawness, throbbing, burning, stinging and itching. In other words, it’s not pleasant.

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“Vulvodynia can really impact your life because you avoid intercourse, and it’s uncomfortable to wear certain types of clothing,” Dr. Strasburg says. “You feel like something is always wrong. It can cause great emotional distress.”

You can ease symptoms by wearing loose clothing and cotton underwear without seams. Change clothes after exercising and use topical lidocaine to ease pain during intercourse. Topical and oral medications prescribed by your physician can also treat vulvodynia as well as cognitive behavioral therapy.

3. Bartholin’s cyst

These common cysts develop when the Bartholin glands responsible for vaginal lubrication become blocked. Many bartholin’s cysts don’t cause pain and don’t always require treatment.

These tender lumps at the vaginal opening may become pus-filled and painful with infection. You may notice the pain whether you’re sitting, walking or having sex.

Try sitting in a warm bath to ease your discomfort. “Talk to your doctor if pain or swelling persists. Surgical drainage or antibiotics may be necessary,” Dr. Strasburg says.

4. Endometriosis

Endometriosis occurs when tissue similar to that of your uterine lining grows in other areas of your pelvis. It’s a common cause of pelvic pain and can also lead to vaginal and vulvar pain.

Not only does this condition cause more painful periods and pain during sex, but it can also cause infertility. Other symptoms include:

  • Painful bowel movements.
  • Painful urination.
  • Fatigue.
  • Nausea.
  • Constipation.
  • Diarrhea.

These symptoms tend to worsen during periods.

Many studies show there is a small but increased risk of ovarian cancer in women with endometriosis. Be aware of the most common symptoms of ovarian cancer, which include:

  • Persistent stomach pain.
  • Persistent bloating.
  • Urge to urinate more frequently or urgently.
  • Difficulty eating or feeling full more quickly.

Notify your physician if you have these symptoms.

Over-the-counter pain medications may help ease your symptoms. If problems persist, your doctor may suggest hormone therapy or surgical options, including hysterectomy.

5. Pelvic floor problems

Pelvic discomfort can also lead to painful intercourse urinary and bowel dysfunction.

Many things can cause pelvic floor pain, so work with your doctor to pinpoint the culprit. A common cause is pelvic floor dysfunction or levator spasm, where pelvic floor muscles spasm as a reflex to other types of pain.

Pelvic congestion syndrome (similar to varicose veins, but in the pelvis) and irritation of the pudendal nerve (one of the main nerves in the pelvis) can also cause pelvic pain.

Ultimately, identifying whether there’s a pattern to your pain can help your doctor treat you.

“Pay attention to your symptoms and get them evaluated as soon as possible,” Dr. Strasburg says. “The most important thing is visiting the doctor. And, if you’re not seeing improvement, you might need to see a specialist.”

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