Yplostylia Varkonin 
Overview
Sexual health is a vital aspect of women’s overall well-being. Among several bothersome issues women can face is vaginal and vulvar pain. Many women report experiencing them and suffering from their debilitating effects on their intimate lives. Women tend to speak less about these problems due to feelings of fear and embarrassment, and doctors can be quick to dismiss their genuine concerns.
Talking about various aspects of vaginal pain, like its causes, symptoms, effects on quality of life, and preventative strategies and treatment modalities, is essential. This would provide women with much-needed guidance and support in breaking barriers to seeking professional care.
Causes and treatment
Vaginal pain can occur due to various underlying issues ranging from conditions that respond to simple treatments to those needing specialized professional involvement. Some of the common causes include:
Vaginal Infections
Infections of the lower genital tract commonly present with vaginal pain and discharge. Sexually transmitted infections are particularly concerning as they can lead to long-term complications such as pelvic inflammatory disease and subfertility. Suspected partner screening and prompt antibiotic treatment for both partners are necessary.
Yeast infections are commonest vaginal infections that cause vaginal pain, discharge, and itching. They are common in pregnant ladies as well as diabetic women and those on antibiotic treatment. Antifungal and probiotic treatments to help maintain a healthy vaginal flora are recommended.
Bacterial vaginosis is the overgrowth of “bad” vaginal bacteria which disturbs the balance of vaginal flora and its natural acidic environment. Douching and use of soaps and perfumed shampoos are risk factors for developing this condition. Treatment is with antibiotics to counter the anaerobic bacterial overgrowth and maintenance of good vaginal hygiene.
Vaginal Dryness
Vaginal dryness can occur in any age group but is particularly common in postmenopausal women due to estrogen deficiency. This causes a burning sensation, bleeding, and pain during sex. This condition is commonly associated with urinary symptoms and is called genitourinary syndrome of menopause. The treatment is with topical estrogen application in the form of vaginal creams and ointments.
Postpartum women who are exclusively breastfeeding can also suffer vaginal dryness. This is due to delayed resumption of ovarian activity, which leads to estrogen deficiency. In such cases, vaginal moisturizers and lubricants are effective in treating vaginal soreness and addressing sexual dysfunction.
Vaginal Pain During Pregnancy
Sharp pain in the private area, also known as lightning crotch, is sometimes reported by pregnant ladies. It comes and goes quickly, like a lightning flash. This is due to the growing fetus putting pressure on the cervix or the nerves surrounding it. Shift your position when you feel the lightning crotch. Make slower movements while getting out of bed or in the car to avoid triggering the pain. Wear belly support belts and maintain a gentle and consistent exercise routine.
Vaginal discomfort may also be due to your vagina swollen and sore while pregnant. The cause is the pressure of the growing uterus on pelvic and perineal blood vessels. It can also be secondary to vaginal yeast infection if associated with itching and discharge. Apply cool packs to ease discomfort and avoid sitting or standing for longer durations to circumvent blood stasis.
Childbirth Injuries
Vaginal births can result in vaginal and perineal tearing and lacerations. Sometimes, these tears heal suboptimally, leading to scarring of the perineum and vulva. Rarely, vaginal stenosis, i.e., narrowing of the vaginal opening or vaginal canal, can occur with improper suturing of tears and episiotomies. These injuries impact a woman’s intimate life and cause her to suffer psychologically.
All such cases need input from a board certified cosmetic surgeon to assess the degree of damage done and to decide the extent and type of corrective surgery required. Vaginoplasty and perineoplasty, when done by experienced hands, are rewarding procedures in restoring the anatomy and treating the associated sexual dysfunction effectively.
Vaginismus
Vaginismus is the painful contraction of vaginal muscles making penetration during sex painful. Women with vaginismus may not be able to use tampons or menstrual cups at all. This can be secondary to vaginal trauma and infections or may occur without any obvious signs of underlying disease. A previous bad sexual experience can make one prone to developing this condition.
The treatment includes psychosexual therapy and relaxation techniques. Your doctor may also ask you to do regular Kegels exercises to gain control of your vaginal muscles. Management is better done under the guidance of specialized therapists with partner involvement.
What is the Pain in the Vulvar Area?
Vulvar pain, the pain in outer genitals like labia, is also commonly categorized under vaginal pain due to its close proximity. The 2 common causes of vulvar discomfort are;
Vulvar Cysts
Painful swellings in the vulva are commonly Bartholin gland cysts, formed due to blockage of Bartholin gland ducts. The cyst components may get infected, forming the Bartholin abscess, causing fever and a generalized feeling of unwellness. Other lumps like sebaceous cysts, fibromas and lipomas are relatively uncommon.
The management depends on cyst size, level of discomfort, and whether the contents are infected. For smaller cysts, your doctor may recommend a sitz bath in warm water several times a day to help in spontaneous rupture and drainage of cyst contents. The treatment of large and infected ones is drainage of cyst contents to relieve the discomfort under anesthesia.
Vulvodynia
Vulvodynia is a long-term painful condition of the vulva that has no clear cause. There might be an aching, throbbing, or burning sensation that makes sex unbearable. Women often report difficulty sitting for longer durations and discomfort wearing tight-fitting underwear.
The pain may be unprovoked but is often provoked with touch. It can be generalized, spreading across the whole vulva or localized to the area surrounding the vaginal opening, vulvar vestibulitis. Usually, the vulva is normal and healthy-looking with no signs of infection, inflammation, or disease.
The treatment is best done by an expert multidisciplinary team of healthcare professionals with a mix of therapeutic modalities, taking into account the emerging trends in chronic pain management. Easing discomfort and finding the right combination of treatments for vulvodynia may take months, even with specialized professional input.
How do you Know if Something is Wrong Down There?
If present, the following symptoms and signs warrant professional evaluation and input:
- Unusual vaginal discharge with altered color or odor and excessive amount
- Vaginal itching
- Vaginal bleeding unrelated to periods like intermenstrual bleeds, bleeding after sex, or postmenopausal bleeding.
- Painful intercourse
- Swelling or lumpiness in the vulva or vagina
Prevention Strategies
Strategies to prevent vaginal/vulval pain include lifestyle modifications like:
- Engaging in safe sexual practices to avoid Sexually transmitted infections. Maintaining a mutually monogamous relationship or using condoms and considering partner STI screening.
- Wearing cotton underwear and loose-fitting breathable clothing to avoid moisture getting trapped and promote vaginal yeast infections.
- Maintaining good hygiene is vital for good vaginal health. Gentle rinsing of the vulval area after urination and wiping front to back in the toilet.
- Avoiding douching and use of soaps, shampoos, and perfumed products on the vaginal area to maintain the natural vaginal flora and acidic environment.
- Using vaginal lubricants and moisturizers for improvement of painful sex and vaginal dryness.
To Conclude
Vaginal pain is a debilitating condition with a negative impact on intimate relationships and the emotional well-being of women. The key to its successful management is the right diagnosis of the underlying cause. Mild vaginal pain may go away on its own. However, it is recommended to get evaluated by your gynecologist for persistent symptoms of vaginal discomfort.
Be wary of home remedies and over-the-counter products, as they can cause more harm than good. Do not suffer in silence and know that guidance, treatment and support are available.
About the Author
Dr. Jehan Ara is a highly qualified consultant obstetrician and gynecologist with a passion for writing and health education. She has more than 10 years of practical patient care experience. She is currently working as an assistant professor of obstetrics and gynaecology in a medical school and a clinical supervisor for post-graduate obstetrics and gynaecology residents at the affiliated teaching hospital. In addition to her clinical work, Dr. Jehan is also a passionate writer and educator. She regularly writes articles and blog posts on women’s health. She is committed to helping women understand their bodies and make informed decisions about their health.
