A sore vagina or vulva is no picnic, but pain that’s not related to your menstrual cycle can be downright uncomfortable. That type of vulval pain is called vulvodynia, and Jean Hailes gynaecologists can help you find the cause.
Pain during sex is also not normal (medically known as dyspareunia) and shouldn’t be ignored. Here are some of the possible causes.
Causes
There are many things that can cause pain in the vulva and genital area. Some are temporary, and some are long-lasting and distressing. These can include insufficient lubrication during sexual intercourse (also known as dyspareunia1), reduced sexual arousal from hormonal changes, vaginitis (a condition where the vulva and genital canal become itchy, dry, painful and red) and vulvodynia (long-term pain in the vulva and pelvic area).
Other causes of vulva or pelvic pain are irritation of the bladder lining (also called irritable bladder syndrome or bladder interstitial cystitis), an overactive clitoris (the little horny thing that hangs off your anus), a urinary tract infection, urethritis (irritation of the urethra, the short tube that carries urine out of the body), and other physical injuries such as cuts from shaving or having a perineal tear (a common injury that occurs during childbirth).
If you have vulvodynia or vulva pain, it’s important to see your doctor. Your doctor may recommend holistic treatments such as pelvic floor physiotherapy and TENS, or prescription ointments to soothe your vulva or vagina. They may also ask you to take a sample of your vaginal discharge for testing (to check for bacteria or fungi, for example). If the results indicate an infection, they’ll treat it with antibiotics. In some cases, they may suggest pelvic pain physiotherapy to help relax your tight muscles or refer you to a therapist or psychologist for psychological counselling.
Treatment
Often, when a vulva feels uncomfortable, it is the result of a health condition. For example, an itchy vulva could indicate a yeast infection or a painful sex life. Itching can also be a sign of menopause, when hormones drop and tissues become thinner, drier and more susceptible to irritation.
A tingling vulva may be a sign of nerve damage from an STI like gonorrhoea or chlamydia or even an allergic reaction to a douche, perfumed tampon, pad or soap. It can also be a side effect of some medications, including birth control pills and antidepressants. If you are experiencing a tingling vulva that does not improve with an over the counter treatment, it’s time to visit your GP.
Vulvodynia is not a disease, but a term for a range of unexplained pain in the vulva. It can affect women of any age and can be debilitating, so it’s important to talk to your GP about it.
A common symptom of vulvodynia is vaginal pain, especially during intercourse or when passing urine. This can also be accompanied by a feeling of pressure or fullness, a cottage cheese-like vaginal discharge and a painful sex life. Other symptoms include vaginal burning, pain when you pee and pelvic inflammatory disease (PID). These conditions can be treated with antibiotics and with the help of a pelvic floor physiotherapist to learn how to exercise your pelvic muscles and release tightened ones.
Prevention
Vaginal pain can be caused by many things, some of which are preventable. It’s important to see your healthcare provider for regular checkups so that any problems can be diagnosed and treated as early as possible. Don’t let embarrassment or fear of vaginal pain stop you from seeking help – your doctor will work to understand and support you.
The vulva is made of many different parts, including the anus (where faeces leave your body), the dam (the spongy area where you pee) and the inner labia, which are tiny little organs with over 8,000 nerve endings. The inner labia connect to form the clitoral hood, which is very sensitive and can feel good when stimulated.
You can help prevent vaginal pain by drinking plenty of fluids, especially water, and using a lubricant before and during sexual activity. Pouring clean, lukewarm water over your vulva after each time you use the bathroom can also help relieve and prevent pain. You can also help prevent bacterial infections by taking calcium citrate supplements or cutting out foods high in oxalates, such as rhubarb, leeks, wheat brain and nuts.
Psychological issues can also cause vulvodynia, such as anxiety and depression, which can lead to low levels of arousal, making it harder to feel good during sex. Having an open conversation with your partner about sex can be helpful. You can also try cognitive behavioural therapy, which is a type of talk therapy that helps you change the way you think and behave to reduce stress.
Questions to Ask Your Doctor
When you have questions about your vulva, never hesitate to ask your doctor. He or she has seen it all before. The discomfort you feel might be an indicator of a health problem that requires treatment. The best way to find out is to talk with your doctor, even if you’re uncomfortable with some of the questions.
Some women experience a feeling of downward pressure in their vulva. This is called dyspareunia. It’s common with menopause, and it may be caused by the loss of estrogen that causes your labia to become thinner and less elastic. It can also cause a sandpaper feeling during vaginal sex, or a dry and itchy sensation after sex. You can help reduce these symptoms by using a lubricant that contains no alcohol.
Another symptom that you should mention to your doctor is pain at and around the entrance (vestibule) of your vagina. This is called vulvar vestibulitis syndrome or VVS. It can be caused by an infection, a change in the balance of bacteria in your vagina, or a piercing.
Some vulva irritation can be caused by tight clothing, which restricts air flow. It’s best to wear loose, cotton underwear, especially when you exercise and have sex. Try using a lubricant that doesn’t contain any alcohol, and a little bit of Vaseline or other mineral oil can help, too.
