Genital pain in women
Pain in the genitals of women occurs with gynecological pathologies, traumatic injuries, neoplasms, local infectious processes. Sometimes they have an irradiating character, they are observed with lesions of the musculoskeletal system, lower intestine and urinary tract. The etiology of the symptom is determined on the basis of complaints, anamnesis, gynecological examination, instrumental studies and laboratory tests. In the course of treatment, medication and physiotherapy techniques are used. If there are indications, operations are performed.
General characteristics
Why women are concerned about pain in the genitals
Pubic pain
Labia pain
Pain in the vagina
Pain in the perineum
Groin pain
Diagnostics
Treatment
Conservative therapy
Surgical treatment
Prices for treatment
General characteristics
Pain in the genitals is widespread, during life it repeatedly occurs in almost all women. They can be physiological or pathological. Minor unpleasant sensations in the lower abdomen for 2-3 days sometimes accompany ovulation. Many patients are concerned about discomfort, pulling or aching pains over the womb in the first days of menstruation.
Soreness in the area of the external genitals can be caused by rubbing underwear, uncomfortable posture during sexual intercourse or repeated intercourse for a short period of time. The physiological nature of the symptom in a woman is indicated by its short duration, connection with external factors, rapid disappearance after the elimination of provoking circumstances.
Pain indicating the presence of pathological processes can be acute and chronic. Acute pain syndrome increases rapidly, is often accompanied by a progressive deterioration of the general condition, may indicate the development of pathologies that require urgent medical care, sometimes life–threatening.
Chronic pain is mainly periodic, associated with the menstrual cycle or external factors (hypothermia, sexual contact, physical activity). More often aching or pulling, weak or moderately pronounced. Sometimes acute pain attacks are observed within the framework of chronic processes.
Why women are concerned about pain in the genitals
Pubic pain
Pain in the pubic area in women is often associated with pathologies of the musculoskeletal system. Injuries to bone and cartilage tissue, surrounding soft tissue structures can be traumatic or non-traumatic. In some cases, they develop against the background of pregnancy. The symptom occurs directly in the projection of the pubis, along the median line, to the right or left of it.
Another possible cause is pathological processes in the uterus and lower urinary tract. In this case, the epicenter, as a rule, is located just above the pubic joint, the pain gives to the pubis. Less often, irradiation in the womb is observed when the appendages are affected. Painful sensations in women are provoked by the following conditions:
Traumatic injuries: bruises of the womb, ruptures of the symphysis, fractures of the branches of the pubic bone.
Purulent-inflammatory processes: osteomyelitis.
Benign and malignant neoplasia: osteomas, osteochondromes, chondroblastomas, chondrosarcomas, metastatic tumors.
Pregnancy-related conditions: symphysitis, pelvic fractures in pregnant women on the background of local lesions (osteomyelitis, tuberculosis) or systemic pathologies (osteodystrophy, osteoporosis).
Diseases of the uterus: endometritis (acute, chronic, postpartum), endometriosis, sarcoma and uterine cancer.
Pathology of appendages: salpingitis, adnexitis, cystic formations, tubal pregnancy.
Diseases of the bladder: acute and chronic cystitis, tuberculosis, concretions, cancer.
Labia pain
The most common etiofactor is considered to be specific and non-specific infections. In addition, pain in the vulva occurs against the background of allergies, atrophic processes. Favorable circumstances for the development of lesions of the labia in women are considered neglect of hygiene rules, the use of inappropriate care products, uncomfortable underwear, hard sex, taking certain medications, hormonal disorders, metabolic and skin pathologies. Pain in the genitals is caused by:
Inflammatory processes: vulvitis, vulvovaginitis, bartholinitis.
Sexual infections: gonorrhea, chlamydia, mycoplasmosis, ureaplasmosis, trichomoniasis, condylomatosis, genital herpes.
Non-inflammatory diseases: vulvar kraurosis, vulvodynia.
Other causes: chronic pelvic pain syndrome, varicose veins of the pelvis.
Pain in the genitals
Pain in the vagina
The causes of pain in the vagina are quite diverse. Along with specific and non-specific infectious diseases, the symptom may indicate the presence of injuries, volumetric processes, omission of internal organs, fistulas, congenital anomalies, etc. A common concomitant sign is pathological discharge. It is often determined that the pain syndrome increases during sexual intercourse. This type of pain in women is found in the following cases:
Injuries: tears, ruptures, foreign bodies.
Vaginitis: candidiasis, gardnerellosis, specific infections.
Volumetric processes: benign neoplasms, cancer and sarcoma of the vagina, sometimes – large cysts of the Gartner duct or vagina.
Genital prolapse: prolapse of the vagina or uterus.
Fistulas: urethro-vaginal, vesicovaginal, rectovaginal.
Hematocolpos: atresia of the vagina or hymen.
With dyspareunia, the pain syndrome is associated with sexual contact, appears before, after or during coitus, varies significantly in strength and nature of unpleasant sensations. Sometimes the symptom is determined in women with endometriosis. Less often, irradiation in the vagina is noted in proctological and urological diseases.
Pain in the perineum
The proximity of the genitals, rectum, and lower urinary tract causes a diverse etiology of pain in the perineum in women. In some cases, the cause is dermatological pathologies, hernias. Depending on the nature of the process, the pain appears acutely or worries chronically, is localized in the depth of the perineum or has a superficial character. Pain syndrome in this area is accompanied by:
Gynecological diseases: vulvitis, vulvovaginitis, vulvodynia, bartholinitis, retrocervical endometriosis. Sometimes pain radiates into the perineum when the uterus and appendages are affected.
Injuries: ruptures of the perineum and vagina during childbirth, traumatic injuries as a result of sexual violence, domestic injuries of the genitals in girls.
Pregnancy: in the late stages (with the pressure of the fetal head on soft tissues), in the postpartum period, especially with complicated childbirth, ruptures, sutures.
Proctological diseases: proctalgia, proctitis, paraproctitis, anal fissure, thrombosis of hemorrhoids.
Other causes: perineal hernias, coccygodynia, lesion of the lower parts of the urinary tract, furuncles of the skin of the perineum.
Groin pain
Groin pain in women may be associated not only with diseases of the genitals. Skin infections often occur in this area. Regional lymph nodes are also located here, into which infectious agents enter both from the genitals and from other foci. Sometimes there is an irradiation of pain sensations from neighboring zones. Possible causes of pain:
Dermatological diseases: folliculitis, furuncle, carbuncle, abscess.
Hernias: inguinal, femoral, recurrent, pinched.
Inguinal lymphadenopathy: gonorrhea, genital herpes, rarely other STIs, nonspecific lymphadenitis with local purulent processes in the feet, shins and thighs, thrombophlebitis.
Gynecological pathologies: adhesions after surgery, irradiation with lesions of the uterus, ovaries and fallopian tubes.
Gastrointestinal diseases: chronic constipation, appendicitis, sigmoiditis, cancer of the lower colon.
Orthopedic and traumatological problems: ARS syndrome, sprained ligaments, coxarthrosis, hip fracture.
Bilateral pains are more typical for STIs and gynecological diseases. With appendicitis, the symptom is detected on the right, with the involvement of the sigmoid colon – on the left. In other cases, pain can be localized from either side.
Diagnostics
The etiology of pain in the genitals is determined by a gynecologist. Women with extragenital pathology are referred for consultation to a proctologist, urologist, dermatologist. During the survey, they find out the time and circumstances of the appearance of the pain syndrome. Its nature, duration, intensity, connection with various external (cold, stress, sexual contacts) and internal (menstrual cycle phase) factors are studied.
As part of the general examination, hernial protrusions, ulcers and other changes are detected. If bone structures are suspected of injury, the stability of the pelvic ring is assessed, the presence of external deformation, bruising, forced limb position, etc. is determined. In diseases of the anus and rectum, women undergo a proctological examination to identify fistula holes, cracks, hemorrhoids, signs of proctitis. The examination plan includes the following diagnostic procedures:
Gynecological examination. Allows you to confirm the presence of injuries, inflammation, genital prolapse, fistulas, volumetric processes, developmental anomalies. The doctor examines the external genitals, examines the vagina and cervix with the help of special mirrors, conducts a bimanual examination. According to the indications, performs a rectovaginal examination, puncture of the posterior vaginal arch, probing of the uterine cavity, special tests.
Ultrasonography. Women are prescribed transabdominal, transvaginal or combined pelvic ultrasound. The technique is used to detect pathological changes in the internal genitals, assess the condition of supporting structures. With proctological diseases, ultrasound of the rectum is performed, with urological pathologies – ultrasound of the bladder or urethra, with hernias – ultrasound of hernial protrusion, with symphysitis – ultrasound of the pubic articulation.
Radiation methods. In case of traumatic injuries, bone and cartilage tumors, osteomyelitis, radiography of the pelvis or hip neck is indicated. Pregnant women are examined for vital signs. Patients with symphysitis have pictures of the pubic joint taken after childbirth. For diseases of the uterus and appendages, hysterosalpingography is sometimes prescribed, for diseases of the gastrointestinal tract – irrigoscopy or proctography, for urological pathologies – urethrography, cystography, overview and excretory urography.
Endoscopic techniques. To determine the cause of pain in the genitals, hysteroscopy, colonoscopy, rectoromanoscopy, urethroscopy, cystourethroscopy may be recommended. If an emergency pathology is suspected that requires urgent surgical intervention (acute appendicitis, tubal pregnancy), diagnostic laparoscopy is sometimes necessary.
Laboratory tests. The standard examination program includes smear microscopy, UAC, OAM. If signs of an infectious and inflammatory process are detected, a microbiological study is prescribed to establish the pathogen, PCR, ELISA or RIF to exclude specific infections. In case of tumors, morphological analysis of biopsies is performed.
Gynecological examination
Treatment
Conservative therapy
Therapeutic tactics are chosen taking into account the cause of pain in the genitals. It is possible to use the following drugs and non-drug methods:
Painkillers. NSAIDs and non–narcotic analgesics are used only after diagnosis, especially when acute conditions occur. Unauthorized medication intake can distort the clinical picture of the disease and make it difficult to carry out diagnostic measures.
Antimicrobial medicines. Nonspecific infections at the initial stage are considered as a reason for prescribing a broad-spectrum antibiotic. In case of insufficient effectiveness, the drug is replaced taking into account the results of microbiological research. With candidiasis, antifungal agents are necessary. For STIs, antibacterial, antiprotozoal or antiviral drugs may be required.
Other means. The treatment regimen may include hormonal therapy, antispasmodics, diuretics, venotonics, antiplatelet agents, antioxidants, vitamin complexes, medications to improve local circulation, medications with sedative effect, vegetocorrectors. It is possible to conduct microclysting, the appointment of rectal candles. In case of ARS syndrome, SHTB, therapeutic blockades are carried out.
Physiotherapy procedures. As part of the therapy of diseases accompanied by pain in the genitals, perineal shower, magnetotherapy, laser therapy, diadynamotherapy, ultrasound, medicinal electrophoresis are used. In case of orthopedic injuries, massage and physical therapy are recommended.
Surgical treatment
With pain in the genitals , the following surgical interventions are performed for women:
Lesions of the osteoarticular apparatus: osteosynthesis of the pelvic bones or femoral neck in fractures; excision of benign neoplasms; resection of the pubic bone or pelvic bones in malignant tumors; sequestrectomy in osteomyelitis.
Genital injuries: removal of foreign bodies, suturing of vaginal ruptures.
Diseases of the external genitals: opening of an abscess, excision of a cyst, marsupialization for bartholinitis; denervation, laser ablation or vulvectomy for vulvar kraurosis; electrocoagulation, laser or radiofrequency removal of condylomas.
Pathology of internal genitalia: tubotomy or tubectomy in ectopic pregnancy; laparoscopic coagulation of endometriosis; resection, oophorectomy or adnexectomy for bulky ovarian formations; removal of the uterus, conventional or expanded pangisterectomy for cancer.
Prolapse, fistulas: excision of fistula passages, sphincteroplasty, levatoroplasty, vaginoplasty, vaginopexy, colporaphy, colpocleesis.
Urological diseases: cystolithoextraction, cystolithotripsy, cystolithotomy, pyelolithotomy, ureterolithotomy in ICD; bladder resection, cystectomy, nephrectomy in cancer.
Proctological diseases: autopsy of paraproctitis; excision of anal fissures; evacuation of thrombosed nodes, latex ligation, sclerotherapy, laser removal, hemorrhoidectomy for hemorrhoids.
Hernias and gastrointestinal diseases: hernioplasty, dissection of adhesions, elimination of intestinal obstruction, appendectomy.
