Pain in the labia region
Pain in the labia region is observed with nonspecific vulvitis and vulvovaginitis, bartholinitis, candidiasis, gardnerellosis, STIs, vulvar kraurosis, vulvodynia. It can be permanent or periodic. In most cases, mild or moderate, has a stinging or burning character, combined with itching, pathological secretions. Less often strong, jerking, bursting. Sometimes supplemented by weakness, general hyperthermia. The cause of the symptom is determined according to the gynecological examination, the results of laboratory and hardware techniques. Treatment includes general and local etiotropic therapy, physiotherapy, hormonal agents. Sometimes surgical operations are indicated.
General characteristics
Why do labia hurt
Bacterial vulvitis
Bacterial vulvovaginitis
Bartholinitis
Candidiasis
Gardnerellosis
STIs
Vulva kraurosis
Vulvodynia
Diagnostics
Treatment
Conservative therapy
Surgical treatment
Prices for treatment
General characteristics
Pain in the labia region is most often observed in acute and chronic specific and nonspecific infectious diseases. Other possible causes are degenerative and atrophic changes, allergic reactions. With local inflammatory processes, there is a danger of upward spread of infection with damage to the vagina, cervix and body of the uterus, ovaries and fallopian tubes. Exogenous factors contributing to the development of this group of pathologies are:
neglect of hygiene;
mechanical injuries of the labia during sexual contacts, with too long use of pads, wearing rough and tight clothes;
chemical irritation and damage to the skin when using inappropriate hygiene products, attempts at self-medication;
abuse of antibiotics, irrational use of hormonal contraceptives, radiation therapy.
Endogenous disorders that create favorable conditions for the occurrence of inflammatory and atrophic processes in this area include:
metabolic and hormonal disorders: decreased estrogen levels, diabetes mellitus, obesity, vitamin and mineral deficiencies;
urethro-vaginal, vesicovaginal and rectovaginal fistulas;
skin diseases: psoriasis, eczema of the perineum;
worm infestations, intestinal dysbiosis.
Why do labia hurt
Bacterial vulvitis
Acute vulvitis is manifested by soreness, which increases with touching, movements, urination. Itching and burning are observed. The labia are reddened, swollen, sometimes covered with erosions and ulcers. With inflammation caused by staphylococcus, the discharge is thick and yellowish, E. coli – greenish, watery, with an unpleasant odor. Sometimes there is general hyperthermia, inguinal lymphadenitis. With vulvitis, girls may have sleep disorders, increased nervous excitability.
With chronic vulvitis, pain, swelling and hyperemia are detected in certain areas of the labia. Itching, burning, and scanty white spots are noted. The sebaceous glands of the perineal area are hypertrophied. The pathology is characterized by a wave-like course with frequent relapses. Synechiae can form in girls against the background of chronic inflammation and ulceration.
Bacterial vulvovaginitis
It is more often detected in women of menopausal age and girls under 10 years old. In the acute form, as in the previous case, itching, burning, pain, swelling and redness are detected. The perineal area and the inner surface of the thighs are often hyperemic, macerated, covered with combs. The type of whites is determined by the type of pathogen. In severe cases, general infectious symptoms occur, erosions appear in the affected area. In the chronic course of vulvovaginitis, the signs are less pronounced, itching and pathological discharge prevail.
Bartholinitis
It can be specific or non-specific. Initially, the labia minora on one side turns red and swells, a nodule forms in the area of the duct of the bartholin gland. Then the lower third of the labia majora also becomes edematous, moderately painful. There is itching, slight malaise. Body temperature sometimes rises to subfebrile figures.
With the development of purulent bartholinitis, unilateral pain increases sharply. Pain sensations acquire a twitching, pulsating, tearing character. The condition worsens, fever is observed, signs of general intoxication. The symptoms are especially pronounced with an abscess of the bartholin gland.
Labial herpes
Candidiasis
Thrush is diagnosed at least once in 75% of women during their lifetime. The main symptoms are burning and itching in the vulva area in combination with abundant curd milky-white secretions with a bad smell. Unpleasant sensations increase at night, after taking a bath and urinating, may be combined with minor soreness. During sexual contact, pain and irritation increase.
Gardnerellez
It is the most common bacterial vaginosis. Along with burning and itching, a woman with gardnerellosis is worried about swelling and redness of the labia, abundant homogeneous foamy, watery or pasty grayish discharge with the smell of rotting fish. Soreness of the labia is insignificant, occurs or increases during sexual intercourse and urination. The general condition is not disturbed.
STIs
As with other infectious processes, the prevailing signs are burning, itching, discharge from the genital tract. Pain syndrome in the initial stages is absent or expressed slightly. It increases with irritation, maceration, the formation of erosive defects, the development of bartholinitis.
Gonorrhea. The duration of the incubation period ranges from 5 to 10 days. The first symptom is abundant white or yellowish discharge, which a woman often interprets as a sign of nonspecific vaginitis. STIs are indicated by urethritis, inguinal lymphadenitis. Bartholinitis is possible, accompanied by sharp unilateral soreness, symptoms of intoxication.
Chlamydia. The incubation period is about 3 weeks. There are pains and burning in the vulva area. There are pains during urination, the urine becomes cloudy. Sometimes there is subfebrility. With the exacerbation of the chronic process, these symptoms are supplemented by signs of an ascending infection – pain in the lower abdomen, groin and lower back.
Mycoplasmosis. Symptoms, on average, manifest 2 weeks after infection. The pains are stinging, non-intense, supplemented by abundant transparent secretions. When the infection spreads to neighboring structures, there are pains during urination, abdominal pain, menstrual cycle disorders, intermenstrual bleeding.
Trichomoniasis. Signs occur 5-14 days after infection. Cutting, pain and itching spread to the labia, urethra, vagina. The vulva is edematous. There are fetid greenish or yellowish abundant foamy whites, sometimes with an admixture of blood. Possible deterioration of well-being, subfebrility, abdominal pain.
Endophytic papillomatosis proceeds covertly, a detailed clinical picture is found in exophytic forms. The labia minora are more often affected, on which small gradually growing “papillae” appear. Formations bleed easily. In the future, the growths turn red, there are pains, itching, whites with an unpleasant smell. With chronization, there is an alternation of episodes of exacerbations and remissions.
With genital herpes, pain, paresthesia, itching, dysuria and pathological secretions are detected even at the stage of prodrome. When rashes appear, the severity of symptoms decreases somewhat. Then the bubbles are opened, leaving behind painful ulcers and erosions. During the healing period, the area of defects is covered with crusts and heals, the manifestations gradually disappear.
Vulva kraurosis
Pathology is observed mainly in elderly women. The leading symptom of vulvar kraurosis is an unbearable paroxysmal itching, which increases at night. Combing of the genitals causes abrasions, cracks, hemorrhages and foci of inflammation. Itching is complemented by pain syndrome. At first, the labia are edematous, hyperemic, and subsequently wrinkled, dry, rough.
Vulvodynia
This disease is characterized by chronic pain in the labia, clitoris, and vestibule of the vagina. With vulvodynia proper, painful sensations are constant, with vulvar vestibulitis – paroxysmal, provoked by pressure on the vestibule zone. Pathology develops against the background of neuropathy of the genital nerve, allergic reactions or individual hypersensitivity to stimuli (synthetic underwear, hygiene products, oxalates in urine, etc.).
The pain can be dull, sharp, aching. Occurs or increases with movements, tampon insertion, sexual intercourse, wearing tight or coarse underwear. Itching and a feeling of stinging are possible. Some women have objective changes – edema, hyperemia, rashes, whitish areas, ulcers, erosion. In other patients, the external genitalia look normal.
Diagnostics
Determining the nature of the pathology is the responsibility of a gynecologist. The initial diagnosis of STIs is carried out as part of a basic examination, if necessary, to clarify the diagnosis and prescribe treatment, the patient is referred to a venereologist. The plan of diagnostic measures for pain in the labia may include the following procedures:
Survey. The specialist determines the nature and duration of the pain, the circumstances of its occurrence, and other symptoms. To determine the possible causes of pain syndrome, a detailed anamnesis is collected: features of the menstrual cycle, the number of pregnancies and births, the presence of gynecological, allergic and somatic pathologies.
Gynecological examination. The doctor assesses the condition of the labia minora and labia majora, perineum, and anus area. Provoizdit examination in mirrors and vaginal examination. The technique allows you to detect swelling, redness, atrophic changes, ulcers, erosions and other signs indicating the etiology of the pain syndrome.
Bacterioscopy. When examining a smear in patients with inflammatory diseases, a large number of white blood cells are detected. The nature of the microflora depends on the type of infection. With bacterial vaginitis and vulvovaginitis, cocci are more often predominant. Fungal cells and mycelium filaments are detected in patients with candidiasis.
Microbiological examination. According to the results of sowing, the characteristics of the microflora and the sensitivity of pathogenic microbes to antibiotics are established. Persistent recurrent course of candidiasis is considered as an indication for determining the subspecies of fungi and their sensitivity to antimycotic agents.
PCR analysis. It is an accurate, highly informative way of identifying STI pathogens. The advantage of the technique is the ability to detect any microorganisms: bacteria, fungi, protozoa, viruses.
Vulva biopsy. It is recommended for ulcers, erosions, areas of atrophy on the labia. It is carried out to exclude malignant neoplasms. The obtained material is examined during histological or cytological analysis.
Colposcopy. It is indicated for nonspecific vulvovaginitis, the ascending spread of specific infections. Allows you to visualize erosions, inflammatory changes.
Gynecological ultrasound. It makes it possible to assess the condition of the internal genitalia, diagnose concomitant pathological processes or determine the cause of the development of inflammation of the labia (for example, when irritated by secretions against the background of salpingoophoritis).
Other tests. With signs of intoxication, a general blood test is prescribed to assess the severity of inflammatory changes. All patients undergo a general urinalysis. If irritation of the vulva is suspected due to parasitosis, scraping for enterobiosis is performed, fecal examination for worm eggs. In case of provoking endocrine and metabolic disorders, the indicators of biochemical blood analysis are studied.
Gynecological examination
Gynecological examination
Treatment
Conservative therapy
The list of general recommendations for most pathologies accompanied by pain in the labia suggests a change in hygiene habits, sexual rest, correction of the regime and nature of nutrition, refusal to use synthetic underwear, highly allergenic or irritating hygiene products. Therapeutic measures for inflammatory and infectious processes include:
Antibacterial agents. In bacterial infections, antibiotics are prescribed for systemic and local use (creams, candles, vaginal tablets), selected taking into account antibiotic sensitivity.
Other etiotropic medications. In polymicrobial vulvitis and vulvovaginitis, combined drugs with antibacterial, antiprotozoal and antimycotic effects are used. Antimycotics are effective for candidiasis, antiviral drugs are effective for HPV and papillomatosis.
Local events. For vulvitis, vaginal candles, douching with antiseptic solutions and herbal decoctions, sedentary baths are recommended. With acute bartholinitis, SMT, UHF and UFO are effective, with chronic – ozokerite, paraffin, infrared laser, mud applications.
Treatment of background pathologies. According to the indications, insulin therapy or doses of hypoglycemic agents are corrected for diabetes mellitus, antiallergic drugs are prescribed, deworming is carried out, infectious foci are sanitized.
Patients with vulvodynia are advised to refrain from eating foods with a high content of calcium oxalate (celery, strawberries, chocolate) in order to reduce the amount of this compound in the urine. With non-intense pain, exercises to strengthen the pelvic floor muscles are useful. Balneotherapy and physiotherapy are effective. If there are signs of atrophy, candles and creams are used to stimulate regeneration. In case of ovarian hypofunction, hormonal therapy is prescribed.
Patients with vulvar kraurosis are recommended antihistamines and sedatives. With persistent itching, a blockade of the genital nerve is performed. Hormonal ointments with estrogens, androgens, corticosteroids and progesterone are applied topically. The type of medication is selected taking into account age and endocrine status. Balneotherapy, reflexotherapy, laser therapy, photodynamic therapy, X-ray therapy are effective. It is necessary to take biostimulants, immunocorrectors and vitamin preparations.
Surgical treatment
In most cases, pain in the labia area is eliminated by conservative methods. Operations may be required in the presence of the following pathologies:
Bartholinitis: marsupialization, cyst removal, removal of the bartholin gland, opening of the abscess.
Vulvar kraurosis: cryodestruction, laser ablation or denervation of the vulva, if malignant tissue degeneration is suspected, vulvectomy.
Condylomatosis: radiofrequency ablation, laser vaporization, cryodestruction, electrocoagulation, vulvar resection, vulvectomy.
