Pain in the vagina
Pain in the vagina is observed in traumatic injuries, endometriosis, dyspareunia, specific and nonspecific vaginitis, prolapse of the uterus and vagina, diseases of neighboring organs. It can be weak, strong, blunt, sharp, cutting, pulling, stabbing, permanent or periodic. It often appears or increases during sexual contacts, accompanied by itching, burning, whites. The cause of the symptom is established on the basis of a conversation, gynecological examination, laboratory and hardware studies. Treatment may include antibiotics, antimycotics, antiviral agents, analgesics, hormones, physiotherapy. In some cases, operations are shown.
Why does the vagina hurt
Medical manipulations
Traumatic injuries
Vaginitis
Endometriosis
Volumetric formations
Dyspareunia
Omission of the genitals
Hematocolpos
Fistulas
Other reasons
Diagnostics
Treatment
Conservative therapy
Surgical treatment
Prices for treatment
Why does the vagina hurt
Medical manipulations
Painful sensations are noted after abortion and diagnostic curettage. They may be disturbed after the installation of an intrauterine device and hysteroscopy. Sore, mild or moderate, decrease and disappear within a few hours or days. The cause of periodic dull or pulling pains are scarring of the vagina after surgical operations, incisions and ruptures in childbirth.
Traumatic injuries
Minor injuries occur with unsuccessful douching, the use of uterine rings and tampons that are not matched in size. The latter option is more often observed in teenage girls and young girls. Sometimes the cause of superficial injuries is careless sexual intercourse or the non-physiological position of a woman’s body during intercourse. There is no bleeding, the pain is not intense, it disappears quickly.
The etiofactor of vaginal ruptures outside the period of labor is violent or too aggressive sexual contacts, drug or alcohol intoxication of partners, rough use of intimate accessories or foreign objects to obtain satisfaction. The presence of a serious lesion is indicated by bleeding and acute pain.
Severe combined injuries can be observed with birth ruptures, pelvic fractures due to high-energy effects. Along with the vagina, the uterus, the perineal region, and neighboring pelvic organs suffer. The clinical picture is determined by the nature and prevalence of damage. There are intense sharp cutting pains, shock, massive blood loss. The condition is life-threatening.
Soft foreign bodies of the vagina and small foreign objects, as a rule, do not cause painful sensations. The appearance of pain syndrome, which increases with urination and sexual intercourse, is possible with prolonged irritation of the mucous membrane and the development of inflammation. Sharp and hard objects wound the walls of the organ, the same clinical picture is observed as with vaginal ruptures.
Vaginitis
For acute colpitis, dull non-intense pressing or bursting pains in the vaginal area are typical. Urination and sexual acts are accompanied by an increase in soreness, pain sensations become more acute, sometimes cutting or stabbing. There is irritation, itching, swelling, hyperemia, local hyperthermia of the vagina and vulva.
With coccoid vaginitis, the discharge is abundant, yellowish-white, with gardnerellosis – transparent, smelling of rotten fish. Patients with thrush (vaginal candidiasis) have a heterogeneous curd-like white discharge. Along with infection with opportunistic microorganisms, colpitis develops in tuberculosis and the following STIs:
gonorrhea;
syphilis;
chlamydia;
trichomoniasis;
mycoplasmosis and ureaplasmosis.
The downward spread of infection entails the occurrence of vulvovaginitis, in which the above symptoms are combined with pain, irritation and redness of the labia, clitoris, perineum, buttocks and inner thighs. In patients with chronic vaginitis, pain occurs extremely rarely. They may appear with exacerbations of pathology after hypothermia and acute respiratory viral infections, during pregnancy or during menstruation.
Vaginal warts
Vaginal warts
Endometriosis
In patients with endometriosis, pressing, pulling and bursting pains are mainly disturbed during sexual intercourse, defecation and urination, especially when foci are located in the vagina, rectum-uterine recess, sacro-uterine ligaments and rectovaginal septum. In about 20% of cases, there is a combination with localized or diffuse pelvic pain, in 40-60% of cases – with dysmenorrhea. Possible menorrhagia, posthemorrhagic anemia, infertility.
Volumetric formations
Pulling or contact pains are more often observed with true benign neoplasms of the vagina: lipomas, fibroids, fibroids, fibromyomas. They are supplemented by unpleasant sensations during sexual intercourse, a feeling of a foreign body, disorders of urination and defecation. In rare cases, soreness during sitting, walking, physical exertion and sexual intercourse is noted in women with large vaginal cysts and Gartner’s duct.
Rapidly increasing intense pain in the vagina, pubis, perineum, lower abdomen are detected in malignant neoplasia – cancer and sarcoma. There are purulent, bloody or succulent discharge, contact and spontaneous bleeding, urinary disorders, constipation or fecal incontinence, swelling of the lower extremities. Common symptoms are weakness, loss of appetite, weight loss, nausea, vomiting.
Dyspareunia
The cause of the pain syndrome is the introduction of the penis into the vagina or frictions. Sometimes pain occurs already at the stage of arousal or only after the completion of intercourse. Painful sensations differ in a significant variety, they are weak, barely noticeable, or painful, unbearable, stabbing, aching or burning. Cover only the vagina or vagina and vulva. They depend on the position and circumstances of copulation.
Dyspareunia can be combined with vulvodynia. It often accompanies vaginitis, vulvitis and vulvovaginitis. In addition, it is provoked by the following gynecological pathologies:
bartholinitis;
malformations of the vagina;
atrophic colpitis;
uterine fibroids;
retroflexia of the uterus.
It is found in adhesive processes and varicose veins of the pelvis. It is detected in interstitial cystitis and Sjogren’s syndrome. Sometimes it is formed due to allergic reactions and microtraumas when using protective equipment. It may be caused by the partner’s incorrect technique or psychological factors.
Omission of the genitals
Discomfort and dull pressing pains bother women with vaginal or uterine prolapse. They are complemented by a feeling of a foreign body, pulling pains in the lower abdomen, in a third of patients they are combined with dyspareunia. There may be bloody discharge from the vagina, mixed urination disorders, colitis, constipation, involuntary discharge of gases. When the uterus is lowered, infertility, algodismenorrhea and hyperpolymenorrhea are often observed.
Hematocolpos
Atresia of the hymen before the onset of menarche is asymptomatic. After the onset of menstruation, there are periodic spastic painful sensations in the lower abdomen and lumbar area. A few months later, after the accumulation of a large amount of blood in the vagina, girls have bursting pains in the vagina due to pressure on the walls of the organ. With hematocolposis on the background of aplasia and atresia of the vagina, the pain is bothered after the first or second menstruation, it becomes permanent earlier.
Fistulas
Painful sensations, itching and burning of the vagina are observed in patients with rectovaginal fistulas against the background of infection. The pain increases during sexual intercourse, forcing a woman to give up sex. There is a release of gases and feces through the vagina, a constant smell of feces. With urethro-vaginal and vesicovaginal fistulas, the symptom worries less often, dysuric disorders and urine leakage through the vagina come to the fore.
Other reasons
Sometimes the symptom is provoked by diseases of nearby organs or has a psychological basis. The cause of pain is:
Proctological pathologies: hemorrhoids, proctitis, paraproctitis, perianal abscess, suppurated coccygeal course, thrombosis of hemorrhoids, rectal tumors.
Diseases of the urinary system: urethritis, cystitis.
Mental disorders: hysteria, neurasthenia, obsessive-compulsive disorder, some psychotic states.
Colposcopy
Colposcopy
Diagnostics
Diagnostic measures are carried out by a gynecologist. If necessary, a sexologist, psychologist, oncologist, and other specialists are involved in the examination. During the survey, the doctor examines the obstetric and gynecological history, finds out how long ago and under what circumstances the pain in the vagina first appeared, how the symptom changed over time, with what manifestations it was combined. To clarify the nature of the pathology , the following methods are used:
Gynecological examination. It is possible to detect inflammation, volumetric processes, omission of internal genitalia, developmental abnormalities, traumatic injuries, scar deformities. Sometimes rectal-abdominal or rectal-vaginal examination is performed.
Colposcopy. The doctor examines the vagina and cervix under a microscope, detects mucosal defects, and studies volumetric formations. According to the indications, performs a targeted biopsy for subsequent morphological analysis of the tissue sample.
Ultrasonography. During the combined ultrasound, a comprehensive view of the state of the pelvic structures is obtained, malformations, post-traumatic changes, adhesive processes are determined. With signs of varicose veins, vascular ultrasound is additionally performed. If pathology of neighboring organs is suspected, ultrasound of the rectum, urethra, and bladder is performed.
Laboratory tests. Smear examination helps to clarify the composition of the microflora in vaginitis. To determine the pathogen and its sensitivity to antibiotics, sowing is carried out on nutrient media. PCR tests are used for STIs. Biopsies are studied during histological or cytological examination.
Other methods. To exclude damage to neighboring organs, rectoscopy, cystoscopy, urethroscopy, ultrasound of the kidneys and ureters, consultation of a proctologist or urologist may be required.
Treatment
Conservative therapy
The list of therapeutic measures is determined by the etiology of pain in the vagina:
Vaginitis. Antibacterial, antiviral and antifungal agents of general and systemic action are recommended. Antiseptic ointments and vaginal candles, disinfectant solutions, sedentary baths with herbal decoctions, potassium permanganate solution, furacilin are used.
Endometriosis. Hormone therapy with the use of gonadotropic releasing hormone agonists, progestogens, antigonadotropic and combined estrogen-progestogenic drugs plays a leading role. It is possible to prescribe medications with anti-inflammatory effects, analgesics, antispasmodics, immunostimulants.
Dyspareunia. In the presence of causal organic pathologies, local anesthetics, hormone replacement therapy, sedative and anti-inflammatory drugs, physiotherapy, gynecological massage are used. In case of psychogenic dyspareunia, psychocorrection is carried out using various techniques.
Prolapse of the uterus and vagina. A special diet, Kegel exercises, Atarbekov gymnastics, estrogen-containing drugs are shown. Individually selected gynecological pessaries are used to support the organs.
Malignant neoplasms. Photodynamic therapy, chemotherapy or radiation therapy with the use of interstitial, intracavitary or remote irradiation are required.
Surgical treatment
Taking into account the nature of the disease , the following surgical interventions can be performed:
Traumatic injuries: suturing of vaginal ruptures, opening of submucosal hematomas, removal of foreign bodies, laparotomy and revision of the abdominal cavity with combined damage to several organs.
Endometriosis: laparoscopic endocoagulation, excision of retrocervical endometriosis, organ-removing interventions in common pathology in patients of the older age group.
Omission of organs: colporaphy, vaginopexy with MESH prosthesis, sling operations, colpocleesis, various variants of vaginoplasty.
Hematocolpos: emptying and sanitation of the hematocolpos, hymenotomy, excision of the vaginal septum, vaginoplasty, excision of the wall of the “blind” vagina.
Fistulas: excision of rectovaginal, urethro-vaginal and vesicovaginal fistulas, levatoroplasty, sphincteroplasty.
Volumetric formations: removal of a benign tumor, excision of a cyst, electroexcision, vaginectomy and hysterectomy for malignant neoplasia.
