8 Causes of Vaginal Pain—And What To Do About It

One part of vaginal health is understanding vaginal pain. Vaginal pain is common, and people with vaginas experience it for several reasons. Pain in or around your vagina can have several possible causes, including infection, injury, health conditions, menopause, childbirth, pelvic floor problems, or allergies. Usually, vaginal pain will go away with self-treatment and time.

An important distinction is that vaginal pain and vulvar pain are different. Pain in the outer tissues of your genitals, like your labia, is vulvar pain. Internal pain is vaginal pain. However, it’s not uncommon for it all to be categorized under vaginal pain.

Health compiled a list of some of the most common sources of vaginal pain and what you need to know about them. 

1. Adenomyosis

Adenomyosis occurs when the lining of the uterus, known as the endometrium, grows into the muscular layers of the uterus. Symptoms of adenomyosis include:

• Pelvic pain
• Vaginal pain
• Painful sex
• Heavy or irregular periods

A hysterectomy, a procedure that removes the uterus, can cure adenomyosis, but it may not be an option for people looking to get pregnant later. Hormonal contraceptives may help relieve symptoms for those who want to preserve their fertility but aren’t trying to get pregnant.

2. Endometriosis

Endometriosis is an inflammatory condition where tissue similar to the one that lines the uterus is found on structures outside the uterus, such as the fallopian tubes, bladder, or ovaries. Symptoms of endometriosis include but are not limited to:

• Digestive issues
• Fatigue
• Infertility
• Pelvic pain

Some people experience endometriosis-related pain only during menstruation, while others have symptoms consistently throughout the month. The pain commonly associated with endometriosis can spread into the nerves in the vulva and vagina, which can cause discomfort. Less commonly, endometriosis lesions can also appear on the vagina and vulva.

The gold standard for endometriosis care is excision surgery, where a surgeon removes visible lesions. Hormonal treatments, like oral contraceptives and intrauterine devices (IUDs), can prevent lesions from growing and reduce symptoms, but they do not eliminate the lesions.

3. Fibroids

A fibroid is a noncancerous growth in the uterus. You can have one or several, and depending on its size and placement, the growth may cause chronic pelvic pain that some describe as a constant feeling of pressure rather than sharp pain.

Fibroids are very common and more likely to develop with age. A healthcare provider can diagnose fibroids with a pelvic exam, but they will likely confirm the diagnosis and get a better sense of exactly where it is and how large it is with tests like an ultrasound.

While some fibroids may need removal, this is not always true. Sometimes fibroids shrink as someone approaches menopause.

4. Sexual Activity

Vaginal pain may be the result of painful sexual intercourse. Genital pain before, during, or after sex is medically known as dyspareunia. In particular, deep dyspareunia is pain deep in the lower pelvis or vagina.

Deep dyspareunia may also be linked to deep penetration during sex. Penetrative sex without enough lubrication can also lead to vaginal pain and discomfort. It can even cause small tears or abrasions inside your vagina or vaginal opening, which can cause pain to persist after sex. 

5. Sexually Transmitted Infections 

The most common cause of vaginal pain is infections. For instance, pelvic, vulvar, and vaginal pain are symptoms of many sexually transmitted infections (STIs). Chlamydia and gonorrhea, two bacterial STIs, can trigger pelvic or lower abdominal pain.

If left untreated, either could lead to a much more serious infection called pelvic inflammatory disease (PID), which happens when the bacteria reach the uterus and other parts of the upper reproductive tract. Signs include pelvic pain and pain during sex. PID requires immediate medical attention, leading to infertility if not caught in time.

6. Vaginal Dryness

Vaginal dryness is one of the most common causes of vaginal pain during and after sex. One of the most common reasons for vaginal dryness is low estrogen, which can be caused by hormonal birth control and perimenopause.

Perimenopause, which occurs five to ten years before menopause, is often also marked by vaginal dryness. When the body goes into perimenopause, your estrogen levels dip, which can cause vaginal dryness and lead to painful penetration.

If you can’t pinpoint your vaginal dryness to hormonal birth control or other hormonal changes in your body, look at your allergy medication. Antihistamines like a daily Zyrtec or Claritin work by drying the mucus membranes in your body, including your vagina.

7. Vulvar Cyst

If you have a painful bump on your vulva, it could be a vulvar cyst, also known as a Bartholin cyst. This occurs when the Bartholin's gland of your vulva becomes blocked with fluid. If a Bartholin cyst is large and bothersome enough, it will require drainage.

The most important thing to do is not to pick it. A sitz bath—soaking in warm warm up to a few inches—with Epsom or sitz salt can be helpful for cyst rupture and drainage.

8. Vulvodynia and Vaginismus

If your vulva feels chronically sore or swollen, you may have vulvodynia. If you have vaginal pain that makes penetration painful—including inserting a tampon—you may have a similar condition called vaginismus. 

Experts don’t know for sure what causes vulvodynia and vaginismus, but they collectively may be brought on by:

• Abnormal responses to infections or trauma
• Allergies to chemicals
• Hormonal changes
• Medication
• Nerve injury
• Stress or anxiety

If you have either of these conditions, talk to a healthcare provider about pelvic floor physical therapy (PT). A physical therapist can teach you how to perform exercises and use other treatments, such as vaginal dilators (wands of graduating sizes), to improve your symptoms.

When To See a Healthcare Provider

If you're experiencing pelvic, vulvar, or vaginal pain and think the cause may be any of the ones above or something else, talk to an OB-GYN. They can help pinpoint what the problem may be and treat it accordingly.

For example, if vaginal dryness is the issue due to birth control, a healthcare provider might be able to switch you to a different pill or type of birth control that won't have that effect.

You'll also want to seek immediate medical attention if you experience vaginal pain and:

• Abnormal bleeding
• Abnormal discharge
• Burning or itching
• Vaginal inflammation
  

A Quick Review

Vaginal pain is common, but that doesn’t mean it’s normal. This type of pain can indicate an underlying condition, such as endometriosis, STIs, or vaginal cysts. No matter the cause of vaginal pain, see an OB-GYN for diagnosis and appropriate treatment.