The Most Common Causes of Vaginal Pain, Plus What to Do About It

Vaginal pain is incredibly common, and people with vaginas experience it for a number of reasons. But with a lot of misinformation out there, and stigmas around sexual health, it can be tricky to know exactly what’s going on. 

An important distinction to make is that vaginal pain and vulvar pain are different. Pain that exists 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 the umbrella term of vaginal pain.

Vaginal pain can be caused by a myriad of conditions, and its symptoms can vary depending on the underlying cause. 

Depending on the condition, you may experience:

• Rawness
• Burning
• Itching
• Soreness
• Stinging
• Throbbing
• Pain during sex

We put together a list of some of the most common sources of vaginal pain, and what you need to know about them. 

Vaginal Dryness

Vaginal dryness is one of the most common causes of vaginal pain during and after sex. Penetrative sex without enough lubrication can 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. 

One of the most common reasons for vaginal dryness is low estrogen, which can be caused by such things as hormonal birth control to perimenopause. 

If you think the cause of your vaginal dryness is your birth control, bring it up to your OB-GYN. They might be able to switch you to a different pill or type of birth control that won’t have that effect. 

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, take a look at your allergy medication. Antihistamines like a daily Zyrtec or Claritin work by drying the mucus membranes in your body, including your vagina.

Your Period

You’re probably familiar with menstrual cramps, bloating, and other PMS symptoms – but vaginal pain can also come with your period. A common premenstrual symptom is water retention, which is caused by fluctuations in your hormones. This water retention can lead to soreness and tenderness in your vaginal tissue. This kind of vaginal pain should be relatively minor, and if it’s not, you should talk to your healthcare provider. 

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 can also trigger dull or sharp pain during sex, particularly if the fibroid is growing near the cervix or upper end of the vagina. During your period, the pain can be more pronounced, especially if the fibroid is growing in such a way that it puts pressure on the uterine lining.

Fibroids are very common, and they are 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 to be removed — especially if the pain is interfering with your quality of life — this is not always the case. Sometimes fibroids shrink as someone approaches menopause.

Endometriosis

Endometriosis is an inflammatory condition where the tissue that lines the uterus is found on structures outside of the uterus such as the fallopian tubes, bladder, or rectum. Endometriosis is commonly found in the pelvis but it can be found on any organ in the body. 

Symptoms of endometriosis include but are not limited to:

• Pelvic pain
• Fatigue
• Digestive issues
• Infertility

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, a procedure where a surgeon will completely remove visible endometriosis lesions. Hormonal treatments, like oral contraceptives and intrauterine devices (IUDs), can prevent lesions from growing and reduce symptoms, but they do not get rid of the lesions.

Adenomyosis

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

Symptoms of adenomyosis are similar to endometriosis and 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 in the future. Hormonal contraceptives may help relieve symptoms for those who want to preserve their fertility but aren’t trying to get pregnant. Another option is a procedure known as a presacral neurectomy, which severs the nerves that send pain signals from the uterus to the brain.

Sexually Transmitted Infections 

The most common cause of vaginal pain is infections. For instance, pelvic, vulvar, and vaginal pain are symptoms of a number of sexually transmitted infections (STIs). 

Chlamydia and gonorrhea, two bacterial STIs, can both trigger pelvic or lower abdominal pain as well as a burning sensation during urination. If left untreated, either could lead to a much more serious infection called pelvic inflammatory disease (PID), which happens when the bacteria make their way to the uterus and other parts of the upper reproductive tract. Signs include pelvic pain and pain during sex. PID requires immediate medical attention, as it can lead to infertility if not caught in time.

If you’re experiencing pelvic, vulvar, or vaginal pain and are sexually active, have a conversation with your OB-GYN about undergoing STI testing. Most STIs can be treated with prescription medication. 

Vulvodynia and Vaginismus

If your vulva feels chronically sore or swollen — so much so that it hurts to be touched, to wear underwear and to sit down for long periods of time — you may have a condition called vulvodynia.

If you have vaginal pain that makes penetration of any kind 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 may be brought on by nerve injury, allergies to chemicals, hormonal changes, medication, or an abnormal response to an infection or trauma. Patients with endometriosis or other kinds of pelvic pain may experience vulvodynia and vaginismus.

There is no definitive cure for vulvodynia or vaginismus. However, if you have either of these conditions, talk to your healthcare provider about pelvic floor physical therapy (PT). A physical therapist can teach you how to perform exercises as well as use other treatments, such as vaginal dilators (wands of graduating sizes), to improve your symptoms.

Other patients find holistic remedies like CBD suppositories and lubricants helpful to alleviate the symptoms. 

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. Try an astringent like witch hazel to extract and clean it. If it persists or is really bothering you, check in with your OB-GYN.

A Quick Review

If you’re experiencing vaginal pain, remember this: Just because this type of pain is common, doesn’t mean it’s normal – it can often be a sign that something is wrong. And even if it isn’t something serious, that doesn’t mean you shouldn’t address it.