It’s normal to experience vulvar pain on occasion. But persistent pain or an irregular period should be a wake-up call that you need to see your doctor.
Typically, pain in the vulva comes from the muscles that support the bladder, rectum and uterus. But sometimes other parts of the body can cause vulvar pain, as in the case of referred pain.
Stress
Stress can affect all areas of your body, including your pelvic floor. When you are stressed, the hormone cortisol increases and can impact your blood pressure, immune system, digestive tract, vaginal health, sleep patterns and more. This can lead to a variety of symptoms, including vaginal cramps.
A normal amount of pain is expected during menstruation, but if you are experiencing severe pelvic pain or cramps, it’s time to call your doctor. Your doctor will likely do a pelvic exam and request a transvaginal ultrasound to see what is happening inside your body.
Other symptoms that may indicate a problem are vaginal itching, spotting, heavy bleeding and pelvic pain after sex or when using a tampon. You may also have a condition called dyspareunia, which is when your vaginal muscles tighten involuntarily as you touch your vulva, such as with sex or when inserting a tampon.
Other common reasons for vaginal cramps include a yeast infection (candida albicans or trichomoniasis), bacterial vaginosis, a pelvic inflammatory disease, PID, or uterine fibroids. Some of the most common symptoms of these conditions are pelvic pain, spotting and/or bleeding after sex or when you urinate, abdominal pain and fatigue, as well as vaginal itching.
Anxiety
The vagina is a sensitive part of your anatomy that’s prone to cramping, but many women don’t know why. One reason might be vaginismus, which is the involuntary tensing or contracting of muscles around your vagina. It’s triggered by fear of penetration — whether it’s from your partner, finger or even a gynecological exam. While vaginismus itself doesn’t cause pain, it can make you more aware of discomfort that may have gone unnoticed if you weren’t anxious.
Another reason could be that your anxiety is making you overly sensitive to the general aches and pains of life, including those associated with the muscles in your genital area. This is why so many people who have anxiety experience excess discomfort during the COVID-19 pandemic.
If you’re noticing vaginal pain that seems to be getting worse, it may be a sign of thrush or other bacteria infections. Those can be easy to treat with antibiotics and over-the-counter creams, but seeing your GP or nurse is always advisable first. Your doctor can also give you a pelvic exam to check your uterus, cervix and fallopian tubes. That way, they can get to the bottom of what’s causing your pain. Then, they can prescribe a treatment that works. If you’re pregnant, they can test for ectopic pregnancies (a dangerous condition where a fertilized egg attaches outside of the uterus). They can also check your blood pressure and do an ultrasound to see what’s going on with your reproductive organs.
Vaginal Infections
There are many infections that can affect the vulva (the external female genitals, including the labia and clitoris) and cause pain. The most common ones are yeast infections, bacterial vaginosis and parasites such as trichomoniasis. They can also be caused by sexually transmitted diseases such as gonorrhoea, chlamydia and herpes, all of which can cause vaginal itching, pain and discharge.
Yeast infections can be treated at home with over-the-counter medications. Other infections, such as bacterial vaginosis, can be diagnosed and treated by your doctor with antibiotics or other medications. Yeast infections and bacterial vaginosis can also lead to pelvic inflammatory disease (PID), which increases a woman’s risk for infertility, chronic pelvic pain and endometriosis.
Muscle spasms are a part of life, but when they occur in the pelvic area, it can be particularly irritating. The musculature in and around the pelvis is complex and interconnected, and it’s not as easy to manipulate with massage or exercise as the muscles in your legs, which can be moved and stretched easily.
When pain in the vulva or vagina is triggered by a uterus lining change, it’s called primary dysmenorrhea. The pain is usually a little different than the typical period cramps, which are actually uterus contractions triggered by a build-up of prostaglandins, hormones that help your uterus contract and relax. If you experience this type of pain more than four times a year, it’s a sign that something else may be going on and you should see your gynecologist for further assessment.
Vulvodynia
If you’ve been having pain in your vulva for a long time, it could be a condition called vulvodynia. This is a type of chronic pain that affects women of all ages and ethnic backgrounds. It feels like burning, stinging or itching in the vulva and vagina. It can be localized (only in a small area, such as the area around your clitoris or vestibule), generalized or mixed (provoked by sexual activity or pelvic exam and unprovoked). The vulva may look slightly inflamed but usually isn’t painful when you touch it. The pain can last for years.
Vulvodynia can cause problems that affect your daily life, including limiting your physical activities and reducing your sex drive. It can also cause depression and anxiety. It’s important to see your doctor as soon as possible so she can diagnose the problem and recommend treatment.
Your doctor will want to check for other causes of your pain, such as a urinary tract infection (UTI) or pelvic inflammatory disease. She will do a physical exam, touching areas of your vulva and vagina to feel the intensity of your pain. She will probably ask you to swab your vulva with a cotton swab so she can check for infections. If you’ve had an STD, your doctor will test your blood for those infections as well.
