When it comes to your vagina, you'll want to keep it in tip-top shape. In general, your vagina shouldn't hurt, so if you start to feel pain, there's probably something going on. Usually, maintaining proper hygiene and taking care of it should keep it safe, but sometimes infections or other medical conditions can come into play and put you at risk of discomfort and sensitivity. If you do notice any pain down there [1], be sure to check with your doctor to see what's going on and what steps to take in finding relief. Here are five reasons your vagina might hurt so much [2].
Menopause
Yup, as you get older and enter menopause, you might start to feel more sensitive down there than you did before. "When women go through menopause, their levels of oestrogen drop over a short period of time. Additionally, testosterone goes down slowly over time," said Dr. Jennifer Landa, MD [3], an ob-gyn and chief medical officer at BodyLogicMD, to POPSUGAR.
Here's why that's important: "Oestrogen and testosterone both help to keep the tissues of the vagina moist and plump. When women's hormones decline, their vaginal cells tend to shrink, making their vaginas feel tighter and extremely dry. This causes a lot of pain with sex and can even cause small tears in the tissue that can be very painful and can make it uncomfortable to apply lubricants and attempt intercourse," she said.
The good news is that this cause of vaginal pain can be effectively and safely treated with vaginal oestrogen or a combination of vaginal oestrogen and testosterone.
Vaginal Infections
"Infections, especially yeast infections, cause a lot of itching and discomfort for women [4]. Vaginal yeast infections are similar to yeast infections in other areas, [and] the overgrowth of yeast causes redness, swelling, itching, and can cause pain," she said. There is also usually a thick, cheesy discharge, so take note of that if you think you might have it.
Luckily, that pain can go away shortly."Yeast infections can be treated with over-the-counter antifungal creams or a prescription oral medication. They also can be effectively treated with boric acid 600mg capsules or suppositories, which are available over the counter," she said.
Vulvodynia
This one's a bit trickier. "This is an unexplained vaginal pain that usually results in extreme tenderness around the opening of the vagina. Some scientists think it comes from having too many yeast infections in the past. Others think it happens from abnormal firing of nerves," she said.
"Many women experience pain that makes sex uncomfortable and intolerable [5]," she said, and since it's hard to pinpoint, it's hard to treat, too. In general, treatments range from topical creams with steroids in them or testosterone cream to oral medications. Even antidepressants have been shown to be effective for some women, she said. "Some women do well with colloidal oatmeal sitz baths or topical lidocaine to numb the area, [and] some women respond to pelvic floor physical therapy," she said.
Herpes
Genital herpes is a common cause of vaginal pain. "You can get infected from someone who has had herpes before either in their mouth or on their genitals. These are different strains of the virus. Even someone who doesn't know they ever had herpes can transmit herpes, and you don't have to have a breakout to be contagious," she said.
When you have herpes, you will have sores that initially look like pimples, but then they break open and have some clear to yellow fluid that weeps out of them and usually crusts over. "The sores are usually about 1/4 inch and round and happen in small bunches. Your doctor can prescribe antiviral medication that quickly takes care of the sores and the pain in most cases," she said.
These sores can come back and tend to be brought on by stress or eating certain foods. "If you get the infections frequently, you can take medication regularly to prevent them and you also should have your partner tested. If they have not been exposed to the virus, you can take the medication [daily] to prevent exposing them," or getting an outbreak where the herpes is active, yourself, she said.
Endometriosis
"This happens when you have endometrial tissue, the tissue normally inside your uterus, somewhere outside of your uterus. This means that when you menstruate, those tissues will bleed also," she said. The body is sensitive to blood being in areas where it normally isn't, and so this can cause pelvic and deep vaginal pain for women [7], she explained.
"The pain will be worse with menses, and many women with this condition experience pain with intercourse," she said. "There are oral medications that can be tried for this condition; some women successfully use the birth control pill continuously to avoid menses with this condition, and sometimes surgical treatment is required," she said. Speak to your OB to decide the best treatment for you.