Pain in the genitals in women occurs with gynecological pathologies, traumatic injuries, neoplasms, local infectious processes. Sometimes they have an irradiating character, are observed with lesions of the musculoskeletal system, lower intestines and urinary tract. The etiology of the symptom is determined on the basis of complaints, anamnesis, gynecological examination, instrumental studies and laboratory tests. In the course of treatment, medical and physiotherapeutic methods are used. If indicated, operations are performed.
general characteristics
Pain in the genitals is widespread, during the course of life it repeatedly occurs in almost all women. They are physiological or pathological. Minor discomfort in the lower abdomen for 2-3 days sometimes accompanies ovulation. Many patients are concerned about discomfort, pulling or aching pain over the womb in the first days of menstruation.
Soreness in the area of the external genitalia can be caused by rubbing underwear, an uncomfortable posture during intercourse, or repeated intercourse in a short period of time. The physiological nature of the symptom in a woman is indicated by its short duration, connection with external factors, and rapid disappearance after the elimination of provoking circumstances.
Pain, indicating the presence of pathological processes, are acute and chronic. Acute pain syndrome increases rapidly, often accompanied by a progressive deterioration in the general condition, may indicate the development of pathologies that require emergency medical care, sometimes life-threatening.
Chronic pain is predominantly periodic, associated with the menstrual cycle or external factors (hypothermia, sexual contact, physical activity). Often aching or pulling, weak or moderately pronounced. Sometimes, within the framework of chronic processes, acute pain attacks are observed.
Why do women worry about pain in the genitals
Pain in the pubis
Pain in the pubic area in women is often associated with pathologies of the musculoskeletal system. Damage to bone and cartilage tissue, surrounding soft tissue structures can be traumatic or non-traumatic. In some cases, they develop during pregnancy. The symptom occurs directly in the projection of the pubis, along the midline, to the right or left of it.
Another possible cause is pathological processes in the uterus and lower urinary tract. In this case, the epicenter, as a rule, is located just above the pubic joint, the pain radiates to the pubis. Less often, irradiation into the womb is observed with damage to the appendages. Pain in women is provoked by the following conditions:
- Traumatic injuries: bruises of the womb, ruptures of the symphysis, fractures of the branches of the pubic bone.
- Purulent-inflammatory processes: osteomyelitis.
- Benign and malignant neoplasias: osteomas, osteochondromas, chondroblastomas, chondrosarcomas, metastatic tumors.
- Conditions associated with pregnancy: symphysitis, pelvic fractures in pregnant women against the background of local lesions (osteomyelitis, tuberculosis) or systemic pathologies (osteodystrophy, osteoporosis).
- Uterine diseases: endometritis (acute, chronic, postpartum), endometriosis, sarcoma and uterine cancer.
- Pathologies of the appendages: salpingitis, adnexitis, cystic formations, tubal pregnancy.
- Bladder diseases: acute and chronic cystitis, tuberculosis, stones, cancer.
Pain in the labia
The most common etiological factors are specific and nonspecific infections. In addition, pain in the vulva occurs against the background of allergies, atrophic processes. Favorable circumstances for the development of lesions of the labia in women are considered neglect of the rules of hygiene, the use of inappropriate care products, uncomfortable underwear, hard sex, taking certain medications, hormonal disorders, metabolic and skin pathologies. Genital pain is caused by:
- Inflammatory processes: vulvitis, vulvovaginitis, bartholinitis.
- Sexual infections: gonorrhea, chlamydia, mycoplasmosis, ureaplasmosis, trichomoniasis, condylomatosis, genital herpes.
- Non-inflammatory diseases: vulvar kraurosis, vulvodynia.
- Other causes : chronic pelvic pain syndrome, varicose veins of the small pelvis.
Pain in the genitals
Pain in the vagina
The causes of pain in the vagina are quite diverse. Along with specific and nonspecific infectious diseases, a symptom may indicate the presence of injuries, volumetric processes, prolapse of internal organs, fistulas, congenital anomalies, etc. Pathological discharge is a frequent concomitant symptom. Often, an increase in pain during sexual intercourse is determined. This type of pain in women is found in the following cases:
- Injuries: tears, tears, foreign bodies.
- Vaginitis: candidiasis, gardnerellosis, specific infections.
- Volumetric processes: benign neoplasms, cancer and sarcoma of the vagina, sometimes - large cysts of the Gartner duct or vagina.
- Genital prolapse: prolapse of the vagina or uterus.
- Fistulas: urethro-vaginal, vesicovaginal, rectovaginal.
- Hematocolpos: atresia of the vagina or hymen.
With dyspareunia, the pain syndrome is associated with sexual contact, appears before, after or during intercourse, varies significantly in the strength and nature of unpleasant sensations. Sometimes the symptom is determined in women with endometriosis. Less often, irradiation into the vagina is noted in proctological and urological diseases.
Pain in the perineum
The proximity of the genitals, rectum, and lower urinary tract causes a diverse etiology of pain in the perineum in women. In some cases, dermatological pathologies, hernias become the cause. Depending on the nature of the process, the pain appears acutely or chronically, localized in the depths of the perineum or has a superficial character. Pain in this area is accompanied by:
- Gynecological diseases: vulvitis, vulvovaginitis, vulvodynia, bartholinitis, retrocervical endometriosis. Sometimes pain radiates to the perineum when the uterus and appendages are affected.
- Injuries: ruptures of the perineum and vagina during childbirth, traumatic injuries as a result of sexual violence, domestic injuries of the genital organs in girls.
- Pregnancy: in the later stages (with pressure on the soft tissues of the fetal head), in the postpartum period, especially in complicated childbirth, ruptures, suturing.
- Proctological diseases: proctalgia, proctitis, paraproctitis, anal fissure, thrombosis of hemorrhoids.
- Other causes: perineal hernia, coccygodynia, lesions of the lower urinary tract, perineal skin boils.
Groin pain
Pain in the groin in women can be associated not only with diseases of the genitals. Skin infections often occur in this area. Regional lymph nodes are also located here, into which infectious agents enter both from the genital organs and from other foci. Sometimes there is irradiation of pain from neighboring areas. Possible causes of pain:
- Dermatological diseases: folliculitis, furuncle, carbuncle, abscess.
- Hernias: inguinal, femoral, recurrent, strangulated.
- Inguinal lymphadenopathy: gonorrhea, genital herpes, less often other STIs, nonspecific lymphadenitis with local purulent processes in the feet, legs and thighs, thrombophlebitis.
- Gynecological pathologies: adhesions after surgery, irradiation with damage to the uterus, ovaries and fallopian tubes.
- Gastrointestinal diseases: chronic constipation, appendicitis, sigmoiditis, lower colon cancer.
- Orthopedic and traumatological problems: ARS syndrome, sprain, coxarthrosis, hip fracture.
Bilateral pain is more typical of STIs and gynecological diseases. With appendicitis, the symptom is detected on the right, with the involvement of the sigmoid colon - on the left. In other cases, pain can be localized on any side.
Diagnostics
Determination of the etiology of pain in the genitals is made by a gynecologist. Women with extragenital pathology are referred for a consultation with a proctologist, urologist, dermatologist. In the course of the survey, the time and circumstances of the appearance of the pain syndrome are clarified. They study its nature, duration, intensity, connection with various external (cold, stress, sexual contacts) and internal (menstrual cycle phase) factors.
As part of a general examination, hernial protrusions, abscesses and other changes are found. If an injury to the bone structures is suspected, the stability of the pelvic ring is assessed, the presence of external deformity, bruising, forced position of the limb, etc. is determined. In case of diseases of the anus and rectum, women undergo a proctological examination to identify fistulous openings, cracks, hemorrhoids, signs of proctitis. The examination plan includes the following diagnostic procedures:
- Gynecological examination. Allows you to confirm the presence of injuries, inflammation, genital prolapse, fistulas, volumetric processes, developmental anomalies. The doctor examines the external genitalia, examines the vagina and cervix using special mirrors, and conducts a bimanual examination. According to indications, performs rectovaginal examination, puncture of the posterior vaginal fornix, probing of the uterine cavity, special tests.
- Ultrasonography. Women are prescribed transabdominal, transvaginal or combined pelvic ultrasound. The technique is used to detect pathological changes in the internal genitalia, assess the state of supporting structures. For proctological diseases, ultrasound of the rectum is performed, for urological pathologies - ultrasound of the bladder or urethra, for hernias - ultrasound of the hernial protrusion, for symphysitis - ultrasound of the pubic symphysis.
- Beam methods. With traumatic injuries, bone and cartilage tumors, osteomyelitis, radiography of the pelvis or femoral neck is indicated. For pregnant women, the study is carried out according to vital indications. For patients with symphysitis, pictures of the pubic symphysis are taken after childbirth. For diseases of the uterus and appendages, hysterosalpingography is sometimes prescribed, for diseases of the gastrointestinal tract - irrigoscopy or proctography, for urological pathologies - urethrography, cystography, survey and excretory urography.
- Endoscopic techniques. To determine the cause of pain in the genitals, it may be recommended to perform hysteroscopy, colonoscopy, sigmoidoscopy, ureteroscopy, cystourethroscopy. If an emergency pathology is suspected, requiring urgent surgical intervention (acute appendicitis, tubal pregnancy), diagnostic laparoscopy is sometimes necessary.
- Laboratory tests. The standard examination program includes smear microscopy, KLA, OAM. When signs of an infectious-inflammatory process are detected, a microbiological study is prescribed to identify the pathogen, PCR, ELISA or RIF to exclude specific infections. In case of tumors, a morphological analysis of biopsy specimens is performed.
Gynecological examination
Treatment
Conservative therapy
Treatment tactics are chosen taking into account the cause of pain in the genitals. It is possible to use the following drugs and non-drug methods:
- Painkillers. NSAIDs and non-narcotic analgesics are used only after the diagnosis is established, especially in the event of acute conditions. Unauthorized medication can distort the clinical picture of the disease and make it difficult to carry out diagnostic measures.
- Antimicrobial medicines. Nonspecific infections at the initial stage are considered as a reason for prescribing a broad-spectrum antibiotic. In case of insufficient effectiveness, the drug is replaced taking into account the results of microbiological studies. With candidiasis, antifungal agents are needed. STIs may require antibiotic, antiprotozoal, or antiviral drugs.
- Other means. The treatment regimen may include hormonal therapy, antispasmodics, diuretics, venotonics, antiplatelet agents, antioxidants, vitamin complexes, drugs to improve local blood circulation, drugs with a sedative effect, vegetocorrectors. It is possible to carry out microclysters, the appointment of rectal suppositories. With ARS-syndrome, CPPS, therapeutic blockades are carried out.
- Physiotherapy procedures. As part of the treatment of diseases accompanied by pain in the genitals, a perineal shower, magnetotherapy, laser therapy, diadynamic therapy, ultrasound, and drug electrophoresis are used. In case of injuries, orthopedic diseases, massage, exercise therapy are recommended.
Surgery
For pain in the genitals, women perform the following surgical interventions:
- Damage to the osteoarticular apparatus: osteosynthesis of the pelvis or femoral neck in fractures; excision of benign neoplasms; resection of the pubic bone or pelvic bones in case of malignant tumors; sequestrectomy for osteomyelitis.
- Genital injuries: removal of foreign bodies, suturing of vaginal ruptures.
- Diseases of the external genitalia: opening of an abscess, excision of a cyst, marsupialization with bartholinitis; denervation, laser ablation or vulvectomy for vulvar kraurosis; electrocoagulation, laser or radiofrequency removal of genital warts.
- Pathologies of the internal genitalia: tubotomy or tubectomy in case of ectopic pregnancy; laparoscopic coagulation of endometriosis; resection, oophorectomy or adnexectomy for ovarian masses; removal of the uterus, conventional or extended panhysterectomy for cancer.
- Prolapse, fistulas: excision of fistulous passages, sphincteroplasty, levatoroplasty, vaginoplasty, vaginopexy, colporrhaphy, colpocleisis.
- Urological diseases: cystolithoextraction, cystolithotripsy, cystolithotomy, pyelolithotomy, ureterolithotomy in KSD; resection of the bladder, cystectomy, nephrectomy for cancer.
- Proctological diseases: opening of paraproctitis; excision of anal fissures; evacuation of thrombosed nodes, latex ligation, sclerotherapy, laser removal, hemorrhoidectomy for hemorrhoids.
- Hernias and diseases of the gastrointestinal tract: hernioplasty, dissection of adhesions, elimination of intestinal obstruction, appendectomy.