Pain in the vagina is observed with traumatic injuries, endometriosis, dyspareunia, specific and nonspecific vaginitis, prolapse of the uterus and vagina, diseases of neighboring organs. It can be weak, strong, dull, sharp, cutting, pulling, stabbing, constant or intermittent. Often appears or intensifies during sexual intercourse, accompanied by itching, burning, leucorrhoea. The cause of the symptom is established on the basis of the conversation, gynecological examination, laboratory and hardware studies. Treatment may include antibiotics, antimycotics, antivirals, analgesics, hormones, physical therapy. In some cases, operations are indicated.
Painful sensations are noted after an abortion and diagnostic curettage. They may be disturbed after the installation of an intrauterine device and hysteroscopy. Raw, weak or moderate, decrease and disappear within a few hours or days. The cause of periodic dull or pulling pains is cicatricial changes in the vagina after surgical operations, incisions and ruptures in childbirth.
Minor injuries occur with unsuccessful douching, use of fallopian rings and oversized tampons. The latter variant is more commonly seen in adolescent girls and young girls. Sometimes the cause of superficial damage is careless sexual intercourse or the non-physiological position of the woman's body during intercourse. There is no bleeding, the pain is not intense, it quickly disappears.
The etiofactor of vaginal ruptures outside the period of labor is violent or too aggressive sexual contacts, drug or alcohol intoxication of partners, the rough use of intimate accessories or foreign objects to obtain satisfaction. Bleeding and acute pain testify to the presence of a serious lesion.
Severe combined injuries can be observed with birth ruptures, pelvic fractures due to high-energy effects. Along with the vagina, the uterus, the perineal region, and neighboring organs of the small pelvis suffer. The clinical picture is determined by the nature and extent of damage. There are intense sharp cutting pains, shock, massive blood loss. The condition is life threatening.
Soft foreign bodies of the vagina and small foreign objects, as a rule, do not cause pain. The appearance of pain syndrome, aggravated by urination and sexual intercourse, is possible with prolonged irritation of the mucous membrane and the development of inflammation. Sharp and hard objects injure the walls of the organ, the same clinical picture is observed as with vaginal ruptures.
For acute colpitis, dull, non-intense pressing or bursting pains in the vaginal area are typical. Urination and sexual acts are accompanied by an increase in soreness, pain becomes more acute, sometimes cutting or stabbing. Irritation, itching, swelling, hyperemia, local hyperthermia of the vagina and vulva are noted.
With coccal vaginitis, the discharge is abundant, yellowish-white, with gardnerellosis - transparent, smelling of rotten fish. In patients with thrush (vaginal candidiasis), there is a heterogeneous cheesy white discharge. Along with infection with opportunistic microorganisms, colpitis develops with tuberculosis and the following STIs:
The downward spread of the infection entails the occurrence of vulvovaginitis, in which the above symptoms are combined with pain, irritation and redness of the labia, clitoris, perineum, buttocks and inner thighs. In patients with chronic vaginitis, pain is extremely rare. They can appear during exacerbations of pathology after hypothermia and SARS, during pregnancy or during menstruation.
Vaginal warts
Patients with endometriosis have pressing, pulling and bursting pains, which are mainly disturbed during sexual intercourse, defecation and urination, especially when the lesions are located in the vagina, recto-uterine cavity, sacro-uterine ligaments and rectovaginal septum. In about 20% of cases, there is a combination with localized or diffuse pelvic pain, in 40-60% of cases - with dysmenorrhea. Possible menorrhagia, posthemorrhagic anemia, infertility.
Drawing or contact pains are more often observed with true benign neoplasms of the vagina: lipomas, myomas, fibromas, fibromyomas. Complemented by unpleasant sensations during sexual intercourse, a feeling of a foreign body, disorders of urination and defecation. In rare cases, pain when sitting, walking, physical activity and sexual intercourse is noted in women with large cysts of the vagina and Gartner's duct.
Rapidly growing intense pain in the vagina, pubis, perineum, lower abdomen are detected in malignant neoplasia - cancer and sarcoma. There are purulent, bloody or sanious discharge, contact and spontaneous bleeding, urinary disorders, constipation or fecal incontinence, swelling of the lower extremities. Common symptoms are weakness, loss of appetite, weight loss, nausea, and vomiting.
The cause of the pain syndrome is the introduction of the penis into the vagina or friction. Sometimes pain occurs already at the stage of arousal or only after the completion of intercourse. Painful sensations are distinguished by a significant variety, they are weak, barely noticeable, or painful, unbearable, stabbing, aching or burning. Cover only the vagina or vagina and vulva. Depend on the posture and circumstances of copulation.
Dyspareunia may coexist with vulvodynia. Often accompanied by vaginitis, vulvitis and vulvovaginitis. In addition, it is provoked by the following gynecological pathologies:
It is found in adhesive processes and varicose veins of the small pelvis. It is detected in interstitial cystitis and Sjögren's syndrome. Sometimes it is formed due to allergic reactions and microtraumas when using contraceptives. It may be due to incorrect partner technique or psychological factors.
Discomfort and dull pressing pains bother women with prolapse of the vagina or uterus. Complemented by the sensation of a foreign body, pulling pains in the lower abdomen, in a third of patients they are combined with dyspareunia. There may be bloody discharge from the vagina, mixed urination disorders, colitis, constipation, involuntary passage of flatus. When the uterus is prolapsed, infertility, algomenorrhea and hyperpolymenorrhea are often observed.
Atresia of the hymen before the onset of menarche is asymptomatic. After the onset of menstruation, periodic spastic pain in the lower abdomen and lumbar region is noted. A few months later, after the accumulation of a large amount of blood in the vagina, girls develop arching pains in the vagina, due to pressure on the walls of the organ. With hematocolpos against the background of aplasia and atresia of the vagina, pain is disturbed after the first or second menstruation, and earlier they become permanent.
Painful sensations, itching and burning of the vagina are observed in patients with rectovaginal fistulas against the background of infection. The pain intensifies during sexual intercourse, forcing a woman to refuse sex. There is a release of gases and feces through the vagina, a constant smell of stool. With urethro-vaginal and vesico-vaginal fistulas, the symptom is less likely to worry, dysuric disorders and urine leakage through the vagina come to the fore.
Sometimes a symptom is provoked by diseases of nearby organs or has a psychological basis. Pain is caused by:
Colposcopy
Diagnostic measures are carried out by a gynecologist. If necessary, a sexologist, psychologist, oncologist, and other specialists are involved in the examination. During the survey, the doctor examines the obstetric and gynecological history, finds out how long ago and under what circumstances pain in the vagina first appeared, how the symptom changed over time, with what manifestations it was combined. To clarify the nature of the pathology, the following methods are used:
The list of therapeutic measures is determined by the etiology of pain in the vagina:
Depending on the nature of the disease, the following surgical interventions can be performed: