This is actually a loaded question. I’m going to be honest here too and say this is one of the top searched things on Google when it comes to vaginal health. I also want to be sure and state, I am not the end all be all for information on this topic. This is not to be used in place of true medical care. If you are experiencing vagina pain you should certainly discuss this with your healthcare provider.
I will share a quick little story before going into some information. This topic is near and dear to my heart because I have suffered from vagina pain myself. Mine has been in the form of vulvodynia and also dyspareunia. Don’t worry, I will be sure to describe them both. To make it simple: I wasn’t able to have sex comfortably. It was awful. It was so painful and I was miserable.
BUT I got help. The purpose of this blog is just for a little bit of information on the topic and I want to be sure you know there is help! So I’m going to answer the 3 questions I’ve seen in my practice as well as the ones I’m seeing searched the most:
We will dissect each of these together by me providing a lot of information from research (I will place the articles, websites, books I’m using at the end of this blog post.) I am also going to add in some of my opinion/expertise!!! So let’s dive in!
What causes the pain at or in the vagina? Well, I can’t actually answer this until I define what the types of vagina pain are.
The picture below is showing you an external view of your vulva. So the pain can occur in any of the areas around the vagina.
Vulvar pain--> This is a bit of an anatomy lesson. Yep, we need to know where things are to determine whether this is what’s going on or not. So, the picture below is a simple image to help you see what I’m talking about. Pain at the vulva, also know as vulvodynia, is pain that lasts more than 3 months and is not because of an infection, skin disorder, or other diagnosis. A lot of times this goes undiagnosed after clearing for all of the other diseases. A client will complain of pain at the vagina, pain during sex, pain with sitting or soft touch even. It can be incredibly detrimental to a female’s health. It is usually described as a burning, stinging, irritation, or even a rawness. I’ve found in my practice it is unfortunately common in those of us with sexual trauma backgrounds.
Some causes are said to be inflammation, irritation of the nerves in the pelvic floor area, some long term infections, reactions to foods, genetic disorders, or even pelvic floor dysfunction.
Definitely get an evaluation from your gynecologist but also a pelvic floor physical therapist because we can help to decrease your symptoms as well as help with modalities like electrical stimulation for the pain or even biofeedback to help up or down train your pelvic floor muscles. Pelvic floor physical therapists can also give you some advice on proper things to consider that might help decrease the pain. We also can help with trigger point release and re-education of the muscles if necessary!
Dyspareunia--> Pain with intercourse. Now, the pain can be superficial or they can be deep. Any aspect of sex that causes pain can be considered dyspareunia. Clients can feel the pain with initial penetration, where the penis is being inserted, or when the penis is inserted, or even with deep thrusting. It is also considered dyspareunia if there is pain after having sex.
There are several causes of dyspareunia. One of which can be vaginal dryness, in which we recommend more lubrication or making sure your hormones are not out of wack (as you are aging, or when you are breastfeeding, etc.). This can contribute to pain with inserting at a superficial level. There could also be irritation from increased sensitivity (the next one I’m talking about), inflammation, injuries to the pelvic floor, hx of surgery, etc.
If there is deep pain (with thrusting or with deep penetration) it can be more related to the cervix, diagnosis like endometriosis, cysts/growths, urinary tract infection, and many more. Hopefully it is quite obvious now that there are MANY things that can actually contribute to dyspareunia.
It’s very important that you see a pelvic floor physical therapist alongside other professionals for this diagnosis mostly because I find it so beneficial to learn about how to relax your pelvic floor and improve your ability to understand your body. You also may find it beneficial to work with/play with other forms of pleasure until you are completely finished with treatment and symptom free. The best part?! It IS treatable!
Vestibulitis--> This is one the most common reasons for painful intercourse, especially being recognized recently. If you look at the photo below, you will see where the vestibule is. Many clients report a “burning” near where the vestibule is when attempting intercourse.
I’ve noticed, in my own experience, my clients will actually suffer from the pain with normal everyday movements as well, not just sex. It makes it difficult to sit or wear underwear. Typically I find a bit of redness at the area as well as increased sensitivity when palpated.
Typically there is also inflammation and nerve irritation involved which causes a vicious cycle that occurs over and over if there is not intervention.
Clients with vestibulitis need to speak with their providers about their nutrition, hydration, hormones, and history or problems with infections. It is also very beneficial to have a pelvic floor PT consult in order to assist with desensitizing the area. We help to calm down your pelvic floor and your nervous system to heal.
I hope you were able to gain some knowledge about the topics described above! Pelvic pain is a broad topic and I could never possibly write about all of them unless I write an entire book!!