A vaginal pain is an uncomfortable pain in the genital area, which is mainly expressed in the vaginal entrance (introitus). It can also spread to neighboring regions of the genital area, such as the labia and vulva.

The pain can have different intensities and qualities. Depending on the underlying cause, vaginal pain is felt either as a stabbing or dull feeling. Some vaginal pain only manifests itself under mechanical stress - especially during vaginal intercourse - whereas other causes can lead to permanent pain, even at rest.

Vaginal pain is not an independent disease, but rather a possible symptom of various diseases.

Read more on the topic: Pain at the vaginal entrance

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Causes of vaginal pain

Vaginal pain is not only subjectively very stressful for those affected, but usually also part of a serious illness.

If vaginal pain occurs, this must be clarified promptly by an examination by the gynecologist, as there are very different causes for the pain. A common cause of vaginal pain is vaginal thrush.

Every woman suffers from an unpleasant vaginal yeast at one point in her life.

This usually manifests itself as itching and crumbly discharge. However, the longer a vaginal thrush is not treated properly or not at all, the sooner the itching turns into a dominant vaginal pain.

This has a burning character and is particularly aggravated by mechanical stress in the form of sexual intercourse.
You can find detailed information on this topic at: Burning sensation during or after intercourse

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A bacterial infection called bacterial vaginosis can also cause burning pain. These are particularly evident during sexual intercourse (dyspareunia). Itching, pain when urinating, a fishy smell of the vagina and a thin, yellowish discharge are typical.

Another cause of vaginal pain is endometriosis. In this disease, the lining of the uterus (endometrium) is found in other parts of the body outside the uterus. Around 2-10% of all women suffer from endometriosis.

In the vagina, the misplaced tissue mainly leads to pain during sexual intercourse, which makes it virtually impossible. The pain is often cycle-dependent (during your period) and can be accompanied by other symptoms such as spotting.

Vaginal pain, which occurs mainly during intercourse or the insertion of a tampon, is also often caused by what is known as vaginismus. This is an involuntary cramping of the vaginal muscles.

In rare cases, vaginal pain conceals malignant tumor diseases. These can lead to accompanying symptoms such as fever, night sweats and unwanted weight loss. The tumor may also be palpable or look like a non-healing wound.

Older women in particular should consult a doctor quickly if they experience such symptoms, as vaginal cancer occurs more frequently in older women.

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A common cause of vaginal pain in women of childbearing age is natural birth. Excessive vaginal hygiene is also often the cause of vaginal pain. Very alkaline washing lotions and shower gels in particular destroy the vaginal flora and can lead to pain. Injuries to the vagina also lead to pain. Most of the time, these manifest themselves when inserting a tampon or during vaginal intercourse.

Finally, the so-called senile colpitis or estrogen deficiency colpitis should be mentioned as the cause of vaginal pain. During the menopause, the falling estrogen level leads to severe itching, bloody discharge and vaginal dryness, which is associated with vaginal pain.

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Inflammation in the vagina

An inflammation of the vagina is called vaginitis in medical terminology. This inflammation usually has an infectious cause, such as a bacterial infection or a yeast infection. Often not only the vagina but also the vulva is affected by the inflammation. In this case, it is called vulvovaginitis.

A common symptom of vaginal inflammation is vaginal pain. This is mainly increased by mechanical loads. A burning sensation when urinating and itching are typical accompanying symptoms of inflammation.

Depending on the cause, there may be an unpleasant smell in the vagina. Bacterial inflammation is often characterized by an unpleasant and fishy odor. However, not only infections cause inflammation in the vagina, but also menopause.

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Senile colpitis, or estrogen deficiency colpitis, affects women going through menopause and is caused by falling levels of estrogen. This acute inflammation of the vagina manifests itself as severe itching, bloody discharge and pain during sexual intercourse. Senile colpitis is treated with vaginal estrogen creams.

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Vaginal fungus

The vaginal thrush is probably the most common infection of the female genitals.

The unpleasant fungus leads to severe itching and a crumbly, whitish discharge. The fungal infection is accompanied by a bad smell and pain in the vagina.

Sexual intercourse or inserting a tampon is especially painful. Urination can also be painful. The pain is more of a burning character and usually only occurs after a long time if the fungus is not treated or only insufficiently treated.

There are various vaginal creams and vaginal suppositories with the active ingredient clotrimazole or miconazole for the treatment of vaginal thrush. Persistent infections may also require treatment with tablets containing the active substances fluconazole or itraconazole.

Read more on the topic: Vaginal thrush, what medicines are there for vaginal thrush?

Diagnosing vaginal pain

Women with vaginal pain should not drag the symptoms around with them for a long time, but rather consult their gynecologist as soon as possible.

He will conduct various tests to determine the cause. The type of pain, accompanying symptoms and the age of those affected usually limit the probable causes.

This is followed by a vaginal examination, during which you inspect the vaginal lining and look for changes such as discharge, bleeding and ulcers.

An unpleasant smell can indicate an infection.

Smears help identify a pathogen. A vaginal ultrasound can also be performed if additional inflammation of the uterus or ovaries or endometriosis is suspected.

If a malignant tumor is suspected, samples are taken from the suspicious tissue in the vagina (biopsy) and examined more closely under the microscope.

Concomitant symptoms

Vaginal pain is a symptom that can occur in various diseases.

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In addition to vaginal pain, there may be other symptoms that are characteristic of the cause. Vaginal discharge or an unpleasant odor from the discharge are common symptoms associated with vaginal pain.

These accompanying symptoms are crucial for infectious diseases of the vagina. The discharge can look different depending on the pathogen. For example, a crumbly whitish / yellowish discharge is typical of a fungal infection.

Greenish discharge, on the other hand, is often found with an infection with trichomonads.

Bacterial vaginosis can also be accompanied by fever, general fatigue, and additional abdominal pain.

Another common symptom of vaginal pain is vaginal itching. This occurs in diseases such as vaginal thrush, endometriosis or vaginal dryness.

Concomitant spotting can also be the result of various causes. Not only vaginal injuries, but also tumor diseases, vaginal dryness, endometriosis and infections can lead to spotting or a bloody-serous discharge. The accompanying symptoms of vaginal pain are diverse and individually very different depending on the underlying cause.

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Treatment of vaginal pain

It does not make sense to treat vaginal pain in isolation with painkillers.

These are usually not effective on the vagina and do not eliminate the cause of the pain.

For vaginal pain to be treated successfully, the cause of the pain must be treated.

The treatments are just as varied as the causes. Vaginal bacterial infections are treated with antibiotics and fungal infections with antifungal agents. In contrast, vaginal dryness during menopause is treated with vaginal estrogen creams or estrogen tablets.

Endometriosis can be treated with drugs as well as surgically. Easily accessible endometrial foci of the vagina are removed in an operation. If there is vaginal pain due to a vaginal tumor, both surgical treatment options and chemotherapy are available.

Painful tears in the perineum that occur during childbirth are sewn and given pain reliever medication. In the case of higher-grade cracks, antibiotics are given preventively to avoid infection.

There are several treatment options available for vaginal pain caused by vaginismus. One possible measure is the use of lubricants during sexual intercourse.

This reduces the friction on the cramped muscles. However, the cause of vaginismus, such as anxiety or stress, should still be treated. Psychotherapeutic discussions are particularly useful in these cases.

Duration of vaginal pain

The duration of vaginal pain depends on the underlying cause. A vaginal thrush is usually an acute event that develops within a few days. With effective anti-fungal therapy, the symptoms also improve within a few days.

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In the case of endometriosis, on the other hand, the cycle-dependent pain usually lasts for several years or decades, as it is a chronic inflammatory disease.

Bacterial vaginosis can also last for weeks or even months. However, this is often also subclinical. This means that she has no symptoms or only very mild symptoms.

Vaginismus also persists for a long time. Many women therefore suffer from pain during intercourse or inserting a tampon for years. After giving birth, vaginal pain should subside within a few weeks.

Pain at the entrance to the vagina

Vaginal pain, which is mainly limited to the entrance to the vagina, usually has a local cause.

A yeast infection is arguably the most common cause of such pain, but endometriosis can also cause pain at the vaginal entrance.

Bacterial infections, on the other hand, are more likely to lead to vaginal pain that affects the entire vagina and not just the vaginal entrance.

Vaginismus also primarily causes pain at the entrance to the vagina. This occurs mainly during sexual intercourse and is usually so strong that full penetration is not possible.

Other possible causes of pain at the vaginal entrance are injuries that usually occur during sexual intercourse and excessive intimate hygiene.

Read more on the topic: Symptoms of vaginal thrush

Vaginal pain during pregnancy

During pregnancy, some women suffer from more or less severe vaginal pain.

Some women describe the pain as a kind of "tearing" pain, similar to overstretching. Mostly a pain is hidden behind it, which comes from the loosening of the ligaments of the pelvis. The pain can occur at the beginning or towards the end of pregnancy and, unfortunately, cannot be treated well with pain relievers. Many women help warm water or physical rest against the pain.

The pain is usually increased by physical exertion. As a rule, they are not permanently present. However, if you experience pain in the vagina during pregnancy, you should consult a gynecologist as soon as possible to rule out other causes, such as infections.

An infection of the vagina, if left untreated, can develop and affect the uterus or ovaries. Such an infection is very dangerous during pregnancy and must therefore be prevented at an early stage.

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Vaginal pain after childbirth

Vaginal birth places a natural, but also enormous, strain on the pelvic floor, the vaginal muscles and the ligamentous apparatus of the pelvis.

During childbirth, almost every woman has more or less pronounced cracks in the vagina. Small cracks do not cause discomfort, whereas larger cracks can cause mild pain after childbirth.

In the first few weeks after the birth, the body adapts again to the circumstances outside of pregnancy. During this time, slight pain in the vagina is normal. Larger loads such as lifting heavy boxes, doing sports and doing housework should be avoided for the time being.

Pelvic floor exercises, on the other hand, can help minimize the pain. Special gymnastics groups for postnatal postnatal exercises are very useful when there is pain. If the pain is very severe, does not improve or is accompanied by a fever and a foul-smelling discharge, an infection may be behind it. Such an infection needs to be treated with bed rest and antibiotics.

Pain between vagina and anus

Pain, which is mainly localized between the vagina and anus, can have various causes.

A common cause is a tear in the perineum during childbirth. The area between the anus and the vagina is called the dam. Perineal tears are especially painful if they are very large or heal poorly. Infections of the wound, which can easily develop from being close to the stool, lead to severe pain in this area.

To counteract this, antibiotics and light laxatives (laxatives) are often prescribed as a preventive measure for severe injuries. The latter lead to the chair being softened a little so that the area is not additionally mechanically stressed.

Hemorrhoids can also cause pain in the area between the vagina and anus. However, this is very rarely the case.

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Vaginal pain when urinating

Vaginal pain that gets worse when urinating or occurs especially when urinating is mostly due to an infection or endometriosis. Both of these can lead to vaginal pain as well as painful urination. A changed discharge or fever is typical for an infection. Endometriosis, on the other hand, is often characterized by burning pain during sexual intercourse.

Menopausal vaginal pain

During the menopause, hormonal changes take place in the female body, which can lead to various climacteric complaints. One possible symptom of menopause is the so-called estrogen deficiency colpitis.

The falling estrogen level during the menopause leads to acute inflammation of the vaginal mucosa, which is accompanied by vaginal dryness and itching.

In addition, vaginal pain occurs, which is particularly pronounced during sexual intercourse.

The mucous membrane is supplied with fewer nutrients, as a result of which it recedes and becomes atrophic. This makes it more prone to infections. A bloody, serous discharge from the vagina is also typical.

Local estrogen creams are available to treat this estrogen deficiency copitis. An important differential diagnosis is a malignant cancer of the vagina. This vaginal cancer occurs mainly in older people and is very rare. However, if the pain persists, a malignant cause should be ruled out.

Vaginal dryness

Vaginal dryness causes burning pain, especially during vaginal intercourse. These can be so strong that sexual intercourse can be impossible.

Many women suffer from vaginal dryness during menopause, but younger women can also be affected due to various causes.

Psychological causes such as stress and anxiety are often responsible for vaginal dryness, but internal diseases such as diabetes, rheumatic diseases or endometriosis can also be the causes. Excessive intimate hygiene is also not a rare cause of vaginal dryness in connection with vaginal pain. The annoying complaints can be treated with various measures.

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