Vagina 12

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Vagina 12


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"Keep a pain journal so you can better characterize the pain to your health care provider if symptoms persist." — Kendra Segura, MD
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There’s no question that vaginal pain sucks—it makes your life more complicated than it has to be (think: having sex, going to the bathroom) and instantly sends you into a panic spiral, wondering, Why does my vagina hurt?
TBH, the potential reason behind your discomfort runs the gamut, from something as simple as a yeast infection or STI to endometriosis. The first step to finding out exactly what is bothering you is to pinpoint where that pain is coming from. "Some women describe the area down below as their vagina," explains Melissa A. Simon , MD, the George H. Gardner professor of clinical gynecology at Northwestern University. In reality, you could be feeling it in your vulva, uterus, or pelvic or abdominal region. Depending on the location, you could be experiencing a different condition.
But what if you’re not sure where your discomfort is coming from? "Keep a pain journal, so you can better characterize the pain to your health care provider if symptoms persist," says Kendra Segura , MD, a California-based ob-gyn and Married To Medicine cast member. "Your vagina should not hurt. There is always a reason."
Of course, for any kind of vaginal pain, you should check in with your doc, especially if the pain is interfering with your daily activities. They can help you figure out what’s going on and prescribe the appropriate treatment.
If you want a better idea of what exactly you might be dealing with down there, check out this list of common causes of vaginal pain, according to the experts.
The most common symptoms of yeast infections are more on the itching and burning side of things, says Gokhan Anil, MD , an ob-gyn in the Mayo Clinic Health System. But they can also be painful (not to mention annoying as hell). "The yeast can impact the inside of the vagina, or directly outside of the vagina, which may cause swelling and redness," says Dr. Anil. You may also experience vaginal discharge. "It's white and commonly described as having the appearance of cottage cheese," Dr. Simon explains.
How to treat it: While you can treat a yeast infection with OTC medications (and may choose to if you've experienced this type of infection before), it's best to seek a doctor's opinion if this is your first time dealing with the condition. Your ob-gyn will perform a pelvic exam and prescribe you an anti-fungal cream to use until your symptoms are gone. And if you do decide to go the OTC route, make sure to see a doctor if your symptoms don't clear up in a week.
Bacterial vaginosis can also cause itching and vaginal discomfort, but any discharge you might have will likely be more watery, and accompanied by a fishy odor. The condition is caused by an overgrowth of bacteria in the vagina.
“Normally, the vagina is populated with good bacteria that keep the pH of your vagina in balance,” Lauren Streicher , MD, the medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause, previously told WH . But when the good bacteria get outnumbered by “bad” bacteria, that’s when you have a case of BV. Docs aren't sure exactly what triggers it, but sex and your period can throw off your vaginal pH.
How to treat it: If you have bacterial vaginosis, a quick round of antibiotics (usually either a pill or cream) from your doctor can squash it and get rid of any symptoms.
Herpes, chlamydia, gonorrhea—generally any kind of sexually transmitted infection (STI) can cause pain down there, says Dr. Anil.
With herpes specifically—which affects about one in every six Americans, according to the CDC , by the way—it's typically nerve- or inflammation-related, says Dr. Anil. "Herpes tends to have specific lesions you can see and are quite tender to the touch," he adds.
Pain from other STIs typically comes from general inflammation. "They tend to create more swelling of the vaginal tissue, which tends to be sensitive to pain and discomfort, as well as burning and itching," says Dr. Anil. Either way, you need a doc to check you out if you're experiencing pain and inflammation of any kind in the vagina area, in order to get things under control.
How to treat it: Fortunately, according to Dr. Segura, STIs are one of the easiest to address on this list. "There is a clear way to treat via antibiotics, and there is a clear method of prevention—abstinence or condom usage," she explains. Chlamydia, gonorrhea, and other STIs can typically be cleared up with medication; and herpes, though not curable, can be managed to reduce future outbreaks and pain.
Vaginal dryness is all about the hormone estrogen—specifically a lack of it. (FYI: The issue doesn't only come up for post-menopausal women, either.)
"At the end of the day, estrogen itself is a growth hormone that improves blood flow to the vagina, thickness of the vaginal wall, as well as the elasticity and lubrication of the vagina," says Dr. Anil. And when there's not enough estrogen coursing through your body—whether it's from your birth control pills, breastfeeding, or, yes, menopause —it can make things pretty painful.
How to treat it: If you feel like your vagina doesn't lubricate the way it used to, it might be time to check in with your doctor, says Dr. Anil. They'll be able to treat you with something topical, or even change your contraception method, to make you a bit more comfortable.
While you may be inclined to blame your own anatomy, you might want to look at your partner too. "Is it really pain in your vagina that you're experiencing, or is it pain during penetration—something you feel inside your belly?" says Mary Jane Minkin , MD, an ob-gyn and the founder of MadameOvary.com . "It can be very hard to differentiate."
Basically, that "belly pain" might actually be coming from a penis penetrating you uncomfortably (possibly because it is large for your anatomy). If sex is uncomfortable for you—and you suspect your partner's size is to blame—try changing positions, specifically ones that don't allow for super deep penetration, like the reverse cowgirl . And make sure to use lube...lots of lube.
And if it's not size, maybe it's what's on your parter's penis. Do they have piercings? Do you have piercings? Both could cause discomfort during sex. It's also important to consider the condoms you're using, Dr. Simon adds. You could be allergic to latex, which could result in itching and vaginal pain.
How to treat it: Your family medicine doctor or gyno will be able to suss this one out via an exam and honest convo with you. They may suggest switching up your condoms or trying a lubrication product.
This is a condition where you can't properly relax and coordinate the muscles in your pelvic floor to have a bowel movement, according to the Cleveland Clinic . It also causes pain during sex in women.
Pelvic floor dysfunction can be a result of traumatic injuries to the area, overusing those muscles, pelvic surgery, being overweight, and aging. Pregnant women are often affected because childbirth can strain the pelvic floor muscles, especially if labor took a long time or was difficult.
On top of pelvic pain, if you also feel the urge to use the bathroom often, are constipated, struggle to have a bowel movement, leak stool or urine, or have pain while peeing, see your doctor for advice.
How to treat it: Pelvic floor dysfunction is usually treated with physical therapy. Your doctor may also recommend medications and relaxation techniques.
Vulvodynia is chronic vaginal pain without an identifiable cause (so, not because of an infection or another medical condition), according to the American College of Obstetricians and Gynecologists (ACOG). "About nine percent of women will have this kind of pain in their lives," says Dr. Minkin, describing the discomfort as occurring during penetration or even when you're inserting a tampon.
For some women, though, pangs of pain are spontaneous and unrelated to sex or touching the area in any way. "It's mysterious in that it can come and go," notes Dr. Minkin.
Vulvodynia isn't well understood, but doctors believe the pain comes from the extra nerve fibers in that outer part of the vagina and vulva. "It's the most enervated part of the vagina," says Dr. Anil.
How to treat it: Doctors who diagnose vulvodynia will often treat it with topical medications such as lidocaine, which are also used for fibromyalgia, another chronic pain condition without a known cause.
Endometriosis is kind of a confusing condition—and pretty tricky for doctors to diagnose too. It is when uterine tissue grows in places outside of the uterus (like inside your pelvic region, your abdomen, or even other places, like your lungs). The disease affects 11 percent of American women of childbearing age and is more common in those in their 30s or 40s, according to the Office on Women's Health (OWH).
The condition is also incredibly painful. "It creates chronic inflammation and scarring around tissues, which can cause pain," says Dr. Anil. The pain can manifest in several ways, per OWH: very painful menstrual cramps, chronic pain in the lower back and pelvis, pain during or after sex, intestinal pain, and pain when you poop or pee.
Endometriosis also causes bleeding or spotting between periods, infertility, and GI issues, such as constipation , bloating , and diarrhea. If your vaginal pain is accompanied by these other symptoms, talk to your doctor ASAP.
How to treat it: Endometriosis is diagnosed through a pelvic exam and imaging tests, but laparoscopy, a kind of surgery that doctors use to look inside your pelvic area, is the only way to be sure that you have it. Treatment typically includes hormone therapy or surgery to remove any tissues that are causing pain.
Pelvic inflammatory disease—an infection of your uterus, fallopian tubes, or ovaries—is another inflammatory condition that can cause vaginal pain. "It can result in scarring inside the pelvic organs, or it may cause [the pelvic organs] to attach to one another, causing chronic discomfort and pain," says Dr. Anil.
FYI, PID is often a result of untreated STIs, such as chlamydia and gonorrhea, according to the CDC , but other kinds of infections can also cause this condition. You're at higher risk of getting PID if you have more than one sexual partner, had PID before, douche, or just got an IUD in the past three weeks.
How to treat it: After a pelvic exam and ultrasound to determine whether you have this condition, your doctor will likely put you on a course of antibiotics to cleat the infection. And using a condom when you have sex can help reduce your chances of getting PID.
Vulvovaginal atrophy is thinning, drying, and inflammation of the vaginal walls that can happen when your body produces less estrogen, so most commonly after menopause (usually in women 50 or over), according to Mayo Clinic . Women who just had a baby and those who are breastfeeding can also experience a dip in estrogen level, though. A decrease of this hormone leads to less vaginal fluid and lubrication, which is usually the first sign of this condition, per the Cleveland Clinic .
This condition can make sex and urination uncomfortable. Besides pain, it can also cause vaginal dryness, itching, and redness. You may also see a yellow discharge, have spotting or bleeding, and feel pressure on your vulvar and vaginal area.
How to treat it: After diagnosis from your ob-gyn, the condition is typically treated with lubricant and hormone therapy.
A long-lasting infection with certain types of HPV is the main cause of cervical cancer, according to the CDC . It's estimated at least half of sexually active people will have HPV at some point in their lives, but few women will actually develop this type of cancer. The best way to prevent it is through regular screening and the HPV vaccine.
Pelvic pain (along with abnormal bleeding and brown discharge) is a symptom of cervical cancer. If you're experiencing these symptoms and haven't had a Pap smear in the past year, talk to your doc.
How to treat it: Depending on the kind and stage, cervical cancer is usually treated with surgery, chemotherapy, or radiation.
If you've gone to your health care clinician and they've determined that there's nothing going on in the health department, you might also want to consider past life events that could have resulted in your pain.
"Did you reveal your history of child abuse, sexual assault, or trauma with vaginal birth?" Dr. Simon asks. All of these non-evident factors could result in vaginal pain, she explains.
How to treat it: If you have experienced sexual assault or surgeries that resulted in a traumatic healing experience, revealing this to your MD could help them recommend the proper treatment—whether that's therapy, medication, or something else. It's important for both docs and patients to remember that mental health is just as important a part of a wellness check as anything else.
Hey, talking about vaginal pain can be totally awk (even though it shouldn't be!). But speaking up to a health care provider is key to finding relief and to ruling out any underlying condition that requires treatment.
If you've already reported your symptoms and feel like they've been brushed off or misdiagnosed by a particular provider, know that this is not uncommon— especially for women and people of color , says Dr. Simon. A big question to ask when it comes to disparities in health care is, "Does the patient feel agency to ask questions of their health care provider?" Dr. Simon points out.
Do you feel like you could ask your MD, "what else could it be, doc?" and they would respond with something other than a dismissal? If the answer to that question is no and you don't feel like you're being heard, know that you are allowed to and encouraged by these pros to find a second opinion.
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Medically Reviewed by Carol DerSarkissian, MD on March 06, 2022
The age-old question of whether or not size matters is typically directed at men. But although they might not talk about it, some women may worry about the size of their vagina and how it affects sexual pleasure, particularly after having a baby .
Not a lot of research has been done in this area. Because so many things affect women’s sexuality, it's hard for researchers to know if vagina size and sexual pleasure are linked.
“Our ability to understand size as it relates to sexual function is poorly understood,” says Christopher Tarnay, MD, director of the division of female pelvic medicine and reconstructive surgery at the UCLA Medical Center.
The vagina is a very “elastic” organ, says Christine O’Connor, MD, director of adolescent gynecology and well women care at Mercy Medical Center in Baltimore.
It's small enough to hold a tampon in place, but can expand enough to pass a baby through. This is because the walls of the vagina are similar to those of the stomach in that they have rugae, meaning they fold together to collapse when unused, then expand when necessary.
“It doesn’t stay one particular size,” O’Connor says. “It changes to accommodate whatever is going on at that time.”
The most commonly used measurements regarding the size of vaginas come from Masters and Johnson’s work from the 1960s. They looked at 100 women who had never been pregnant and found that vagina lengths, unstimulated, range from 2.75 inches to about 3¼ inches. When a woman is aroused, it increased to 4.25 inches to 4.75 inches. Regardless of how long the vagina is, the area that is thought to be important for most women’s sexual response is the outer one-third.
So how does length relate to sexual satisfaction? No one seems to know for sure.
Tarnay says the main issues women report is discomfort during sex. This typically happens if the vagina is too short or tight or if they have a prolapse. In prolapse, the uterus, bladder , or other organs fall out of place, typically after childbirth.
But in general, vaginal length "probably doesn’t matter,” Tarnay says. “There is such a wide range of normal. One can be completely assured that in the absence of prolapse, length has no impact on sexual satisfaction.”
What may make a difference, Tarnay says, is what he calls the genital hiatus -- the vaginal opening. If there's a problem, it typically happens after childbirth.
The vaginal opening likely changes only slightly after birth, Tarnay says. In 1996, doctors began using a measurement called the pelvic organ prolapse quantification system as a way of helping them see how well they were doing repairing that area after childbirth.
This was the first time there was a true before-and-after measurement, Tarnay says. Doctors have used the system to look at populations of women and found that there is a slight increase in the size of the opening after vaginal deliveries. The issue may be more related to muscular weakness or injury in that area, Tarnay says.
“Women who are able to contract the pelvic floor muscles can increase or decrease the size of the hiatus,” he says. “Increasing pelvic floor muscle tone can reduce looseness.”
Kegel exercises can be very effective at strengthening these muscles, Tamay says may generally improve sex .
A study published in the Australian & New Zealand Journal of Obstetrics and Gynaecology in 2008 found that women who regularly did Kegel exercises reported greater sexual satisfaction than women who didn’t do Kegels.
To find the muscles you use to do Kegels, you can either insert a finger into the vagina and squeeze the surrounding muscles or stop the flow when urinating. After you’ve found the muscles, practice contracting them for five to 10 seconds, and then relax. If you can’t hold for that long, work your way up. Repeat the process 10 to 20 times, three times a day. While doing these exercises, breathe normally and try not to use the muscles in your legs, stomach, or bottom.
Some women sustain nerve injury during birth and can’t feel these muscles. Tarnay says there arephysical therapists who specialize in helping women learn how to do Kegels.
Worrying about vagina size and whether or not it changes over time is the wrong concern, O’Connor says. She notes that other things -- like lubrication, arousal, and having and a good relationship with your partner -- have a much greater impact on sexual enjoyment for women.
A 2010 study published in the International Urogynecology Journal bears out her opinion. Researchers used medical records, an exam, and questionnaire of 500 gynecological patients aged 40 and older to see if there was a correlation between vaginal length and opening size and sexual satisfaction.
The researchers found that desire, arousal, orgasm, pain, and sexual satisfaction weren't linked to vagina size. 
“It is not an exact physical fit you are looking for in terms of sexual function,” O’Connor says. “It is more about the communication between the two par
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