Welcome to this Decision Guide.

By answering a series of questions, you will learn about the more likely reasons for your vaginal pain or discomfort. This guide is not intended to substitute for the in-office care and the advice of your physician.

Vaginal discomfort can occur even when there is nothing out of the ordinary that you can see or feel in the genital area.

Click here to begin.

Some vaginal pain can be distinguished by whether or not it is made worse by sex.

Is your pain worse during sex?

Yes, my pain is worse during sex.

No, sexual activity has little effect on the pain.

Many women have vaginal pain with their periods.

Do you get vaginal pain only around the time of your period?

Yes, my vaginal pain is only around the time of my period.

No, my vaginal pain occurs at times other than close to the time of my period.

Sometimes vaginal pain can be the sign of an infection. Other signs of vaginal infections include vaginal discharge, itchiness, and an unpleasant odor.

Do you think you may a vaginal infection?

Yes, this is possible.

No, this seems very unlikely.

Some women experience vaginal discomfort when they have a urinary tract infection.

If you have a urinary tract infection you also may feel:

• Burning with urination

• An urge to urinate frequently

Do you have either of these symptoms?

Yes, I have one of these symptoms.

No, I don't.

It sounds like you do not have a urinary tract infection or a vaginal infection as the cause of your pain.

Sometimes pain from other areas of the body can radiate into the vagina and labia. Doctors call this referred pain.

Is the pain worse when you are walking or standing?

Yes, the pain is worse when I am walking or standing.

No, the pain is not worse when I am walking or standing.

There are several possible explanations for your vaginal pain. You will need to visit with your doctor so that your pain can be evaluated.

If you are an older adult, particularly if you have ever given birth, it is possible that your pain is coming from a shift in position of your uterus. If the uterus is not fully supported by the ligaments and muscles that hold it in its usual position in the pelvis, the uterus can "slump" downwards into the vagina. This problem is named uterine prolapse. The pain that is associated with uterine prolapse is often described as "heavy," "aching," or "pulling."

Some skin conditions affect the entrance to the vagina and can cause vaginal pain. An example is the skin change, "lichen sclerosis." Your doctor can inspect your skin in the genital area for changes that might offer an explanation.

You have reported that you have pain at times other than during or close to your menstrual cycles. It is possible that you have a condition named endometriosis, even though your pattern of pain is not typical. Endometriosis occurs when the type of tissue that lines the uterus is also located in places outside of the uterus. This tissue enlarges during prior to menstruation and it can create irritation in your pelvis or lower abdomen.

Pain from the lower abdomen or kidneys can sometimes be felt in the vagina. This type of pain is called referred pain, and it can occur when there is no problem within the vagina itself. A hernia or a kidney stone are examples of problems in the abdomen that can cause pain in the vagina.

You will need to see your doctor for evaluation of your discomfort.

Since you have pain when you are walking or standing, it is possible that your pain is coming from a shift in position of your uterus. If the uterus is not fully supported by the ligaments and muscles that hold it in its usual position in the pelvis, the uterus can "slump" downwards into the vagina. This problem is named uterine prolapse and it may cause more exaggerated symptoms of pain or a heavy sensation in the vagina when you are upright. Uterine prolapse is particularly common after childbirth, and it can develop over many years. The pain that is associated with uterine prolapse is often described as "heavy," "aching," or "pulling."

Pain with walking or standing can also come from muscles and bones or joints that are weight-bearing. Pain in the hip can radiate to the groin and vagina. Pain from the hip will be worse with any motion of the hip joint. It will also be worse when you are standing because the hip is carrying your weight.

Hip pain can happen with a hip fracture, arthritis, bursitis, and other problems.

If you have pain or burning when you urinate, you may have a urinary tract infection.

Contact a doctor today so you can be evaluated for a possible urinary tract infection. If you have an infection, you will need treatment with antibiotics.

It is also possible for burning with urination to be caused by irritation or infection in the urethra, the tube that drains the bladder. The urethra empties urine at the opening of the vagina. Irritation in the urethra is named urethritis. Urethritis can be caused by infection (such as the sexually transmitted diseases chlamydia or gonorrhea) but it can also result from chemical irritation or an allergy reaction after use of bubble bath, spermicides, latex condoms, or other products.

Women who are past menopause can have irritation caused by thinning and sensitivity of the tissue that lines the urethra and vagina. After menopause there is less estrogen in the body. Estrogen keeps the vaginal lining and urethra well lubricated. Without estrogen, the vaginal lining can get irritated easily (atrophic vaginitis) and pain may occur with urination. Creams that contain estrogen or estrogen supplements by pills or patches may help.

Estrogen supplementation after menopause has possible side effects. Estrogen-containing creams deliver only small amounts of estrogen to the rest of your body, but they need to be provided by a doctor after a discussion of possible side effects.

Please close this guide and visit our Decision Health Guide on Vaginal Discharge, Itching or Irritation.

The nerves that signal pain in the uterus extend down into the vagina and labia. While the uterus is contracting to push out menstrual blood, those nerves can be irritated and pain can be felt within the vagina.

This is usually not a symptom of any serious condition. The medical term for pain during menstruation is "dysmenorrhea." You can treat the symptoms of menstrual period pain with over-the-counter ibuprofen or acetaminophen.

Sometimes vaginal pain that occurs during menstruation can be caused by endometriosis. Endometriosis occurs when the type of tissue that lines the uterus is also located in places outside of the uterus. This tissue enlarges during prior to menstruation and it can create irritation in your pelvis or lower abdomen. If you have significant vaginal pain during menstruation, you should talk to your doctor about endometriosis.

Vaginal pain that is worse during sexual intercourse can occur for several different reasons.

Pain with intercourse commonly occurs when you have a vaginal infection. Signs of vaginal infections include vaginal discharge, itchiness, or an unpleasant odor.

Do you think you may a vaginal infection?

Yes, this is possible.

No, this seems very unlikely.

Some women have pain with intercourse due to vaginal dryness. Vaginal lubrication occurs in response to sexual arousal. If you are not sufficiently aroused before penetration, intercourse may be painful.

Even with sufficient arousal, some women still do not produce enough lubrication.

You can try an over-the-counter lubricant such as Astroglide or K-Y Lubricant to help with these symptoms.

This dryness is often especially bothersome for women after menopause.

Are you in or beyond menopause (have not had your period for over a year)?

Yes, I am menopausal.

No, I have not reached menopause.

Sometimes our emotions get expressed as physical sensations. For example, stress can cause some people to get tension headaches. In a similar way, stress and tension, especially if they are related to issues with a sexual partner, can cause painful sexual intercourse (dyspareunia). This can also happen for women who have experienced sexual trauma in the past.

Have you had a traumatic sexual experience or significant stress that makes you very tense during sexual intercourse?

Yes.

No.

Your answers do not point to a specific cause of your vaginal discomfort. Make an appointment with your doctor.

If you have pain that worsens prior to and during your menses with many of your menstrual cycles, it is possible that you have a condition named endometriosis. Endometriosis occurs when the type of tissue that lines the uterus is also located in places outside of the uterus. This tissue enlarges during prior to menstruation and it can create irritation in your pelvis or lower abdomen.

Arrange a visit to discuss your symptoms with your doctor.

Painful sexual intercourse (dyspareunia) is very common following sexual trauma, and you may benefit from counseling. Your stress from past trauma is the most likely explanation for your pain.

Of course, there are other possible explanations for your pain. If you have pain that worsens prior to and during your menses with many of your menstrual cycles, it is possible that you have a condition named endometriosis. Endometriosis occurs when the type of tissue that lines the uterus is also located in places outside of the uterus. This tissue enlarges during prior to menstruation and it can create irritation in your pelvis or lower abdomen.

You have indicated that you have entered menopause and are having vaginal pain that is worse with sex.

After menopause there is less estrogen in the body. Estrogen keeps the vaginal lining well lubricated and keeps the tissues that line the vagina more capable of stretching. Without estrogen, the vaginal lining can get very dry and less elastic, a condition called atrophic vaginitis. This can result in painful sexual intercourse (dyspareunia).

You can try using over-the-counter lubricants to help with the dryness. If this is not effective, you should talk with your doctor. Creams that contain estrogen or estrogen supplements by pills or patches may work better for you. Estrogen supplementation after menopause has possible side effects. Estrogen-containing creams deliver only small amounts of estrogen to the rest of your body, but they need to be provided by a doctor after a discussion of possible side effects.

Please close this guide and visit our Decision Health Guide on Vaginal Discharge, Itching or Irritation.