It’s not normal to have pain in your vulva or vagina, and it shouldn’t be accepted as something you just have to deal with. Pain in the vulva and vagina can have many causes, including infection, injury, health conditions, age-related changes, and pelvic floor problems.
If the cause of your pain isn’t obvious, you may have a condition called vulvodynia.
Inadequate lubrication
Women can experience pain and discomfort during sex when there isn’t enough vaginal lubrication. Using a water-based lubricant can help to ease the friction and pressure that can occur during sexual penetration. If the problem persists, try changing your sexual technique or switching to a softer lubricant.
Vaginal dryness can lead to painful sex and can be exacerbated by rough sex or by certain health conditions like psoriasis or eczema. Dry skin can also cause chafing and soreness.
A lack of lubrication can also be caused by the aging process or by hormonal changes. The low estrogen levels that come with menopause can lead to a loss of elasticity and thickness in the vulva and a decrease in lubrication. Low estrogen levels can also lead to chronic vulva pain, called vulvodynia. A common form of vulvodynia is a sore vagina, and another is pain in the clitoral area, known as clitorodynia.
Infection
Some infections can cause pain in the vulva and vagina. These include a yeast infection (usually caused by the naturally occurring fungus candida albicans), which causes itching and a cottage cheese-like discharge; bacterial vaginosis, which usually causes a watery or grey/greenish vaginal discharge with a fishy odour; and genital herpes and STIs like chlamydia and gonorrhea, which can make sex painful and unpleasant.
If you have these symptoms, your doctor may prescribe creams or ointments to soothe the skin and moisturise it. Lidocaine gel or ointment can help to numb the area, which can reduce pain during intercourse. You can buy a topical ointment with lidocaine from a pharmacy, but ask your doctor’s advice first.
Other home treatments may include wearing looser clothes and using unscented tampons or pads. A lubricant can also help, and it’s important to avoid douching or steaming. If the pain persists, your doctor may recommend a painkiller or antidepressant. If you’re over 50, your doctor might suggest hormone replacement therapy to balance the levels of your body’s natural estrogen and progesterone, which can ease vulva pain.
Injuries
During childbirth, the pelvic muscles can be damaged. This may be because of the strong forces that are put on the pelvic tissues during labor and delivery or because of a cut (episiotomy) made to help speed up the birthing process. The weakened support of the muscles can result in pelvic organ prolapse (the muscles or tissues that hold up your uterus, bladder and anal sphincter) or other problems such as urinary incontinence or bowel leakage.
A recent TikTok trend involving a thumb in the vagina has caused concern among medical professionals. The person does this to encourage a bowel movement but it is not a cure for constipation and can actually cause more harm than good. It is called splinting and has been shown to be harmful in studies.
You should talk to your health care provider if you have pain inside your vagina, a bulge in the lower part of the vagina, have accidents such as bowel leakage or have severe constipation. Your health care provider can do a pelvic exam by having you strain or push like you are having a bowel movement to see how well the muscles and tissues are supporting your pelvic organs.
Pelvic floor problems
The pelvic floor is a hammock or sling of muscles that supports your bladder, uterus and rectum (in men). It also plays a role in sexual health. Pregnancy, childbirth and ageing can weaken the pelvic floor muscles. Problems such as urinary or fecal incontinence, pelvic organ prolapse (where the bladder, uterus or rectum drop into or out of the vagina) and chronic constipation can result.
These problems can cause pain, heaviness or fullness in the vulva and pelvic area and can feel worse after having sex or when you’re passing a stool. Symptoms include:
If you’re experiencing these symptoms, talk to your doctor or GP as soon as possible to get an expert opinion. Your doctor will use external and internal manual techniques to check your pelvic floor muscles for spasms, knots or weakness. They’ll also ask about your medical history and whether you have any underlying conditions that may be contributing to the pain. For example, some STIs such as chlamydia and gonorrhoea can cause vulval and vaginal pain. Other STIs such as herpes can contribute to pelvic inflammatory disease, which can lead to painful sex and low back pain.
Stress
Pain and itching in the vulva can be caused by irritation or infection. Infections can be caused by viruses (like herpes), bacterial infections (such as thrush) or by a condition called lichen planus. Irritation can be caused by shaving, soaps, lotions or feminine hygiene products. A painful sensation during sexual intercourse is also a common cause of vaginal pain.
Stress is another factor that can make the vulva more sensitive. Chronic stress can reduce the amount of moisture in the vulva, which can upset the pH balance and lead to thrush, bacterial vaginosis or other problems. It can also affect the quality of sex, making it less pleasurable and leading to a reduction in intimacy.
If your pain is due to anxiety it may be helpful to seek psychological counselling or a cognitive behavioural therapy. These treatments will help you learn to manage your stress levels and can improve the way that pain in the vulva impacts your relationship with your partner. Psychosexual counseling can be particularly helpful if your vulvodynia has affected your sexual relationship.
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