Pain in or around the vagina can have many causes. It may be from the actual vagina, or the labia and skin that form your vulva (the outside of your genitalia).
Coughing or sneezing exerts sudden pressure on the pelvic area. If your pelvic floor is weak, this can cause problems like urinary leakage.
Causes
The pelvic area contains organs that are held in place by a muscle structure called the “pelvic floor.” As people age, the muscles weaken and their support structure can fail. This causes the organs to droop into the vaginal canal. The symptom is the feeling of heaviness or fullness in the vagina. A person may feel as if her bladder, uterus or rectum are sagging down into the vagina. This is called pelvic organ prolapse. It is often painless, but it can be painful when coughing or straining.
Other common causes of vaginal pain are infections like yeast infection, bacterial vaginosis and sexually transmitted infections (STIs). These problems can cause burning pain and itching in the vulva area. The infections can also cause a rash or swollen lymph nodes in the vulva.
If a woman has the herpes virus, it can affect the upper part of the vagina and cause pain. Herpes is a sexually transmitted disease that is spread through skin contact or oral sex.
Pelvic floor exercises or physical therapy can help treat pain in the vulva. A healthcare provider can teach you how to do these exercises. They are similar to the Kegel exercise that strengthens the pelvic muscles.
Symptoms
The way vaginal pain is felt by a person is unique to that individual. However, common symptoms include a heaviness or fullness in the pelvic area that gets worse with activity and especially when standing, lifting or coughing. Symptoms may also be accompanied by a feeling that something is slipping out of the pelvic area and in some cases other organs such as the urethra, bladder or rectum can slip out.
A gynecologist will diagnose a prolapse during a routine exam. They will insert a gloved finger in the vagina and feel for any fullness in the area. They will also ask about past pregnancies and deliveries. They will also run tests for infections such as bacterial vaginosis, yeast infections (usually caused by Candida) and genital herpes.
The doctor may also test for chlamydia, which is an sexually transmitted disease that can cause pelvic pain. Symptoms of this infection include a painful sex life, itching in the vulva and abnormal discharge from the vagina.
A gynecologist will prescribe medication for an infection if necessary. They will also recommend other treatments, such as wearing a pantyliner and doing Kegel exercises to strengthen the pelvic floor muscles. They will also suggest that the person maintain a healthy weight and eat a high fiber diet to avoid constipation, which can also strain the pelvic floor muscles.
Treatment
There are different treatments for pelvic pain, depending on the cause. Your doctor may recommend lifestyle changes, such as exercising and eating a healthy diet. They might also suggest doing Kegel exercises to strengthen your pelvic floor muscles. This involves squeezing your pelvic muscles together and holding them for 10 seconds twice a day. Your doctor might also prescribe hormone replacement therapy.
Other treatments include taking over-the-counter or prescription pain relievers and wearing loose-fitting clothing that doesn’t irritate your vulva. Some women find that avoiding certain foods, such as dairy and gluten, helps. Your doctor may also want to perform an ultrasound examination of your uterus and vaginal canal, or have you fill out a pelvic pain questionnaire.
If you had a c-section (or cesarean section) or other surgery during your pregnancy, your doctor may need to examine your womb for problems. You might have a pus collection (called a pelvic abscess) or a clot in your uterus or in the area of your surgery. This can be life-threatening, so your doctor will need to drain the pus or clot and give you antibiotics.
A cystocele — a prolapsed bladder — can also be painful with coughing. This happens when your bladder drops from its usual position in the pelvis and presses on the wall of the vagina. It may cause pain during the day and at night. Your symptoms might include leaking urine, a feeling of pressure in the lower back and over the tailbone and pain during sexual intercourse.
Prevention
The muscles of the pelvic floor can be weakened by repeated bouts of sudden pressure such as from sneezing or coughing. These muscles are designed to withstand such bouts, but if they become too weak, the organs that the muscle is supposed to support can collapse into the vagina, creating a heavy feeling in the vulva and sometimes urinary leakage (stress incontinence).
The bladder, uterus and intestines are usually held in place by the muscle of the pelvic floor. When the muscle becomes too weak, these organs can slip out of position and create a heavy feeling in the vulva, accompanied by pain when you cough or sneeze. Prolapsed organs are usually a symptom of an underlying condition such as urinary tract infection, constipation, vaginitis or herpes.
You can help protect your pelvic floor from damage by strengthening the muscles with regular exercise, staying hydrated and maintaining a healthy weight. You should also wear loose-fitting underwear to avoid putting too much pressure on the pelvic muscles. If you need to sneeze or cough, do so with your mouth open to prevent the pressure from going into the vulva. You can also try contracting your abdominal muscles firmly just before you cough or sneeze to prevent the pressure from impacting the pelvic floor. This is called the Valsalva maneuver.
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