It Hurts To Put In Tampons —What’s Going On?
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This article originally appeared on Health

Q: All of the sudden it hurts to use tampons. What could be wrong?

Is your flow very light? Sometimes it’s slightly painful to insert or remove a tampon simply because your vagina is dry. You may also be drier after childbirth or during breast-feeding or perimenopause, when levels of estrogen are low. Using a lubricant should help relieve the dryness and make it easier for the applicator to slide in.

Alternatively, your pelvic muscles may not be relaxed enough while you put the tampon in or pull it out. See if it helps to take a deep breath, then completely release your pelvic muscles, before you fiddle with a tampon. Although it’s uncommon, some women have a condition known as vaginismus, which makes the muscles of the vaginal canal tense up, and they may feel a tearing or burning sensation if anything is inserted. Doing Kegel exercises often helps relax the pelvic floor. But for some women, vaginismus is related to underlying stress or anxiety about sex, and counseling may be helpful.

If you would describe the pain as more of a stinging when you put a tampon in, it could be a sign of vulvodynia, a pain disorder that affects the vulva. Treatment varies from woman to woman: Some find relief by using a cold pack or taking a low-dose antidepressant. Switching to cotton menstrual products and underwear may also be worth a try. If you’re having trouble getting a tampon in at all, there’s also a possibility that you have a cyst, a small sac typically filled with fluid either on or in the vaginal lining.

A cyst can form if the vaginal wall gets injured during childbirth or surgery, or due to a bacterial infection. It usually doesn’t cause much discomfort. If the cyst is small and isn’t really bothering you (aside from obstructing your tampon insertion a bit), you probably don’t need to treat it. Some vaginal cysts go away on their own. But if it’s growing in size or causing real pain, it could be infected and may need to be surgically removed.

Experiencing pain with tampon use could also indicate cervical inflammation, endometriosis or an infection caused by an STD. Clearly the answer isn’t black and white, so I would encourage you to stop using tampons if it’s uncomfortable and visit your gynecologist, who can perform a pelvic exam to get to the root of your pain and find a solution.

Health’s medical editor, Roshini Rajapaksa, MD, is assistant professor of medicine at the NYU School of Medicine.