This feature originally appeared on health.com.
It’s alarming to experience pain anywhere in your body. Yet pain on or near your vagina might be the most worrisome. Looking up symptoms on Google can ramp up the anxiety you already feel. And though you know you should call your ob-gyn, explaining the pain can be embarrassing—and you worry she won’t take you seriously.
It’s time to end the mystery and confusion surrounding vagina pain and decode why your private parts are hurting. “Women don’t necessarily know what to do about it or they feel ashamed, like ‘oh I should just live with it,’” says Prudence Hall, MD, gynecologist and author of Radiant Again & Forever. “But they shouldn’t! We can find out what the cause is and treat it, just like any other medical condition.”
No more brushing aside symptoms like a sharp pain during sex, burning on your vulva, and other clues that something’s not right with this super sensitive body part. We asked Dr. Hall to round up the most common causes of vaginal discomfort and explain to us the conditions you can treat yourself, as well as which ones are more serious and require a doctor’s care.
Without enough vaginal lubrication, having sex can be uncomfortable, if not downright painful. Vaginal dryness during sex can also leave you with tiny tears or minor abrasions inside your vagina or at your vaginal opening, which in turn can cause lingering pain until they heal.
What’s the reason you might not be producing adequate levels of lubrication? It’s usually caused by low estrogen levels. If you’re on the Pill or another hormonal birth control method, this could be to blame; in some women, they reduce the amount of estrogen circulating in the body—and that leaves you high and dry down below.
Dr. Hall says that some women who have been on hormonal birth control for years don’t realize that they’ve been dealing with vaginal dryness until they stop taking it and their body begins producing estrogen naturally. “They go off the Pill and say ‘oh my God, I have all this discharge!’ That’s normal,” she explains. Ask your doctor to switch you to a different birth control pill or another type of hormonal birth control, which may not lead to dryness.
Perimenopause can also put the brakes on lubrication, because your begins producing less estrogen. “[Perimenopause] starts five to ten years before menopause, so in your late thirties to early forties, and one of the hallmarks is vaginal dryness,” says Dr. Hall. Once women reach menopause and their estrogen levels drop significantly, vaginal dryness tends to be a big issue. “Women have extreme vaginal dryness and atrophy and it’s really painful during sex, their vaginas can split and tear,” she says. She suggests taking advantage of good lube during sex and talking to your doctor about options that can boost estrogen levels.
No hormonal changes and still experiencing vaginal dryness? It may be your allergy medication, says Dr. Hall, since antihistamines are designed to dry mucus membranes. “If it dries up the nose, it dries up the vagina,” she says. “A mucus membrane is a mucus membrane, no matter where it is on the body.”
Cramps you know. But your period can set you up for a different kind of pain as well—vaginal pain and discomfort before, during, and after menstruation. “As women approach their period, they retain a little bit more fluid in their muscles and really all over their bodies—that’s why women get more headaches around their period—and certainly some vaginal pain can happen then too,” says Dr. Hall.
This kind of pain should be relatively minor and nothing that would keep you from pursuing your usual activities. If it’s severe, however, let your doctor know.
A fibroid is a noncancerous growth in the uterus. A woman could have one or several, and depending on its size and placement, the growth may cause chronic pelvic pain that some describe as a constant feeling of pressure rather than stabby kind of pain.
Fibroids can also can trigger dull or sharp pain during sex, particularly if the fibroid is growing near the cervix or upper end of the vagina. During your period, the pain can be more pronounced as well, especially if the fibroid is growing in such a way that it puts pressure on the uterine lining.
Fibroids are very common, and they are more likely to develop as women age; African-Americans are also more prone to them. A doctor can diagnose fibroids with a pelvic exam, but he or she will likely confirm the diagnosis and get a better sense of exactly where it is and how large it is via tests such as an ultrasound. While some may need to be removed, especially if the pain is interfering with your quality of life, “not all fibroids need to be corrected—some don’t grow or cause issues,” says Dr. Hall. In many cases, they shrink as a woman approaches menopause.
Endometriosis is a condition in which endometrial tissue—the uterine lining—makes its way out of the uterus and adheres to other parts of the pelvic cavity, such as the fallopian tubes, bladder, and ovaries, says Dr. Hall. The adhesions that form are hormonally sensitive. As your hormones rise and fall with your monthly cycle, they swell and bring on pelvic pain. The adhesions “actually bleed when you have your period,” says Dr. Hall.
Sometimes the pain from endometriosis is minimal and only happens as menstruation hits, causing super bad cramps that may not ease with over-the-counter pain pills. For some women, however, it’s a chronic pain that limits their day-to-day activities, says Dr. Hall. Even sex can become painful; it’s often a sharp, jabby kind of pain if the adhesions are on or near the cervix.
Up to 10% of women of childbearing age in the United States has endometriosis, but it’s tricky to diagnose, and not all doctors are well-versed in it. If you suspect it might be the cause of your pain, check in with your ob-gyn and explain your symptoms. She may prescribe your birth control pills; because the Pill stops ovulation, you don’t get your period—and there’s no build up of the uterine lining. Other hormonal treatments are also available. Existing adhesions can be removed via laparoscopic surgery, which can dramatically reduce pain. (Unfortunately, endometriosis tends to recur.)
Andenomyosis is “similar to endometriosis, but the endometrial tissue grows in the muscular wall of the uterus, instead of outside the uterus,” says Dr. Hall. The result: pelvic pressure, heavy, crampy periods, and sometimes painful sex, she adds. The cause of andenomyosis isn’t known, but experts say that it tends to strike women toward the end of their childbearing years and goes away after menopause.
Your doctor can diagnose the condition and help you take steps to manage it. That may include recommending anti-inflammatory pain medicine or hormonal meds such as birth control pills. A hysterectomy may also be an option if the pain is severe and can’t be eased with medication.
The scary thing about STDs (and the reason you should get checked if you have unprotected sex with someone you aren’t totally sure is STD-free) is that they often don’t have noticeable symptoms, says Dr. Hall.
But one sign of many STDs is pain. That can be more of a burning, inflamed kind of pain if you have genital herpes, a sexually transmitted virus that causes breakouts of lesions on or around your vagina. Trichomoniasis, an STD caused by a parasite, may lead to redness and soreness of the genitals.
Chlamydia and gonorrhea, two bacterial STDs, can both trigger pelvic or lower abdominal pain as well as a burning sensation during urination. If left untreated, either could lead to a much more serious infection called Pelvic Inflammatory Disease (PID), which happens when the bacteria make their way to the uterus and other parts of the upper reproductive tract. Signs include pelvic pain and pain during sex. PID is major; it can lead to infertility if not caught in time.
If your down-below pain sounds similar to the kind of pain these STDs can cause, let your ob-gyn know and tell her you want to get tested. Chlamydia and gonorrhea can be cured with antibiotics, trichomoniasis is treated with meds as well, and herpes breakouts can be minimized and managed with antiviral medication.
If your vulva feels chronically sore or swollen—so much so that it hurts to be touched and even sitting down for long periods makes the pain worse—a condition called vulvodynia may be to blame. “It’s when pain fibers have been activated in the vulva, and just touching the outside of the vulva can cause a lot of pain,” says Dr. Hall.
Experts don’t know the exact cause of vulvodynia, but it may be brought on by nerve injury, allergies to chemicals, hormonal changes, medication, or an abnormal response to an infection or trauma. Inserting a tampon can be crazy painful, and sex almost impossible because of the severity of the pain, which is often described as a burning sensation. It’s not something many people are familiar with, but it is more common than you’d think.
Many women who experience symptoms don’t talk to their doctors about it, often because they’re embarrassed or they fear the pain will be dismissed as psychological. But it is a real physical condition, and getting a diagnosis is the first step toward managing the pain.