Vaginal pain is an issue that most patients aren’t comfortable discussing. Some surveys show that close to 10% of women between 18 and 40 have experienced vaginal pain lasting more than 3 months at some time during their life. What is more troubling is that less than 60% of those women discussed the issue with their health care provider and are living with their vaginal pain!
The International Society for the Study of Vulvovaginal Disease has classified Vaginal Pain (VP) into categories in an effort to better describe the type, location, and potential source of vaginal pain. The two most common terms used to describe vaginal pain are Vulvodynia with or without a physical source, and Vaginismus. Let’s look at these in more detail.
Chronic vaginal pain, not necessarily associated with sexual activity (Vulvodynia), can be localized to one spot or affect the entire vaginal opening or deep into the vagina. It is often described as a chronic burning pain and can be caused by some of these:
1) Specific disorders such as:
a) Vaginal atrophy and dryness in menopausal women
b) Inflammation due to chronic diseases like diabetes and cancer
c) Inflammation due to infections from yeast or trichomoniasis
d) Chronic skin conditions like contact dermatitis
2) A previous nerve or muscle injury which results in a chronic spastic response and an over responsive pain center in the brain. Things like physical injury to the vagina, vaginal delivery with pelvic nerve stretching, pelvic surgery, and pelvic masses compressing on pelvic nerves can be causes.
3) Undetermined: sometimes no definitive source or physical findings are found. The pain can actually be caused by an over reactive pain center in the brain that was triggered by a very minor, unnoticed insult. These patients also tend to have more chronic fatigue, depression, and fibromyalgia.
On physical exam, patients often will be extremely sensitive to even the slightest touch of a cotton swab.