Vaginal Pain: Causes and When to See a Doctor

Where the pain is

Pinpointing the location helps narrow the cause:

• Vulva (outer lips, clitoris, skin around the opening): skin conditions, infections, irritants, vulvodynia
• Vaginal opening (vestibule): provoked vestibulodynia, dryness, tears, Bartholin cysts, vaginismus
• Inside the vagina: infections, dryness, pelvic floor spasm
• Deep, with sex: endometriosis, pelvic inflammatory disease, ovarian cysts, pelvic floor problems

Common causes of vaginal pain

Infections

• Yeast infection: itching, burning, soreness and thick white discharge. Common after antibiotics, in pregnancy and with diabetes.
• Bacterial vaginosis: thin gray discharge with a fishy smell. Pain is usually mild.
• Trichomoniasis: a sexually transmitted infection with frothy yellow-green discharge, itching and pain with urination or sex.
• Genital herpes: tingling, then painful blisters and shallow sores. The first outbreak can cause fever and severe pain with urination.
• Chlamydia and gonorrhea: often silent, but can cause pelvic pain, discharge and pain with sex.
• Urinary tract infection: burning with urination that can feel like vaginal pain.

Dryness and hormonal changes

Low estrogen after menopause, while breastfeeding, or with some cancer treatments thins and dries the vaginal tissues. This is called genitourinary syndrome of menopause or vaginal atrophy. It causes dryness, burning, pain with sex, urinary urgency and recurrent infections.

Irritants and allergies

Scented soaps, bubble baths, douches, wipes, pads, spermicides, latex condoms and some lubricants can cause contact dermatitis with burning and redness.

Skin conditions

• Lichen sclerosus: itchy, white, thin, crinkled skin that can crack and scar. Needs treatment to prevent changes in anatomy and a small risk of skin cancer.
• Lichen planus: painful raw areas inside the vagina and on the vulva.
• Eczema and psoriasis.

Cysts and lumps

A Bartholin cyst forms when the gland beside the vaginal opening becomes blocked. It is a painless lump on one side, but if it becomes infected (abscess) it turns hot, swollen and very painful. Other vaginal cysts are usually painless.

Muscle and nerve causes

• Vaginismus: involuntary tightening of the pelvic floor muscles, making penetration painful or impossible.
• Pelvic floor muscle dysfunction: chronic aching and pain with sex from tight muscles.
• Vulvodynia: vulvar pain lasting at least 3 months without an identifiable cause. It may be provoked by touch (such as sex or tampons) or constant, and burning or raw in quality.
• Pudendal neuralgia: burning pain in the genital area, worse when sitting.

Injury, childbirth and surgery

Tears or episiotomy during childbirth, injury during sex or after assault, and scar tissue after surgery can cause pain.

Vaginal pain during sex

Pain with sex (dyspareunia) is common and not something you need to accept. Causes depend on where it hurts:

How the cause is found

A doctor or gynecologist will ask about the type of pain, when it occurs, discharge, sexual history, contraception, menopause or breastfeeding, products used, and previous treatments. Examination includes looking at the vulvar skin, a gentle cotton-swab test to map tender areas, and a speculum or one-finger exam if comfortable. Tests may include:

• vaginal swab for pH, yeast, bacterial vaginosis and trichomoniasis
• STI testing for chlamydia, gonorrhea and herpes
• urine test
• skin biopsy for persistent skin changes
• pelvic ultrasound for deep pain

You can ask for the examination to stop at any time.

Treatment

• Yeast infections: antifungal creams, suppositories or a single oral tablet. Recurrent infections need longer courses.
• Bacterial vaginosis and trichomoniasis: antibiotics. Partners are treated for trichomoniasis.
• Herpes: antiviral medicine, which shortens outbreaks.
• Dryness: vaginal moisturizers used regularly, lubricants for sex, and low-dose vaginal estrogen, which is safe for most women.
• Lichen sclerosus: strong steroid ointment, then maintenance.
• Bartholin abscess: drainage, often with a small catheter or minor procedure.
• Vaginismus and pelvic floor dysfunction: pelvic floor physical therapy, vaginal dilators and counseling.
• Vulvodynia: a combination of gentle vulvar care, topical lidocaine before sex, pelvic floor therapy, medicines for nerve pain (such as amitriptyline or gabapentin), cognitive behavioral therapy and, for some, surgery for provoked vestibulodynia.

Gentle vulvar care

• Wash with water only, or a fragrance-free cleanser on the outer skin.
• Wear cotton underwear and avoid tight clothing.
• Avoid douching, scented products and wipes.
• Use a water- or silicone-based lubricant during sex.
• Pat dry rather than rub.

Frequently asked questions

What causes vaginal pain?

Common causes are yeast and other vaginal infections, sexually transmitted infections such as herpes, dryness from low estrogen, irritation from soaps or products, Bartholin cysts, skin conditions like lichen sclerosus, pelvic floor muscle spasm, and vulvodynia. Deep pain with sex can come from endometriosis or pelvic infection.

Why does it hurt inside my vagina during sex?

Pain on entry is often caused by dryness, a yeast infection, vaginismus or vestibulodynia. Deeper pain may come from endometriosis, pelvic inflammatory disease or pelvic floor tension. Using lubricant and taking time to relax can help, but persistent pain should be checked by a doctor.

What is vulvodynia?

Vulvodynia is chronic vulvar pain lasting at least 3 months without a clear cause such as infection or skin disease. It often feels burning, stinging or raw, and may be triggered by touch, sex or tampons. Treatments include pelvic floor therapy, nerve pain medicines and topical anesthetics.

Can a yeast infection cause vaginal pain?

Yes. Yeast infections cause itching, burning, soreness and pain with urination or sex, often with thick white discharge. If symptoms do not clear after treatment, return quickly, or you have more than 3 to 4 a year, see a doctor, as other conditions can look similar.

Is vaginal pain after menopause normal?

It is common but treatable. Falling estrogen thins and dries the vaginal tissues, causing dryness, burning and painful sex. Regular vaginal moisturizers, lubricants and low-dose vaginal estrogen are very effective. Any bleeding after menopause should always be checked.