The 12 Most Common Causes of Vaginal Pain, According to MDs

In general, your vagina shouldn’t hurt, so if you start to feel pain, there’s probably something going on. Usually, maintaining proper hygiene and taking care of it should keep it safe, but sometimes, infections or other medical conditions can come into play and put you at risk of discomfort and sensitivity.

If you do notice vagina pain and find yourself asking “Why does my vagina hurt?” or “Why am I throbbing down there?,” it’s best to check with your ob-gyn to see what’s going on. They’ll be able to assess the situation and let you know what the next steps are in order to find relief. In the meantime, here are some potential reasons your vagina might hurt so much.

Experts Featured in This Article:

Jennifer Landa, MD, is an ob-gyn and chief medical officer at BodyLogicMD.

Kenosha Gleaton, MD, is a board-certified ob-gyn and Natalist medical advisor.

Rajal Patel, MD, is a gynecologist and vulvovaginal specialist at Northwestern Medicine Center For Sexual Medicine and Menopause.

Why Does My Vagina Hurt?

If you’re feeling a sharp pain in your private area or general discomfort down there, it can be concerning. Vaginal pain can stem from a number of things, from vaginal dryness to sexually transmitted infections.

Before we get into why your vagina hurts, it’s important to point out that vulvar pain (external pain, primarily on the outer genital tissue) and vaginal pain (internal pain) are technically different but are often used interchangeably to describe general pain down there.

“Many women think it’s all the same thing,” women’s health specialist Jessica Strasburg, MD, tells the Cleveland Clinic. “To a lot of people, your vagina includes the vagina and the vulva,” she says. “But the cause of these types of pain are very different.” Here’s where your vagina pain may be coming from.

Menopause

Yup, as you get older and enter perimenopause or menopause, you might start to feel more sensitive down there than you did before. “When women go through menopause, their levels of estrogen drop over a short period of time. Additionally, testosterone goes down slowly over time,” Jennifer Landa, MD, an ob-gyn and chief medical officer at BodyLogicMD, tells POPSUGAR.

Here’s why that’s important: “Estrogen and testosterone both help to keep the tissues of the vagina moist and plump. When women’s hormones decline, their vaginal cells tend to shrink, making their vaginas feel tighter and extremely dry. This causes a lot of pain with sex and can even cause small tears in the tissue that can be very painful and can make it uncomfortable to apply lubricants and attempt intercourse,” Dr. Landa says.

The good news is that this cause of vaginal pain can be effectively and safely treated with vaginal moisturizers and lubricants for some people, while others may require an increase in estrogen via creams or certain medications, per the Mayo Clinic.

Vaginal Dryness

In addition to menopause, vaginal dryness can also be caused by a number of other things, from a general decline in hormone levels to breastfeeding, per the Cleveland Clinic. Even certain medications, particularly anti-estrogen medications (like those used to treat uterine fibroids or endometriosis), certain antidepressants, and antihistamines (i.e. allergy medicines), can be responsible for vaginal dryness, Cleveland Clinic reports. If you’re experiencing vaginal dryness, it’s best to talk to your doctor to figure out the cause. In some cases, the fix could be as simple as incorporating a vaginal moisturizer or lube into your routine.

Vaginal Infections

“Infections, especially yeast infections, cause a lot of itching and discomfort for women. Vaginal yeast infections are similar to yeast infections in other areas, [and] the overgrowth of yeast causes redness, swelling, itching, and can cause pain,” says Dr. Landa. There is also usually a thick, cheesy discharge, so take note of that if you think you might have it.

Luckily, that pain can go away shortly. “Yeast infections can be treated with over-the-counter antifungal creams or a prescription oral medication. They also can be effectively treated with boric acid 600mg capsules or suppositories, which are available over the counter,” Dr. Landa explains.

Bacterial vaginosis (BV) is another common vaginal infection associated with pain, itching, and abnormal discharge. In fact, every year, one in three people with vaginas will get BV. Fortunately, it can be treated with prescribed antibiotics, like clindamycin or metronidazole.

If you think you might have a vaginal infection, reach out to your doctor to see what course of treatment is best for you.

Vulvodynia

This one’s a bit trickier. “This is an unexplained vaginal pain that usually results in extreme tenderness around the opening of the vagina,” Dr. Landa says. So the pain is specifically around the vulva and it can make sex uncomfortable for some, and downright intolerable for others since it’s hard to pinpoint and treat.

In general, treatments range from topical creams with steroids in them or testosterone cream to oral medications. Even antidepressants have been shown to be effective for some women, Dr. Landa says. “Some women do well with colloidal oatmeal sitz baths or topical lidocaine to numb the area, [and] some women respond to pelvic floor physical therapy,” she explains.

Vaginismus

Vaginismus is a type of sexual dysfunction that occurs when the vaginal muscles contract or tense up at the start of sex or during sex, which can cause pain and discomfort. It can also occur for some people when inserting a tampon or during an annual exam. It’s important to note that these involuntary contractions, muscle spasms, sharp pain, or a burning sensation when attempting vaginal penetration, are not normal, Rajal Patel, MD, a gynecologist and vulvovaginal specialist at Northwestern Medicine Center For Sexual Medicine and Menopause, previously told POPSUGAR. If you think you may be experiencing vaginismus, flag it to your ob-gyn, who can recommend the best course of treatment. That could look like pelvic physical therapy, vaginal-dilator therapy, cognitive behavioral therapy, and/or a prescription medication to minimize the pain.

Sexually Transmitted Infections

Sexually transmitted infections (STIs) are a very common cause of vaginal pain.

Chlamydia and gonorrhea, for example, can both cause lower abdominal pain, pelvic pain, and painful urination that typically burns. And genital herpes can cause pain and tenderness in the genital area, per the Mayo Clinic.

When you have herpes, you can have sores that initially look like pimples, but then they break open and have some clear to yellow fluid that weeps out of them and usually crusts over. “The sores are usually about 1/4 inch and round and happen in small bunches,” Dr. Landa says, which can cause pain and discomfort.

When it comes to treating STIs, your doctor can prescribe antiviral medication or antibiotics that take care of the sores or pain in most cases, Dr. Landa says.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs that can cause serious symptoms (e.g. pain in the lower abdomen, heavy discharge, unusual bleeding from the vagina) and reproductive complications, like infertility. It occurs most often via sexually transmitted bacteria that have spread from the vagina to the uterus, fallopian tubes, or ovaries, per the Mayo Clinic. The Cleveland Clinic notes that gonorrhea and chlamydia cause 90 percent of all PID cases. Other times, PID can occur when normal bacteria travel to your reproductive organs, which can happen after IUD insertion, childbirth, miscarriage, and pelvic surgery, per the Cleveland Clinic. PID is typically treated with antibiotics, but the medication cannot reverse any scarring associated with the disease.

Endometriosis

Endometriosis is essentially “when you have endometrial tissue, the tissue normally inside your uterus, somewhere outside of your uterus. This means that when you menstruate, those tissues will bleed also,” Dr. Landa says. The body is sensitive to blood being in areas where it normally isn’t, and so this can cause pelvic and deep vaginal pain for women (among other symptoms), she explained.

“The pain will be worse with menses, and many women with this condition experience pain with intercourse,” Dr. Landa says. “There are oral medications that can be tried for this condition; some women successfully use the birth control pill continuously to avoid menses with this condition, and sometimes surgical treatment is required,” she said. Speak to your ob-gyn to decide the best treatment for you.

Fibroids

Uterine fibroids are noncancerous growths in the uterus that can range from completely asymptomatic to severely symptomatic, causing pain in the lower abdomen, pain during sex, abdominal cramps, and difficulty urinating, among other things, according to the American College of Obstetricians and Gynecologists. Sometimes, fibroids can also cause pregnancy loss and infertility.

When treating fibroids, your doctor may suggest birth control (like the pill, IUD, Nexplanon, etc.) or a medication like Lupron to shrink the growths, Kenosha Gleaton, MD, board-certified ob-gyn and Natalist medical advisor, previously told POPSUGAR. Other times, surgery, like a myomectomy, may be recommended to remove the fibroids without impacting your fertility. And in some instances, endometrial ablation or a hysterectomy may be considered if you’re not concerned about future pregnancies, Dr. Gleaton says.

Vulvar Cyst

Pain down there can also be caused by a vulvar cyst, which is essentially a bump on the vulva. These are also commonly referred to as Bartholin’s cyst and caused by a backup of fluid in the gland, which can cause tenderness and pain near the vaginal opening, pain during sex, discomfort while walking or sitting, and fever, per the Mayo Clinic. These cysts can sometimes be addressed with home treatment (like a sitz bath), and other times, they require surgical drainage or antibiotics (when an infection occurs). Your doctor will be able to best address the right course of treatment for you.

Period Cramps

Period cramps are often associated with pain in the pelvis or lower abdomen, but they can also make their way to the vagina. This type of pain is usually manageable, but if you’re experiencing severe pain during your period, it’s important to tell a doctor to ensure it’s not something more serious like vulvodynia or endometriosis.

Dyspareunia

Sex, for the most part, should not be painful — unless you consensually want it to be. If you’re experiencing vaginal pain during or after sexual intercourse, you may have dyspareunia. This is something you should talk openly about with your healthcare provider as it can be the result of something as minor as not enough lubrication to something more serious like fibroids, per the Cleveland Clinic.

The Bottom Line:

Ultimately, vaginal pain is not normal and if you’re feeling discomfort down there, it’s best to check in with your ob-gyn so that they can assess your symptoms. They’ll be able to rule out or recommend treatment for the conditions above — or determine if it’s something else altogether.

Alexis Jones is the senior health and fitness editor at PS. Her passions and areas of expertise include women’s health and fitness, mental health, racial and ethnic disparities in healthcare, and chronic conditions. Prior to joining PS, she was the senior editor at Health magazine. Her other bylines can be found at Women’s Health, Prevention, Marie Claire, and more.

Isadora Baum is a freelance writer, certified health coach, and author of “5-Minute Energy”.