Superficial and deep pain
Classifying by location of pain is the first step to diagnosis. Superficial pain is felt at the entrance to the vagina at the very beginning of penetration and is most often associated with dryness, inflammation, skin diseases of the vulva, postpartum scars or vulvodynia. Deep pain occurs with deep insertion and radiates to the lower abdomen - it is usually caused by diseases of the pelvic organs: endometriosis, chronic inflammation of the appendages, adhesions, fibroids, prolapse of organs. There is also a mixed version, as well as secondary muscle spasm that develops due to pain.
- Superficial - at the entrance to the vagina
- Deep - with deep penetration
- The mixed form is common
- Secondary spasm of the pelvic floor muscles
- Primary - from the beginning of sexual activity
- Secondary - appeared after a period of painless intimacy
Reasons
The most common cause of superficial pain is insufficient hydration. It occurs with a lack of excitement and haste, but also with estrogen deficiency during menopause, during breastfeeding and while taking certain medications. Next in frequency are infections and inflammations, candidiasis, lichen sclerosus, scars after episiotomy and operations. Deep pain is caused by endometriosis, chronic salpingoophoritis, adhesions, fibroids, ovarian cysts, pelvic organ prolapse, as well as irritable bowel syndrome and bladder disease.
- Vaginal dryness and lack of arousal
- Estrogen deficiency during menopause and lactation
- Vaginitis, vulvitis, infections
- Scars after childbirth and operations
- Endometriosis and adhesions
- Chronic inflammation of the appendages, fibroids, cysts
- Pelvic floor muscle tension and anxiety
Associated symptoms
It is worth paying attention not only to the pain itself, but also to what accompanies it: this greatly narrows the range of causes. Burning and itching with discharge indicate inflammation, dryness and tightness - estrogen deficiency, pain on certain days of the cycle and painful menstruation - endometriosis, frequent urination and pain - bladder problems. Chronology is also important: at what point did the pain appear, is it related to childbirth, surgery, a change of partner, or taking medications. It is helpful to write down these details before your visit.
- Itching, burning and discharge
- Dryness and tightness of the mucous membranes
- Painful and heavy periods
- Pain in the lower abdomen outside of intimacy
- Frequent urination and pain
- Bloody discharge after intimacy
- Tension, fear and avoidance of intimacy
What examinations are needed
The doctor asks in detail about the nature and localization of the pain, then examines the external genital organs and examines them in the mirrors, identifying inflammation, scars, and skin changes. A smear on the flora and examination for sexually transmitted infections are required. A pelvic ultrasound shows the condition of the uterus, ovaries and allows one to suspect endometriosis and adhesions. The tone of the pelvic floor muscles is assessed separately. In case of deep pain of unknown origin, diagnostic laparoscopy may be required, as well as consultations with a urologist and proctologist.
- Examination of the vulva and speculum examination
- Flora smear and PCR for infections
- Ultrasound of the uterus and ovaries
- Pelvic floor muscle assessment
- Urinalysis for urinary symptoms
- Diagnostic laparoscopy according to indications
What to do and how to treat it
Treatment is directed to the cause. For dryness, water-based lubricants, humidifiers and, in menopause, topical estrogens are simple and effective measures. Inflammation is treated according to the results of smears, endometriosis and fibroids are treated according to appropriate schemes, including surgical treatment. If the pelvic floor muscles are tense, use relaxation exercises and work with a specialist. The behavioral part is also important: sufficient foreplay, comfortable positions, refusal of intimacy through pain, open conversation with your partner. If the pain persists, the help of a psychologist is useful.
- Lubricants and moisturizers
- Local estrogens for atrophy
- Treatment of infections based on test results
- Therapy for endometriosis and other pelvic diseases
- Relaxation of the pelvic floor muscles
- Sufficient foreplay and position changes
- Psychological support for persistent pain
