Sudden, intense pain in the vaginal or vulvar area can be alarming. The term “vaginal pain” includes discomfort felt in the vulva (the external genital area) or internally within the vagina itself. This acute discomfort can range from a sharp, stabbing sensation to a deep, throbbing ache or a persistent burning feeling. Determining the underlying cause is the first step toward finding effective relief.
Acute Pain: Infections and Irritants
Severe vaginal pain often arises from common infections or exposure to irritating substances. These conditions cause rapid inflammation, which the delicate tissues of the vulva and vagina register as intense pain. Infections like candidiasis (yeast infection) cause burning, redness, and itching, sometimes accompanied by a thick, white, odorless discharge. Bacterial Vaginosis (BV) typically presents with a thin, grayish-white discharge and a strong, fishy odor that may worsen after intercourse.
Some sexually transmitted infections (STIs) also cause acute pain. Genital herpes is a notable example that causes painful sores and blisters. Trichomoniasis, a parasitic STI, may cause a frothy, greenish-yellow discharge and irritation, including pain during urination and sex. Self-diagnosis based solely on discharge color or odor can be unreliable since symptoms often overlap.
Contact dermatitis is a frequent cause of acute pain and irritation in the vulvar area. This reaction occurs when the skin contacts an irritant or allergen, leading to redness, swelling, and a raw, burning sensation. Common triggers include harsh laundry detergents, scented soaps, douches, and chemicals in some hygiene products. The pain can be sudden, feeling like stinging or rawness.
Pain Linked to Intercourse and Hormonal Changes
Pain triggered by physical activity or linked to shifting hormone levels represents a distinct category of discomfort. Pain occurring during or after sexual activity is medically termed dyspareunia, categorized as either superficial or deep. Superficial dyspareunia is felt at the vaginal entrance or vulva upon initial penetration, often caused by inadequate lubrication, minor tissue tears, or localized infection.
Deep dyspareunia is felt further inside the pelvis during deep thrusting, indicating potential issues with internal organs or pelvic structures. This pain can be related to conditions like endometriosis, ovarian cysts, or pelvic inflammatory disease. The discomfort may be sharp or dull, sometimes continuing for hours after intercourse.
A reduction in estrogen levels can lead to genitourinary syndrome of menopause (GSM), previously known as vaginal atrophy. This hormonal change occurs most commonly after menopause, but also during breastfeeding or due to certain medications. GSM causes the vaginal walls to become thinner, drier, and less elastic. The resulting tissues are easily irritated, leading to dryness, burning, and pain during sexual activity.
Chronic and Unexplained Pain Conditions
When acute causes like infection or trauma are ruled out, pain persisting for three months or longer suggests a chronic condition. Vulvodynia is chronic vulvar pain without an identifiable cause, manifesting as burning, stinging, or rawness. This pain can be localized (vestibulodynia), affecting only the vaginal opening, or generalized, affecting multiple areas of the vulva spontaneously.
Vulvodynia pain is believed to stem from nerve irritation or an overreaction of nerve fibers, making the area hypersensitive to light touch. Activities like wearing tight clothes, prolonged sitting, or tampon insertion can provoke discomfort. Pelvic floor dysfunction is another source of chronic pain, where tension or weakness in the supporting muscles causes referred vaginal pain and pressure. This muscle tension can contribute to painful intercourse and urinary symptoms.
Specific dermatological disorders can cause persistent pain and physical changes to the genital area. Lichen Sclerosus is a chronic skin condition causing white, itchy, thin patches on the vulva and anus. Untreated, it can lead to scarring, narrowing the vaginal opening and causing pain during sex and urination. Lichen Planus is an inflammatory condition that causes painful, bright red erosions and ulcers on the vulva and inside the vagina.
Immediate Action: When to See a Healthcare Provider
Severe vaginal pain warrants a prompt medical evaluation to identify the cause quickly. Seek immediate medical attention if the pain is accompanied by a high fever, sudden swelling of the vulva, or severe abdominal or pelvic pain. Other red flags requiring urgent care include an inability to urinate, dizziness, or a rapidly spreading rash.
If you have unusual discharge, a strong odor, or persistent pain not relieved by comfort measures, schedule a visit with a healthcare provider within one to two days. Self-treating without an accurate diagnosis can worsen the underlying condition or delay appropriate treatment.
During the medical evaluation, a doctor typically performs a physical examination and may take a swab of the discharge to check for infections, including a pH test. For chronic or unexplained pain, the diagnostic process involves ruling out infections, assessing hormone levels, and checking for muscle tension or skin changes. Accurate diagnosis is the most effective pathway to a targeted treatment plan and relief.