Gynaecology › Pelvic and Vaginal Pain
Pelvic and Vaginal Pain
Pelvic pain is among the commonest reasons women consult a doctor, and it often becomes a symptom that is simply lived with for years. Yet pain has a cause, and once that cause is identified it can be treated.
Possible sources of the pain
- Endometriosis and adenomyosis
- Ovarian cysts
- Adhesions following previous infection
- Fibroids
- Vaginal dryness and tissue thinning
- Overactivity of the pelvic floor muscles, including vaginismus
- Bowel and urinary tract causes
- Causes related to an intrauterine device
Pain during intercourse
Pain during intercourse points to different causes depending on whether it is felt at the entrance or deep inside. Burning and difficulty at the entrance often relate to dryness, infection or muscle spasm, while deep pain is associated with endometriosis, cysts or adhesions.
Many women find this difficult to raise. There is no symptom that cannot be discussed in a consultation; describing it is where treatment begins.
Assessment
When the pain began, how it relates to periods and intercourse, and its character are all listened to in detail. Examination and ultrasound identify most causes; urine and infection tests, further imaging or diagnostic laparoscopy are added where required.
Treatment
- Medication directed at the underlying cause
- Hormonal treatment for endometriosis and adenomyosis
- Appropriate antibiotic treatment where infection is present
- Local oestrogen and moisturising treatments
- Referral for pelvic floor physiotherapy
- Laparoscopic surgery in selected cases
