Chronic pelvic pain of vagina and vulva

Pelvic pain is chronic if it lasts six months or more and does not improve with treatment. Vulvodynia is chronic pain of the vulva that lasts for three months or more without a cause.

You might feel pelvic pain in the area that includes your bladder, uterus, lower back and rectum.

Vaginal pain is felt inside the vagina, while vulvar pain occurs outside the vagina.

Causes of chronic pelvic pain include:

• Endometriosis. This condition develops when cells that line the uterus grow abnormally outside the uterus on such organs as the ovaries, bladder or rectum. There is no cure, but there are treatments for the symptoms.
• Adenomyosis. The inner lining of the uterus, known as the endometrium, breaks through the muscle of the uterus. Treatment depends on the severity of the symptoms, which can include cramping and pressure.
• Interstitial cystitis. Also known as Bladder Pain Syndrome, IC is a condition with symptoms similar to a urinary tract infection—a frequent urge to urinate, pain and pressure—but no UTI is present. The cause is unknown, and treatments can help alleviate symptoms.
• Ovarian cysts. Treatment ranges from over-the-counter medicine for pain to surgery to remove the cyst.
• Pelvic Inflammatory Disease. PID is an infection of the female reproductive organs, including your uterus, fallopian tubes or ovaries. A sexually transmitted disease can cause it, but so can other infections. It’s treatable if caught early.
• An injury or disease that irritates the nerves.
• Cancers of the reproductive tract.
• Uterine fibroids that grow on or in the uterus.
• Irritable bowel syndrome and other digestive disorders.
• Musculoskeletal disorders.

Many conditions have similar symptoms, and your doctor will do an examination to rule them out.

Tests, if needed, may include blood tests, pregnancy tests, urinalysis and cultures of the cervix and vagina. You may also need an ultrasound, a computerized tomography (CT) scan, MRI and X-ray.

Depending on your symptoms, procedures may include:

• Laparoscopy, a minimally invasive procedure to view the pelvic area.
• Colonoscopy to view the entire length of the large intestine.
• Sigmoidoscopy to examine the sigmoid colon.
• Cystogram, a procedure that captures images of the bladder.

Known as high-tone pelvic floor disorder, this condition happens when there is too much tension on the pelvic floor muscles, which control bladder and bowel function. These muscles must relax so you can urinate, have a bowel movement or begin to have sex. When these muscles seize up, you might feel as though the pain is in your bladder or rectum.

Causes include trauma, stress, back problems and post-surgical pain.

Muscle relaxers can help with acute flareups. Steroid injections can also assist with the pain.

Physical therapy to improve core strength, stretching and directed massage—also known as trigger-point therapy—are best for long-term results.

Your health care provider will determine if the pain is isolated or if it’s caused by another condition. If the vulva is irritated, the doctor will look for a skin condition that can lead to inflammation, cracking and irritation. Any ulcers would be visible. Treating skin issues early can prevent scarring and keep the skin from becoming fragile.

If you have pain in the vagina, you might have vaginitis. Common types include bacterial vaginitis, yeast infections, and trichomoniasis, each of which has a different treatment.

You might also have vulvodynia.

Chronic pain around the opening of the vagina (the vulva) that lasts for three or more months and has no identifiable cause is known as vulvodynia. Burning and irritation can make it hard to sit or have sex. You may have a throbbing sensation and itching. It might occur throughout the area or just in one spot.

The cause is unknown, but researchers are looking for links between one or more of the following:

• Injuries or irritation to the nerves in the vulva.
• Weak pelvic floor muscles or muscle spasms.
• Allergies and hypersensitivities.
• An increase in the number and sensitivity of pain-sensing nerve fibers in the vulva.
• Hormone changes.
• Elevated levels of inflammatory substances in the vulva
• Genetic susceptibility to chronic inflammation, widespread chronic pain or an inability to combat infection.
• Conditions that affect muscles and bones near the vulva.

As with pelvic muscle spasms, physical therapy is a long-term treatment that can relax the tissue and relieve muscle tension. It may also involve biofeedback and trigger-point therapy.

For short-term relief, your doctor might suggest medications for nerve pain or topical anesthetics.

Anyone experiencing pain can benefit from talking with a behavioral health specialist. To be sure, treating chronic genital and pelvic pain often requires a multidisciplinary approach involving gynecologists, urologists and physical therapists.