I've Got Pain "Down There"

By Anne Brown, MD, FACOG

Capital Women's Care

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I've Got Pain "Down There"

There are a variety of sources of gynecologic pain, ranging from the vulva/vaginal area to the abdomen and pelvis. Women are embarrassed at times to bring up these issues with their medical providers, and so it is important to encourage and educate women and their partners about how to talk openly about what may be bothering them.

Most women will experience vaginitis with discharge and/or itchy vulva at some point in their lives, and oftentimes are even able to self-manage the problem with over the counter medicines. Symptoms that persist or recur frequently require a gynecological consultation to rule out more severe problems such as STDs, cancers, or other skin conditions such as lichen sclerosus. Fortunately most patients respond well to readily available diagnosis and treatments.

Some more challenging pain conditions include dyspareunia (sexual pain), vaginismus (pain caused by involuntary muscle contraction with vaginal penetration), and vulvodynia (chronic nerve pain arising from the labia/vaginal entrance). They can happen spontaneously or as a result of trauma, surgery, radiation, infection, etc. This group of diagnoses respond to a combination of medications and pelvic physical therapy that may include vaginal dilator therapy, sex therapy, and occasionally surgical intervention. Dysparuenia due to menopausal changes can also be addressed with laser vaginal rejuvenation therapy.

Pain in the upper pelvis can arise from the cervix, uterus, ovaries and fallopian tubes. Sometimes pain from the gastrointestinal or urinary tract can also mimic pain from the female organs, i.e. kidney stones, diverticulitis, etc. It can gradually build over time, or be more acute in onset.

We will see patients who have been to the emergency department for severe pain sometimes after having ovulated or ruptured an ovarian cyst, and these symptoms will usually resolve on their own. Other conditions such as endometriosis will traditionally build over time and be the worst around the time of the menstrual period. It often requires a combination of surgery and chronic hormone therapy to stay in control of endometriosis symptoms.

Patients with pelvic inflammatory disease (usually due to STDs) can have either acute symptoms or sometimes will present with chronic pelvic pain and/or infertility at a later time. Rarely, cancer in the pelvis presents primarily with pain.

Patience and persistence is needed when addressing these various pain problems, and working with an experienced, dedicated, and sensitive professional can make a big difference in a patient's quality of life and also that of their sexual partner.