The amount of pain and other symptoms you experience around your period will vary from person to person. But there are a few things that most people can expect.
Cramps are a common premenstrual symptom, caused by hormone fluctuations. But pain can also be a sign of a more serious health issue, such as uterine fibroids or endometriosis.
The vaginal wall
The vulva (the external genitalia) has muscles that make it move and a layer of skin that protects internal organs. It also has nerves, blood and lymph vessels. The cervix and glands near the vagina secrete mucus to keep the area moist.
During the menstrual cycle, hormones cause the muscles in the vaginal walls to tighten. This can cause pain. It’s usually most noticeable in the area closest to the vaginal opening, but it can be felt throughout the whole vulva.
It’s normal to feel a little bit of pain down there during your period. But if it gets worse or lasts longer than usual, talk to your doctor. They may prescribe something to help.
A medical condition called vulvodynia is another possible cause of pain. It occurs when the lining of the vagina becomes itchy and painful. It’s usually caused by hormone changes and is treated with medications.
Another common cause of period pain is yeast or genital herpes infections. These can be treated with antifungal creams or suppositories. You can find these over-the-counter, but if you’ve never had a yeast infection before, ask your doctor before trying them.
Some women have severe cramps during their periods, called secondary dysmenorrhea. This is because of a medical problem in their uterus or pelvic organs, like endometriosis, fibroids or a cystocele or heamorrhoid cyst.
The hymen
The hymen is a thin piece of tissue that encircles part of the vaginal opening. It’s present at birth and has no known function, but it does help keep bacteria and other foreign particles from entering the vagina. The hymen is made of elastic tissue that varies in shape, and it can stretch or tear, often as a result of daily activities, hormonal changes, tampon use, or sexual activity. Some women experience pain and light bleeding when their hymen ruptures, while others are completely unaware that it has happened.
Many people assume that the hymen “breaks” when they have their first penetrative sex, but this is false. The hymen is naturally worn down over time, and it typically develops openings that allow for penetration long before your first sexual encounter. It also can be stretched or torn as a result of everyday activities, like gymnastics and riding a horse, and it’s very rare for someone to have an imperforate hymen (which would prevent blood from leaving the vagina).
If you’re experiencing vulva pain, try using lubricant before engaging in sexual activity and taking it slow to avoid pain or irritation. It’s also important to avoid douches and feminine hygiene washes, as these can wash away the good bacteria in your vulva that help fight off yeast infections and bacterial STIs like chlamydia and gonorrhoea.
The vaginal lining
Some cramping in the vulva is normal and can be expected when your uterus contracts to shed the lining. But pain in the vulva that occurs outside of this time, especially during intercourse or when inserting a tampon, may indicate an underlying medical issue. Cramps or pain in the vulva that occur outside of your period are called secondary dysmenorrhea, and they can have many causes.
The most common cause of vaginal pain before, during and after menstruation is a bacterial infection called chlamydia or gonorrhea. Symptoms include painful or burning urination, a foul-smelling discharge and pelvic pain. A doctor can diagnose chlamydia or genital warts by performing a pelvic exam using gloved fingers to feel your vulva and cervix, then ordering an ultrasound to get a better look at your uterus and other reproductive organs.
Another condition that can cause pelvic pain is hematocolpos, when blood is unable to pass out of the uterus because of an imperforate hymen. This can lead to a missed period, abdominal pain and even pelvic surgery. Hematocolpos can be diagnosed by your doctor by performing a pelvic exam and checking your hymen for a hole. Your provider can also check for hematocolpos by requesting an ultrasound of your uterus and ovaries. Fibroids, a condition where tissue resembling the uterine lining grows outside of your uterus, can also cause pelvic pain. To confirm this diagnosis, your healthcare provider will perform a pelvic exam with a special tool called a speculum and order an ultrasound of your uterus and ovary.
The vaginal opening
The vulva is made of two parts: the vaginal opening, where the cervix protrudes through it; and the perineum, which extends down from the bottom of the vulva. A hole in the middle of these connects your bladder to the outside world (your urethral opening).
The inner vaginal walls have several folds that provide both structure and flexibility. The outer layer is called mucosal tissue and is similar to the skin in your mouth and nose. Underneath this are layers of muscle, collagen and elastin fibers that give the vagina its shape and ability to stretch. These tissues also help the vagina absorb fluids and increase lubrication during sexual arousal.
A small area on the front wall of the vagina, near the clitoris, is called the G-spot. This is a sensitive area that can feel intensely pleasurable when stimulated.
During periods, it’s normal to feel pain in the pelvic area because of menstrual cramps in the uterus and release of prostaglandins by the uterus. But some people may also have pain in the vulva as well. This is referred pain and can be caused by psychological issues such as anxiety or depression, as well as by trauma. It can also be a sign of an infection, or a problem like a vaginal septum or didelphic uterus (having two uteruses and cervixes).
If you’re having period pain in the vulva and pelvic area, talk to your doctor about it. They can rule out problems and offer advice for symptom relief.
