Pain in the vaginal canal is usually associated with an underlying medical and/or psychological condition.
Vaginal pain is experienced usually during vaginal manipulation or sexual intercourse. Approximately 50–85% of the causes are due to organic (medical) conditions. However, it is typical for the medical condition to be compounded by psychological issues such as depression and problems associated with sexual identity. The primary entity concerns dyspareunia, a vaginal pain experienced during sexual intercourse. The vagina has three physiological functions: an outflow duct for menstrual discharge, to receive the penis during sexual intercourse, and as the birthing canal. The overall prevalence for dyspareunia is 20% (15% of women and 57% of men). A significant percentage of breast cancer and hysterectomy patients demonstrated sexual dysfunction.
Causes and symptoms
The causes can be categorized as organic, due to a medical condition and/or psychological difficulties. Medical conditions can include chronic diseases, minor ailments, breast cancer, and medications. Psychological cause can be related to physical or sexual abuse. Pregnancy and hormonal changes (decreased estrogen) have significant negative impact on sexual activity, desire, and satisfaction. Dyspareunia can be divided into three types of pain: superficial, vaginal, and deep. Superficial pain is associated with attempted penetration. This is usually caused by changes in anatomy, irritative condition, or vaginismus. Vaginal pain is associated with friction, indicating a problem with lubrication and /or arousal disorders. Deep pain is related to thrusting and is indicative of pelvic disease or an inability for pelvic relaxation.
The diagnosis must be pursued with diligence and in a comprehensive manner. A careful history and physical examination is essential. Procedures that can be used include surgical investigation (laparoscopy) and treatment of the underlying cause(s).
Treatment is directed at diagnosing the underlying condition, which can be medical and/or psychological cause(s). Treatment can include surgery, hormonal therapy (replacements), psychotherapy, and pain control protocols.
The prognosis depends on the primary cause. If treatment is aggressively pursued and patient compliance is satisfactory the overall outcome is favorable.
There are no precise preventive measures since the condition can result from normal aging and/or progressively worsening psychological disease.
Ryan, Kenneth J., et al, eds. Kistner's Gynecology & Women's Health. 7th ed. Mosby, Inc., 1999.
Goroll, Allan H., et al. Primary Care Medicine. 4th ed. Lippincott, Williams & Wilkins, 2000.
Tasman, Allan, et al eds. Psychiatry. 1st ed. W. B. Saunders Company, 1997.
The American College of Obstetricians and Gynecologists. 409 12th St., S.W., PO Box 96920, Washington, D.C., 20090-6920.
Laith Farid Gulli, M.D.
Kathleen Berrisford, MSW, CSW
Laproscopic surgery— A surgical procedure to correct or diagnose an underlying disease.