A sore vulva isn’t normal, and it should never be ignored. If your lady bits are hurting after sex, make an appointment with your doctor right away.

Your GP may take a sample of the tissue inside your vulva to check for signs of infection, like thrush or sexually transmitted infections (STIs, such as chlamydia and herpes). They might also do a pelvic exam.

Causes

Pain in your vulva (the external skin that forms the female genitalia) or vagina is no picnic, and it can be distressing. But it’s not something to ignore, as your body is trying to tell you about a serious problem.

It can be caused by infections, irritation or even damage. Many of the causes are easily treatable with medication, home care or changes in behavior. But persistent pain without a clear cause, called vulvodynia, can be difficult to diagnose and treat.

The most common vulvar infections are yeast infections and bacterial vaginosis (BV). Yeast infections are caused by a fungus called Candida albicans, which also causes infections in other moist areas of the body like the mouth, skin folds and fingernails. Yeast infections are more common in sexually active women, but they can affect women who aren’t.

Bacterial vaginosis is caused by a change in the balance of bacteria in your vagina. It is common and can be triggered by pregnancy, birth control pills, menopause, certain health conditions and some types of clothing.

Symptoms include itching, burning or tenderness, sometimes accompanied by a thick, cottage cheese-like discharge. You may have a burning sensation after you go to the bathroom or after using tampons, pads or lubricants. It may be triggered by sex or when you touch the area. Some doctors call it a “no-cause” pain, while others describe it as being always present or “provoked.”

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Treatment

Pain in the vulva, or external female genitalia (labia and skin), can have many causes. Infections, pregnancy, health conditions like HIV, menopause, and even allergies can make the vulva sore. Depending on the cause, treatment can range from self care to medication and physical therapy.

Pelvic, vulvar, and vaginal pain that isn’t related to your monthly cycle may be an indicator of sexually transmitted infections (STIs). Talk to your OB-GYN about getting tested for STIs, especially if you’ve had recent sex.

Most common causes of vulva pain are vaginitis or yeast infections. These are caused by an imbalance of bacteria in the vagina. Symptoms include itching, a cottage cheese-like discharge, and sometimes a fishy odor. It’s important to tell your healthcare provider how the pain and other symptoms affect your day-to-day life.

To treat vaginitis or a yeast infection, your doctor will probably prescribe antibiotics or antifungal medications. If your vulva is itchy, you can try applying a topical anesthetic to relieve the discomfort. If your vulva pain is caused by a blockage in one of the glands that line the opening of the vagina, your doctor will drain the cyst. They may also recommend that you avoid soaps, bubble baths, washing powders, lube, and condoms that contain fragrance or preservatives. If the pain is centered around a particular area, your doctor will gently probe the area with a cotton swab and test it for irritation or inflammation.

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Prevention

Women should be aware of the signs and symptoms of vaginal infections such as yeast infection, trichomoniasis, bacterial vaginosis, herpes, chlamydia or gonorrhea. These include itching, a foul smell, cottage cheese-like discharge and pain. These infections can spread from person to person through sexual contact. A change in urination habits may also be a sign of an infection.

Prevention includes washing the vulva with plain warm water, not soap and not using bubble baths. Also, avoid irritants like perfumed soaps, shower gels, shaving cream and lubricants. Change tampons and pads frequently, especially after sports or exercise. Wipe from front to back after using the toilet. This prevents spreading fecal bacteria from the anus into the vulva. Wear breathable cotton underwear instead of tight nylon, spandex or lycra to keep the vulva area cool and dry.

If your vagina is painful when you wipe, see your health care provider for treatment. Infections can be caused by many things such as pregnancy, sex, medications or changes in hormones. Your doctor can swab your vulva lining to look for infection and test for other causes of pain. They may also take a sample of your urine and perform other tests such as pelvic ultrasound or cystoscopy to find the cause of the pain. They may also ask you to share information with your sexual partners to help prevent sexually transmitted diseases.

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Diagnosis

To diagnose vulvodynia, your healthcare provider will ask you about your past health, symptoms and family history. They may also do a physical exam, which includes checking the outside of your vulva and cervix and feeling for any lumps or bumps. Your healthcare provider may also use a smooth, tube-shaped tool (speculum) to open your vulva and examine the inside. They’ll touch different parts of your vulva and ask when it hurts, and how much it hurts. They may also do a cotton swab test, in which they gently brush a cotton swab over your vulva and check when the contact feels painful.

Vaginitis is a common cause of pain in the vulva and can have many causes, including an infection, a change in the balance of bacteria in your vulva or a problem with the glands that produce your hormones. Vaginitis can sometimes have an odor or itch, and it may feel like a burning sensation. STIs, thrush and yeast infections can also cause vaginal pain and discharge.

Avoid irritating your vulva by wearing loose, comfortable clothing, washing the area with plain water or soap and skipping shower gels with deodorant or perfume. Avoid rubbing or douching your vulva and only wipe from front to back after using the toilet, to avoid spreading fecal bacteria into your vagina.