Persistent Pain in the Genital Area: When to Seek Further Evaluation

Pain in the genital area?

I have been experiencing pain in my genital area for two months.
I have visited three different gynecologists, and they all said that the ultrasound and urine tests were normal.
The only finding was redness at the urethral opening, which seems to have some broken skin.
I feel significant pain when sitting or riding a bike, along with a sensation of swelling.
I also experience frequent urination, sometimes difficulty urinating, and pain during urination.
After urinating, the pain in my genital area worsens, and I also have symptoms of lower abdominal pain and backache.
Is it really just an injury to the urethral opening causing this, or could there be damage to the vagina or urethra internally, or possibly to nearby nerves? Since I have not engaged in sexual intercourse, an internal examination has not been performed.
The doctors have prescribed topical ointments, but they haven't been effective, and the pain has persisted for a long time.
Now, I feel so much pain that it makes me feel weak all over, nauseous, and dizzy.
If my symptoms continue like this, should I insist on an internal examination by a doctor to check the vaginal area? Or could these symptoms be indicative of another underlying condition?

Nü, 20~29 year old female. Ask Date: 2018/04/15

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I have been experiencing pain in my genital area for two months.
I have visited three different gynecologists, and they all said that the ultrasound and urine tests were normal.
The only finding was redness at the urethral opening, which seems to have some skin breakdown.
I feel significant pain when sitting or riding a bike, along with a sensation of swelling.
I also experience frequent urination, sometimes difficulty urinating, and pain during urination.
After urinating, the pain in my genital area worsens, and I also have symptoms of lower abdominal pain and backache.
1.
Is it possible that only the urethral opening is injured, or could there be damage to the vagina or urethra internally, or possibly to nearby nerves?
Answer: Since the ultrasound and urine tests are normal, a urine culture is still needed.
2.
Because I have not engaged in sexual activity, an internal examination is not possible.
The doctors have prescribed topical ointments, but they have not been effective, and the pain has persisted for a long time.
Now I feel so much pain that it causes overall weakness, nausea, and dizziness.
If the symptoms continue like this, is it necessary for the doctor to perform an internal vaginal examination?
Answer: An internal vaginal examination is not necessary.
3.
Could these symptoms possibly be caused by another underlying condition?
Answer: A urine culture is needed to completely rule out a urinary tract infection.

Reply Date: 2018/04/15

More Info

Persistent pain in the genital area can be a distressing and complex issue, especially when initial evaluations, such as ultrasounds and urinalysis, return normal results. Given your symptoms, including localized pain, swelling, urinary frequency, and discomfort during urination, it is crucial to consider a few potential underlying causes and the appropriate next steps for evaluation.

Firstly, the redness and possible abrasion at the urethral opening may indicate a localized infection or irritation. Conditions such as urethritis (inflammation of the urethra), vulvodynia (chronic pain in the vulvar area), or vestibulodynia (pain at the entrance of the vagina) could be contributing factors. Even without sexual activity, these conditions can arise due to various reasons, including infections, allergies, or irritants.

The pain you experience while sitting or riding a bike suggests that the discomfort may not be limited to the urethra but could involve surrounding structures, including the vagina, pelvic floor muscles, or even nerves in the area. Conditions like pelvic floor dysfunction or nerve entrapment can lead to significant pain and discomfort, which may not be immediately apparent without a thorough examination.

Your symptoms of nausea, dizziness, and overall weakness could be indicative of a more systemic response to chronic pain. Chronic pain can lead to significant psychological and physical stress, which may manifest as fatigue, nausea, and even dizziness. This highlights the importance of addressing not only the physical aspects of your pain but also the emotional and psychological components.

Given that your symptoms have persisted for two months and have not improved with topical treatments, it is advisable to seek further evaluation. An internal examination may be necessary to assess for any underlying conditions that could be causing your symptoms. While it may feel uncomfortable, an internal examination can provide valuable information about the health of your vaginal and urethral tissues, as well as the pelvic floor.

Additionally, if the internal examination does not reveal any abnormalities, further diagnostic tests may be warranted. This could include a referral to a specialist, such as a urologist or a pelvic pain specialist, who can conduct more specific tests, such as cystoscopy (a procedure to look inside the bladder and urethra) or pelvic floor assessments.

In summary, while the initial evaluations have not indicated any significant issues, the persistence and severity of your symptoms warrant further investigation. It is essential to communicate openly with your healthcare provider about the impact of these symptoms on your quality of life and to advocate for a comprehensive evaluation that includes both external and internal assessments. If necessary, consider seeking a second opinion or a referral to a specialist who can provide a more in-depth analysis of your condition. Your health and comfort are paramount, and persistent pain should always be taken seriously.

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