Vaginal Infections and Painful Intercourse: Causes and Solutions

Vaginitis and dyspareunia?

Hello Doctor, I have the following questions to ask.
First, regarding vaginitis, it has been a year since I first experienced a Candida vaginitis, and I have had frequent recurrences.
I have been diagnosed with both fungal and bacterial infections (mixed type) at a gynecology clinic, and I have been hospitalized once for pelvic inflammatory disease.
I believe I have been diligent in my self-care, such as maintaining hygiene and taking probiotics.
During my most recent visit, the doctor performed a pelvic exam and noted that I had little discharge and no signs of infection.
However, I often feel discomfort down there; I experience unexplained pain in the vagina, and there is itching around the vaginal opening.
After urination, I feel particularly uncomfortable, and the doctor found that pressing on my vagina also causes pain.
What could be the issue here?
Additionally, regarding dyspareunia, I experience pain during sexual intercourse, described as a tearing sensation in the vagina.
If penetration is too deep, I also feel pain in my lower abdomen, but the pain occurs only during intercourse.
No matter how much lubricant I use, I still experience pain.
The doctor has mentioned that my anatomy does not present any issues, and I have seen another physician who diagnosed me with possible inflammation or tightness of the pelvic floor muscles.
However, after taking medication for a while, there has been no improvement.
Is it possible that I have vulvodynia, or should I explore other potential causes? Thank you, Doctor.

Miss Lin, 20~29 year old female. Ask Date: 2020/06/26

Dr. Wu Xianghui reply Obstetrics and Gynecology

Vaginal infections can cause abnormal discharge, itching, fever, and lower abdominal pain, which are among the most common symptoms in women.
The causes are numerous, and treatment methods require comprehensive health education.
It is recommended to consult a specialist in obstetrics and gynecology for evaluation.

Reply Date: 2020/06/26

More Info

Understanding vaginal infections and painful intercourse can be complex, especially when symptoms persist despite treatment. Based on your description, it seems you are experiencing a combination of recurrent vaginal infections, discomfort, and pain during intercourse, which can significantly impact your quality of life.

Causes of Vaginal Infections and Pain
1. Recurrent Infections: You mentioned having recurrent yeast infections and bacterial vaginosis. These conditions can be caused by an imbalance in the vaginal flora, often influenced by factors such as hormonal changes, antibiotic use, or even lifestyle factors like diet and hygiene practices. Chronic infections can lead to inflammation, which may cause persistent discomfort even when no active infection is present.

2. Vulvodynia and Vestibulodynia: The pain you experience during intercourse, described as a tearing sensation, could be indicative of vulvodynia or vestibulodynia. These conditions involve chronic pain in the vulvar area without an identifiable cause and can be exacerbated by touch or pressure, including during sexual activity. This pain can be linked to muscle tension in the pelvic floor, which may be what your doctor suggested.

3. Pelvic Floor Dysfunction: If your pelvic floor muscles are too tight or in spasm, this can lead to pain during intercourse and discomfort after urination. Pelvic floor dysfunction can be caused by various factors, including previous trauma, childbirth, or chronic pain conditions.

4. Hormonal Factors: Hormonal fluctuations, particularly those related to menstrual cycles, can also affect vaginal health and sensitivity. Low estrogen levels, for example, can lead to vaginal dryness and discomfort, making intercourse painful.

Solutions and Recommendations
1. Consult a Specialist: Since you have seen multiple doctors and still experience symptoms, it may be beneficial to consult a specialist in pelvic pain or a gynecologist with experience in vulvar disorders. They can perform a thorough examination and possibly recommend further testing to rule out conditions like vulvodynia or pelvic floor dysfunction.

2. Pelvic Floor Physical Therapy: Engaging in pelvic floor physical therapy can be highly beneficial. A trained therapist can help you learn exercises to relax and strengthen your pelvic floor muscles, which may alleviate pain during intercourse and improve overall comfort.

3. Topical Treatments: For vulvodynia or vestibulodynia, topical anesthetics or medications may be prescribed to help manage pain. Additionally, using lubricants during intercourse is essential, but if you find that they are not helping, discussing alternative options with your healthcare provider is advisable.

4. Lifestyle Modifications: Maintaining good hygiene, wearing breathable cotton underwear, and avoiding irritants (such as scented products) can help reduce the risk of infections. Additionally, incorporating probiotics into your diet may help restore the natural balance of bacteria in your vagina.

5. Psychological Support: Chronic pain can lead to anxiety and stress, which may further exacerbate symptoms. Seeking support from a mental health professional or joining a support group can provide coping strategies and emotional support.

6. Regular Follow-ups: Since your symptoms are persistent, regular follow-ups with your healthcare provider are crucial. They can monitor your condition, adjust treatments as necessary, and provide ongoing support.

In conclusion, while recurrent vaginal infections and painful intercourse can be distressing, understanding the underlying causes and exploring various treatment options can lead to significant improvements. It’s essential to advocate for your health and seek specialized care to address your concerns comprehensively.

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