Tenderness of vagina

Vaginal tenderness is a sensation of discomfort or pain of the vagina felt upon touch or during sexual intercourse. Tenderness of the vagina is often associated with other symptoms affecting the lower female genital tract, such as vaginal dryness, itching, swelling of the labia, and vaginal discharge. The discharge can be of variable color (white, yellowish, green, or containing blood) and can be foul-smelling. Pain felt during sexual intercourse, or dyspareunia, is usually present together with vaginal tenderness, but can also be a symptom on its own. Vaginal tenderness can be seen in infections of the vagina and the cervix, endometrial hyperplasia and various other conditions.

Tenderness of vagina may be associated with many conditions, including:

Endometrial hyperplasia

Endometrial hyperplasia is a condition of excessive proliferation (growth and multiplication) of the cells of the endometrium (Pic. 1), or inner lining of the uterus. Most cases of endometrial hyperplasia result from high levels of estrogens, combined with insufficient levels of the progesterone-like hormones which ordinarily counteract estrogen's proliferative effects on this tissue. This may occur in a number of settings, including obesity, polycystic ovary syndrome, estrogen producing tumours (e.g. granulosa cell tumour) and certain formulations of estrogen replacement therapy. Endometrial hyperplasia is a significant risk factor for the development or even co-existence of endometrial cancer, so careful monitoring and treatment of women with this disorder is essential. Symptoms of endometrial hyperplasia include abnormal vaginal bleeding, dryness of the vagina, excessive growth of body hair, menorrhagia (excessively heavy menstrual flow), amenorrhea (absence of menstrual periods), mood swings, pain during sexual intercourse, rapid heart rate (tachycardia) and tenderness of the vagina.

Gonorrhea infection

Gonorrhoea is a sexually transmissible infection (STI) caused by the bacterium Neisseria gonorrhoeae (Pic. 2). The infection is usually spread from one person to another through vaginal, oral, or anal sex. Gonorrhoea can get infect the urethra, anus, cervix or uterus and can lead to serious complications. Half of women with gonorrhea do not have symptoms, whereas others have vaginal discharge, lower abdominal pain, or pain with sexual intercourse associated with inflammation of the uterine cervix. Untreated gonorrheal infection can lead to spreading of the bacterium and inflammation of the uterus, Fallopian tubes and/or ovaries, a condition called Pelvic inflammatory disease (PID, Pic. 3). Around 2% of women are affected. The main complication is the formation of a pyosalpinx (abscess) and ectopic pregnancy is 6 times more likely after a pelvic infection. Untreated PID can result in long term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer.

Candidiasis

Yeast infection of the vagina and external female genitalia, called vulvovaginal candidiasis, is caused by overgrowth of Candida yeast species (Pic. 4) in the vagina.  

The most common clinical manifestations of vulvovaginal candidiasis are itching, redness, burning, vaginal discomfort and sometimes a white "cottage cheese-like" discharge from the vagina. Yeasts of the Candida genus were isolated from the vaginas of 19% of apparently healthy women, i.e., those who experienced few or no symptoms of infection. 

External use of detergents or douches or internal disturbances (hormonal or physiological) can perturb the normal vaginal flora, consisting of lactic acid bacteria, such as lactobacilli, and result in an overgrowth of Candida cells, causing symptoms of infection, such as local inflammation. Pregnancy and the use of oral contraceptives have been reported as risk factors. Diabetes mellitus and the use of antibiotics are also linked to increased rates of yeast infections.

Trichomoniasis

Trichomoniasis is an infectious disease caused by the parasite Trichomonas vaginalis (Pic. 5). About 70% of women and men do not have symptoms when infected. When symptoms do occur they typically begin 5 to 28 days after exposure. Symptoms can include itching in the genital area, a bad smelling thin vaginal discharge, burning with urination, and pain with sex. Having trichomoniasis increases the risk of getting HIV/AIDS. It may also cause complications during pregnancy. Trichomoniasis is a sexually transmitted infection (STI) which is most often spread through vaginal, oral, or anal sex. It can also spread through genital touching. People who are infected may spread the disease even when symptoms are not present.

Cervical cancer

Worldwide, cervical cancer (Pic. 6) is the fourth most common cancer in women. It is rare for women to have any signs or symptoms of cervical cancer early in the disease. When the disease is more advanced women can experience abnormal vaginal bleeding, (such as bleeding after sex, bleeding after menopause or intermittent bleeding), unusual vaginal discharge, vaginal tenderness, discomfort or pelvic pain.