Vaginal Pain During Pregnancy

Overview

During pregnancy, many women experience vaginal/lower abdominal pain for many  different reasons. The cause of your vaginal pain is likely to be based on what trimester of pregnancy you are in. The most common causes of vaginal pain during pregnancy include round ligament pain, pelvic girdle pain (PGP), fungal/bacterial infections, and ‘lightening crotch’.^1,2,3 Other, rare but more serious causes of vaginal/abdominal pain include STDs, miscarriage, preterm labour, or ectopic pregnancy^1[1,7]. Do not hesitate to contact your doctor or a healthcare professional for advice on your symptoms.

How does it feel to have vaginal pain during pregnancy? 

For many pregnant women, vaginal pain feels like a sharp or stabbing pain² but has also been described as ‘lightning pain’^[3]. Some women describe the location of the pain as between the vagina and anus, while others feel pain in the area above the vagina, called the pelvis.¹ In general, any pain felt in the lower abdomen or groin area is thought to be a form of vaginal pain.

Vaginal pain during pregnancy: what does it mean? 

During pregnancy, increases in blood flow to the vagina may cause discomfort and pain, and also sensitise your vagina and cervix during OB-GYN exams, or sex.[4] There are several reasons you may be suffering from vaginal/lower abdominal pain during pregnancy. Most of the time, vaginal pain is harmless and will not affect your foetus in any way.¹

Causes

There are many causes of vaginal pain. The cause of your vaginal pain is likely to be dependent on how many months pregnant you are (known as the trimesters of pregnancy), you and your body. Pregnancy includes three trimesters over 9 months:⁶

• The first trimester spans approximately 1-13 weeks
• The second trimester spans from 14-26 weeks
• The third trimester spans from 26-40 weeks, or 26 weeks to giving birth

First and second trimesters

Round ligament pain

As a foetus grows, the uterus and the round ligaments of the uterus must expand. These pains are caused by a hormone called relaxing, released from the placenta during early pregnancy. This hormone helps your uterus muscles to relax and expand to make room for the growing foetus. 

As the round ligaments stretch and relax during pregnancy, it often causes short and painful muscle spasms known as round ligament pain. These spasms are harmless and extremely common. Compared to other vaginal pains during pregnancy, round ligament pain feels like a dull ache extending from the pelvis to the hip bones.³ Although most women experience this type of vaginal pain in the second trimester, some women experience this pain during the first trimester also.²

Pelvic pain or pelvic girdle pain (PGP)

Pelvic girdle pain, also known as pubic symphysis dysfunction can occur at any time during pregnancy and is estimated to affect 1 in 5 people at some point during pregnancy. This type of pelvic pain also originates from rapid stretching and relaxing of the muscles and ligaments of the cervix, but also the bones of the pelvis and pubis. The pain is often worsened when walking, lifting or standing on one leg.^1,7

Second and third trimesters

The term ‘lightning crotch’ many women refer to whilst pregnant is usually experienced late in pregnancy when the baby begins to move down into the pelvic area. As the baby presses against your cervix and nerves, eventually, this added pressure on the nerves creates quick stabbing, and sharp pains, although some women experience this as pins and needles.³

Yeast infections

It is also common during the second and third trimesters to develop yeast infections as your levels of hormones change and your immune system weakens slightly during pregnancy. Yeast infections are normal during pregnancy and extremely common. Signs of a yeast infection include 

• White, bad-smelling vaginal discharge 
• Vaginal itching

It is important to seek treatment quickly if you believe you have a yeast infection as they can be more difficult to control during pregnancy.⁵  To find out more about yeast infections, prevention and treatment, please access here.

Urinary tract infections

Another relatively common cause of vaginal pain may stem from urinary tract infections (UTIs). As it can be difficult to feel the difference between pain in the bladder, vagina and pelvis, a urinary tract infection may be overlooked as the culprit behind your vaginal pain.⁷

To help you identify whether you have a UTI, symptoms include⁸

• Burning while you pee
• Needing to urinate more frequently than normal
• Pee that is dark, cloudy, or has an off smell
• Blood in your pee

Serious causes of vaginal pain

Although most causes of vaginal pain during pregnancy are harmless, vaginal and pelvic pain or discomfort may indicate a more serious cause such as ectopic pregnancy, miscarriage, preterm labour or STDs.^1,7 These causes of vaginal/pelvic pain are rare, however, if you are worried you may be suffering from one of these causes, please consult with your doctor immediately.

How to manage vaginal pain during pregnancy

Pelvic floor exercises

To lessen your vaginal pain during pregnancy, you can try pelvic floor exercises. These exercises help to strengthen your pelvic floor, vaginal, back and hip muscles which have added benefits of increased bladder control.¹ By regularly engaging in these exercises, your strengthened muscles will reduce pelvic pain and PGP (pelvic girdle pain).

Antenatal yoga

Partaking in yoga before giving birth has many benefits. Yoga is key in strengthening your core muscles while engaging the key areas involved in vaginal pain, including the abdomen, hips, back and pelvis. Yoga also helps improve your blood circulation and overall fitness which can considerably reduce your vaginal pain.^2,4 As an added bonus, yoga is great for improving your mental health and well-being.

Medication

If you can , as advised by your doctor, taking paracetamol can help to relieve vaginal pains. Please consult with your doctor first before taking any type of pain medicine while pregnant. 

If your vaginal pain is caused by a fungal infection, such as a yeast infection (candida), you will be prescribed medications by your doctor. These usually include antifungal creams or tablets inserted into the vagina, known as pessaries.⁵

Supportive bands/belts

To help relieve some vaginal pressure built up by the foetus pressing on the pelvis and nerves, a supportive pregnancy band can be worn to support the weight of the bump. This can be useful for different types of vaginal and pelvic pain while also reducing strain on the back and hips.¹

Other

General advice to help relieve vaginal/lower abdominal pain includes⁴ 

• Warm baths to soothe tight and sore muscles
• Try to limit movement that increases pain (e.g. walking upstairs)
• Sleep with a pillow between your legs to support your hip and back muscles
• Lie on your left side to lessen vaginal pressure and improve blood circulation
• Wear flat and supportive shoes to help support your muscles and posture

When to see a doctor

Although most vaginal and abdominal pains described in this article are harmless and do not affect the foetus, abdominal pains have many causes. Please consult with a doctor if you experience abdominal pain accompanied by any of the following symptoms:^1,2

• Bleeding
• Difficulty walking
• Nausea or vomiting
• Dizziness
• Fever
• Bad headaches

Summary

The main points of this article are:

• Vaginal pain is a common symptom during pregnancy and is harmless in the vast majority of cases
• Different causes of vaginal pain relate to your trimester of pregnancy. Most commonly these are round ligament pain, pelvic girdle syndrome, and ‘lightening crotch’, but they may be indicators of more serious causes such as preterm labour or ectopic pregnancy
• Management strategies to lessen your vaginal pain include moving carefully, pelvic floor exercises, antenatal yoga, and supportive pregnancy bands
• If your vaginal pain won’t go away, you are unsure of your symptoms, or you require advice on medication or treatment, it is advisable to speak to a healthcare professional