Pain Down There

Women experience lots of moments that men can only experience as an observer. For starters, there's childbirth, breastfeeding, and multiple orgasms. But while the female body enjoys plenty of chromosomal perks, certain aspects of having a woman's anatomy aren't so hot.

Mittelschmerz, menstrual cramps, and vulvodynia, just to name a few common aches and pains, plague the most sensitive female parts. But what exactly are they, and why won't they leave us the heck alone?

It may sound like a type of German cookie, but it's actually a pain in the side. When a woman ovulates, about two weeks before menstruation, she may feel a slight pain on one side of her lower abdomen. Usually lasting a few hours, this pain, known as Mittelschmerz, is quite common. For most women, the pain is not severe enough to require treatment. It's simply a reminder that ovulation is taking place.

According to Vivien Hanson, M.D., clinical investigator at the University of Washington School of Medicine, the pain probably originates in the spot where the egg breaks out of the ovary as it begins its trip down the fallopian tube. The pain is irregular, meaning it may not show up one month, it may happen on the same side of the abdomen every month, or it can alternate sides. If the pain is severe, an over-the-counter anti-inflammatory such as ibuprofen should take care of the pain, says Hanson. The use of oral contraceptives or the Depo-Provera shot may also help solve the problem by suppressing ovulation.

Menstrual Cramps
Two weeks later, there's a different pain to contend with. Menstrual cramps are caused by the hyperactivity of the pelvic muscles and organs, particularly the uterus, says Howard Glazer, M.D., a clinical associate professor of psychology in psychiatry and in obstetrics and gynecology at Cornell University Medical College and an associate attending psychologist at New York Presbyterian Hospital. Like Mittelschmerz, the discomfort of cramps (which ranges from dull to severe) can be eliminated, or treated by using oral contraceptives or the Depo-Provera shot or by taking pain relievers such as ibuprofen and Naprosyn.

Lifestyle changes may reduce the incidence and severity of cramps. These include

  • practicing yoga

  • adapting stress reduction techniques

  • getting regular exercise

  • making dietary changes such as reducing or eliminating sugar, salt, fatty acid, alcohol and caffeine

Non-drug remedies include

  • acupressure

  • hot water bottles or heating pads

  • rehabilitation of the muscles of the pelvic floor

You can also look forward to a cramp-free future. As women get older or have children, cramps tend to become less severe.

You've gone to the doctor for months only to hear "all the tests came back negative." Now what? Burning, itching, and stinging "down there" are common symptoms of several female health problems. Vulvodynia, or chronic vulvar pain (the area between the clitoris and vagina, but not excluding either) shares some of the symptoms of yeast infections, bacterial infections, and certain sexually transmitted diseases, making diagnosis difficult. It is common for a patient to have the conditions for months or even years and see several doctors before receiving the correct diagnosis, says Glazer.

Unlike these other diseases, vulvodynia (which is not a disease but a symptom, like a stomachache) can make sitting, walking, wearing tight clothes, and crossing the legs difficult. Even worse, it makes sex painful, which in turn often leads to depression, sexual dysfunction, and relationship woes because of the woman's fear of intimacy.

What are the possible causes?
Unlike several of the conditions with which it shares symptoms, vulvodynia is not an STD. Theorized causes include:

  • Childhood sexual abuse

  • Allergies

  • Chemical sensitivities (to ingredients in sexual lubricants and health and beauty products such as shampoo)

  • Oxalate sensitivityhigh levels of oxalate in the urine

  • Hormone problemsirregular periods, endometriosis or ovarian problems

  • Nerve damage

Is there a cure? While there is no cure, effective treatments are out there. For some women, the following treatments have proven useful for reducing and eliminating pain:

  • Biofeedbacklearning to relax your pelvic muscles

  • Acupuncture

  • Low-oxalate diet combined with calcium citrate supplements

  • Antidepressants and/or tricyclic antidepressants

  • Anti-inflammatories

  • Elimination of perfumes, dyes, soaps and medications from the affected area

If you are suffering from vulvodynia, don't suffer in silence. Seek professional medical help from a health care provider who is willing to work with you to find an appropriate treatment. Being an informed patient increases your chance of finding a solution to your problem. For more information on vulvodynia, check out the following resources:

The National Vulvodynia Association
PO Box 4491
Silver Springs, MD 20914-4491

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The HealthCentral Editorial Team

HealthCentral's team of editors based in New York City and Arlington, VA, collaborates with patient advocates, medical professionals, and health journalists worldwide to bring you medically vetted information and personal stories from people living with chronic conditions to help you navigate the best path forward with your health—no matter your starting point.