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After a long day, you’re finally scrolling through Netflix, when it happens — an all-out uterine assault. Wincing, you think, “MY VAGINA IS TRYING TO KILL ME!”

While this definitely isn’t the case, knowing what causes vaginal cramping is the first step in making peace with your nether region. Here are some causes of cramping and what you can do about it.

Urinary tract infection (UTI)

Bladder infections caused by bacteria are the most common type of UTI. They can cause problems in any part of your urinary tract, which includes your bladder, ureters, kidneys, and urethra.

While the body naturally flushes out bacteria through urination, UTIs are incredibly common.

At least 40 to 60 percent of women will develop a UTI at some point in their life, and 1 in 4 are likely to have a repeat infection.

You’re more likely to develop a UTI if you’re sexually active, have gone through menopause, or if you use diaphragms or spermicide as birth control.

UTIs can be treated at home through a variety of affordable remedies:

  • Drink up. The more you hydrate, the more you pee. The more you pee, the more likely the bacteria will be flushed from your system.
  • When you gotta go, you gotta go. If you have the urge to urinate, do it! If you hold it in, the bacteria will linger.
  • Cranberry juice. Cranberries can prevent E. coli from spreading in your urinary tract. They also contain antioxidants like polyphenols, which contain homeopathic antibacterial properties.
  • Probiotics. Foods like yogurt and sauerkraut are rich with probiotics. Eating these produces more hydrogen peroxide in your urine and lowers its pH, making conditions less favorable for bacteria. It’s also good for your digestive system.

Bacterial vaginosis (BV)

As beloved Betty White once said, “[Vaginas] can take a pounding.” However, that doesn’t mean it should. BV is the most common vaginal infection for people 15–44 years of age with a vagina.

The female reproductive system relies on a delicate balance of hormones and good bacteria. This balance is more at risk when you’re pregnant, have a new sex partner, multiple sex partners, or if you douche.

The good thing is, you cannot get BV from toilet seats, swimming pools, or bedding.

Symptoms may include:

  • abdominal pain and cramping
  • pain, itching, or burning in the vagina
  • a thin white or grayish discharge
  • a strong fishy odor
  • painful urination

BV can increase your chances of contracting STIs like gonorrhea, chlamydia, and HIV. If left untreated, it can also lead to pelvic inflammatory disease (PID), which decreases your chances of conceiving.

BV is typically treated with a number of prescription medications, including:

  • Metronidazole (Flagyl, Metrogel-Vaginal) — available as both an oral medication and a topical gel that is applied to the vagina.
  • Clindamycin (Celocin, Clindesse) — a cream treatment that is applied directly to the vagina. Clindamycin can weaken latex condoms during treatment and for a few days following treatment.
  • Tinidazole (Tindamax) — an oral antibiotic. It may cause an upset stomach.

Sexually transmitted infections (STIs)

According to the CDC, STI cases in the U.S. were at a record high in 2017. With 1.7 million cases of chlamydia, over 550,000 cases of gonorrhea, and over 30,000 cases of syphilis, it was not a great year for vaginas.

If such STIs are left untreated, women are at a higher risk of chronic pelvic pain and infertility. In some cases, it can be life-threatening.

Trichomoniasis

Trich, as it’s often called, is incredibly common, with one million new cases estimated each year. Despite this, it’s given less screen time in the cultural sphere than you’d think.

Symptoms include:

  • itching, burning, or redness of the genital region
  • discomfort when urinating
  • yellowish or greenish vaginal discharge
  • fishy smell

The most important thing is to practice safe sex and to be routinely screened for STIs.

But if you do wind up catching an STI, don’t panic. Most are treatable and/or manageable with antibiotics or antiviral medications.

Dysmenorrhea

Dysmenorrhea might sound like the name of a Greek goddess, but it’s actually just the clinical term for menstrual cramps.

The prevalence of dysmenorrhea varies between 16 to 91 percent of women of reproductive age. On average, 2 to 29 percent of women experience severe pain.

There are two types of menstrual cramps — primary and secondary.

Primary dysmenorrhea involves mild to moderate period cramps that are not linked to any other issues. The pain usually sets in one to two days prior to bleeding or after the bleeding starts.

Fatigue, digestive cramping (hello diarrhea), and nausea are also common symptoms. Typically, the pain lessens with age.

Secondary dysmenorrhea involves pain connected to reproductive disorders such as uterine fibroids, infection, and endometriosis. This pain usually lasts longer than typical cramps.

There are many ways to help relieve menstrual cramping from the comfort of home:

  • Take an over-the-counter (OTC) pain medicine like ibuprofen (Advil), naproxen (Aleve), or acetaminophen (Tylenol).
  • Exercise. Low-impact aerobic exercise can help blood circulation, which reduces cramping.
  • Apply a heating pad on your abdomen or lower back.
  • Soak in a hot bath.
  • Have an orgasm (by yourself or with a partner).
  • Get more sleep.
  • Use a hormonal birth control method.

Dyspareunia (aka painful sex)

This is another painfully long word which translates to pain caused by penetration. In some cases, even inserting a tampon can trigger pain.

Dyspareunia can be caused by:

  • yeast infections or a UTI
  • vaginal injury
  • vaginal inflammation
  • poorly fitted diaphragm or cervical cap
  • muscle spasms
  • vaginal dryness
  • abnormalities inside the uterus, including fibroid growth or a tilted uterus
  • ovarian infection
  • pelvic inflammatory disease (PID)
  • endometriosis

Treatments vary by cause. Depending on the type of dyspareunia you’re facing, you may want to try lubricant before intercourse. However, it’s best to consult a healthcare professional if the pain persists.

Endometriosis

This condition occurs when tissue similar to the uterine lining grows outside the uterus. It affects more than 11 percent of American women between the ages of 15 to 44.

Women in their 30s and 40s are most commonly affected.

Symptoms of endometriosis include:

  • chronic pain in the genital and pelvic region
  • pain during or after sex
  • intestinal pain
  • pain during bowel movements or urination
  • bleeding between periods
  • infertility

While there is no way to prevent endometriosis entirely, you can reduce the risk by lowering your estrogen levels (estrogen helps to thicken the lining of your uterus). Hormonal birth control may help reduce symptoms.

Here are some home remedies to help ease discomfort from endometriosis:

  • Take a warm bath or apply a heating pad to relax pelvic muscles and reduce pain.
  • Try OTC pain relievers. Ibuprofen, acetaminophen, or naproxen can reduce inflammation, which can help subdue discomfort. It’s best to consult a healthcare professional to gauge the appropriate dosage, as these are dangerous if used incorrectly.
  • Avoid inflammatory foods such as gluten, refined sugar, and processed meats. Consuming omega-3 fatty acids may also help with inflammation.
  • Exercising helps to lower estrogen levels and increases your happy hormones.

Adenomyosis

This is a condition where the inner lining of the uterus breaks through the muscle wall.

It can cause severe menstrual cramps, intense abdominal pressure, and bloating. Women who experience adenomyosis often say it produces a knife-like stabbing sensation.

The invasive tissue growth also causes particularly heavy periods. It’s more typical in women in their 30s and 40s and in those who have had a C-section or fibroids removed.

While not life-threatening, the pain and heavy bleeding can be very disruptive.

Treatment varies by the severity of the condition. To reduce the symptoms, a doctor may prescribe:

  • anti-inflammatory medications such as ibuprofen or naproxen
  • hormonal treatments such as oral contraceptives.
  • endometrial ablation — an outpatient procedure that involves removing uterine lining.
  • uterine artery embolization — a procedure to stop blood flow to the affected area, typically used to treat uterine fibroids.
  • MRI-guided focused ultrasound surgery — a technique that uses waves to generate heat and remove unwanted tissue.
  • hysterectomy — a procedure to surgically remove the uterus. This is the only way to cure the condition.

Pelvic floor disorders

The pelvic floor is a group of muscles and ligaments that provide support to your bladder, uterus, and rectum. Pelvic floor dysfunction can lead to issues in your sex life, urination, and bowel movements.

It can be caused by childbirth, obesity, pelvic surgery, nerve damage, or a traumatic injury.

Kegel exercises can help with urinary incontinence and pelvic floor musculature. Physical activities such as stretching and yoga may help to relax your pelvic muscles. Minimally invasive surgery is also an option.

Pelvic inflammatory disease (PID)

PID includes pelvic peritonitis, endometritis, and tubo-ovarian abscess. In most cases, PID is caused by polymicrobial infections, often linked with chlamydia and gonorrhea.

Symptoms may include:

  • longer, heavier periods
  • vaginal discharge
  • nausea
  • fever
  • lower abdominal pain

Most cases are treatable with antibiotics, treating STDs in partners, and temporary abstinence.

Uterine fibroid

Fibroids are muscular tumors that grow on the uterine wall. While the word “tumor” is unsettling, most fibroids are totally benign, and many women don’t notice them.

Those who do experience symptoms may have increased cramps during menstruation and heavier bleeding.

Fibroids typically arise in women in their 30s and 40s, and often shrink on their own after menopause. Women who are obese and/or eat a lot of red meat are at a higher risk.

Medications are typically prescribed to shrink the fibroids, as removal is not recommended.

Vulvodynia

The external area of your genitals is called the vulva. If vulvar pain (yes, that’s a word) lasts longer than three months, you may be experiencing vulvodynia — a condition which affects 8 percent of women.

General symptoms include burning, stinging, irritation, and rawness. Everything from food allergies to genetic conditions can cause this. But fear not! There are simple ways to prevent and heal vulvodynia including:

  • Let a girl breathe. Wear 100 percent cotton underwear and go bottomless to bed.
  • Be gentle. Avoid soaps and lotions that contain dyes, perfumes, and other harsh chemicals.
  • Lube up. Lubricants during sex, or other sexual acts, can help minimize vulvar friction.

Vaginitis

Vaginitis is quite common and is not necessarily caused by sexual activity. It can come in the form of a bacterial, yeast, or parasite infection.

According to the CDC, 21.2 million women aged 14 to 49 experienced it in a three-year test study. Of these women, 84 percent reported no symptoms.

Yeast infections, caused by an excess of candida, are extremely prevalent. Candida is a fungus that exists naturally in small amounts in the mouth, gastrointestinal tract, and vagina.

Signs of candida overgrowth include:

  • vaginal itching
  • burning
  • thick, chunky discharge

Most people with a vagina will experience a yeast infection at least once in her lifetime. It’s nothing to be ashamed of, and there’s plenty of OTC medicines to help.

Vaginismus

Vaginismus is the involuntary contraction of muscles in the vagina. The muscle contractions make sexual intercourse or other forms of penetration painful or even impossible.

While this condition is rare — only 1 to 17 percent of women experience the condition per year worldwide — it poses extreme difficulties to those affected.

Identifying the cause can be difficult, as it’s often triggered by to psychological and social factors.

Kegel exercises are known to help, because tightening and relaxing these muscles helps rebuild voluntary control.

Inflammation of the cervix (cervicitis)

The cervix is the lowest part of the uterus, where menstrual blood exits. During labor, the cervix expands to allow the baby to pass through the birth canal. Sometimes the cervix can become inflamed.

Possible symptoms may include:

  • frequent, painful urination
  • pain during intercourse
  • bleeding after intercourse
  • bleeding between periods
  • unusual vaginal discharge

The condition often results from an STI like chlamydia or gonorrhea, but it can stem from noninfectious causes as well, e.g. a latex allergy.

Successful treatment involves ridding the body of the underlying cause. Some common treatment options include:

  • antibiotics
  • cryosurgery
  • silver nitrate

Ovarian cyst

Ovarian cysts are fluid-filled sacs in the ovaries. The ovaries are located in the lower abdomen on both sides of the uterus.

In the U.S., approximately 5 to 10 percent of women seek help for ovarian cysts in their lifetime. Of these, 13 to 21 percent have cysts that are found to be malignant. So they’re rare, but can lead to serious health concerns.

Symptoms of ovarian cysts include:

  • abdominal bloating and swelling
  • painful bowel movements
  • pelvic cramping and pain before or during your period
  • breast tenderness
  • nausea and vomiting

More worrisome symptoms that require immediate medical attention include:

  • severe, sharp pelvic pain
  • fever
  • faintness or dizziness
  • rapid breathing

Treatment for ovarian cysts depends on the type and severity of the symptoms. Common treatment options include:

  • birth control pills
  • laparoscopy
  • laparotomy

Early pregnancy symptoms

Cramping and light bleeding are common occurrences during the first trimester, so try not to worry.

This is the implantation process, when the embryo attaches to the wall of the womb. Your uterus is also stretching during this time, which can also cause lower abdominal cramping similar to period cramps.

Premature labor

A preterm birth is when birth happens before the 37th week of pregnancy. Around 1 in 10 infants born in the U.S. will be preemies. Some warning signs for early labor are:

  • pelvic pressure, which may feel like the baby is pushing down
  • contractions that occur every 10 minutes
  • low, dull backaches
  • a significant amount of vaginal discharge

Braxton Hicks contractions (the fool’s gold of labor pains) can produce a similar cramping sensation in the abdomen.

It’s always a good idea to call your doctor or go to a hospital if you experience a worrisome or significant change happening in your body.

Ectopic pregnancy

Ectopic pregnancies occur when a fertilized egg attaches outside of the uterus. While the pregnancy symptoms may begin as normal, they can quickly become worrisome.

If you feel extremely sharp abdominal pain, hemorrhaging, or severe pelvic discomfort, contact your doctor immediately.

STIs such as chlamydia and gonorrhea can increase your chances of ectopic pregnancy. Ectopic pregnancies account for 4 to 10 percent of pregnancy-related deaths.

Miscarriage

Heartbreaking, and more common than you may think. Approximately 10 to 20 percent of all pregnancies end in miscarriage. Most occur in the first trimester when the fetus is not developing normally.

Some general symptoms include:

  • abnormal vaginal bleeding
  • cramping and pain in the abdomen and lower back
  • tissue passing from the vagina

However, if you’re experiencing these symptoms, that does NOT mean you’re definitely having a miscarriage.

Each pregnancy is different, and many women who experience these symptoms go on to have healthy pregnancies and happy babies. Listen to your body and seek help if you feel something is wrong.

Additionally, to minimize the risk of having a miscarriage:

  • seek regular prenatal care
  • take prenatal vitamins
  • limit caffeine intake
  • avoid smoking, alcohol, and drug use

Unlike popular belief, having sex and doing physical activities such as jogging don’t increase the risk of miscarriage.

Some mild vaginal discomfort is to be expected during menstruation, but it’s a good idea to call your doctor if you experience any new or unusual pain in your vaginal area.

Some urgent symptoms which merit a trip to the doctor include:

  • unusual odor or discharge
  • itching
  • an urgent and frequent need to pee
  • cloudy or smelly urine
  • spotting between periods

Serious symptoms that require immediate attention include:

  • heavy bleeding
  • fever
  • chills
  • sudden or severe pelvic pain
  • dizziness or fainting

What you can expect

Your doctor will likely do a pelvic exam to check the vagina, cervix, uterus, ovaries, and fallopian tubes. Your doctor may also request a transvaginal ultrasound to get a clearer picture of your pelvic health.

Bottom line

The vagina is among the most powerful muscles in the human body. But with great power comes great vaginal responsibility.

It’s important to treat your vagina with love and respect. Listen to your body and be proactive, seeking help when something just feels off. There’s no shame in going to the doctor.