Gynaecological problems

Dysmenorrhea (painful periods)

Dysmenorrhea can cause many women to experience discomfort during their menstrual cycle. This pain can begin a few days before the period starts and then reduces as menstrual bleeding finishes. For a small percentage of women, the pain is severe and interferes with carrying out normal everyday tasks. There are two main types of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea. In the first, the pain occurs within healthy women and is not related to any specific problem within the uterus or other pelvic organs. However, in the latter, the menstrual pain is linked to an underlying disease or structural abnormality within or outside the uterus, such as endometriosis, fibroid tumours and ovarian cysts, or from the use of an intrauterine device for birth control. 

Possible symptoms can include:

• Pain before and during periods in the lower abdomen.

• Cramping pain in the lower abdomen and sometimes back pain.

• Heavy bleeds.

• Periods may be regular or irregular.

For more information about dysmenorrhea (painful periods), its treatment and management, visit:www.pelvicpain.org.uk

Endometriosis

Endometriosis describes a condition where the lining of the uterus grows on the outside of the uterus. This can result in tissue attaching to the ovaries or fallopian tubes and sometimes to the bladder or intestines. This tissue is not shed during menstruation, unlike the lining of the uterus. 

Possible symptoms can include:

• Pain typically a few days ahead of a period and usually lasting throughout the period (where normal period pain is less severe and doesn’t usually last for the duration of the period).

• Pain may be worse ahead of the period starting and affects the lower abdomen and pelvic area where it can be a constant ache.

• Sex may be painful and the pain experienced deep within the body, lasting a few hours after sex.

• There may be other symptoms such as bleeding between periods and pain on emptying the bowel or bladder.

For more information about endometriosis, its treatment and management, visit: www.endometriosis-uk.org and NICE guidance on Endometriosis.

Adenomyosis

Adenomyosis is a condition where the lining of the uterus starts to grow directly into the muscle wall of the uterus. During a period, the lining cells of the uterus bleed and the misplaced cells within the muscle wall also bleed which causes pain. Trapped in the muscle, the blood cannot escape from the cervix as it normally would. As a result, the blood and tissue accumulate and cause swelling in the uterine muscle wall. 

Possible symptoms can include:

• The accumulation of blood and tissue can cause both intense pain and cramping.

• The condition can feel like labour pains and result in a feeling of pressure on the bladder and bowel.

• Bleeding can be heavy when the blood is finally released from the muscle wall.

• Loss of energy can result from associated anaemia. The cause of adenomyosis is not fully understood, but it may be a link between various hormones. 

For more information about adenomyosis, its treatment and management, visit: www.pelvicpain.org.uk 

Pudendal neuralgia and nerve entrapment

This condition can affect both men and women where the pudendal nerve has been damaged, trapped or irritated. It is usually a chronic condition and can be very painful and distressing. The pudendal nerve is a key nerve in the pelvis and runs through the lower buttocks, the area around the buttocks and genitals (perineum) and the area around the anus, as well the vulva, labia and clitoris in women. 

Possible symptoms can include:

• A feeling of burning, shooting pain or prickling.

• An over-sensitivity to touch such that clothing hurts.

• The feeling is worse when sitting and can improve when standing.

•  It tends to stay constant although sometimes it isn’t as severe.

• Pins and needles or numbness in this area.

• A feeling of swelling around the perineum.

• Needing to go to the toilet more frequently.

• Pain during arousal or sex.

For more information about pudendal neuralgia and nerve entrapment, their treatment and management, visit: www.pudendalhope.info 

Fibroids

Uterine fibroids are growths that can form on the inside walls of the womb (uterus) and they are also known as myomas or leiomyomas. They are made up of muscle and fibrous tissue and can vary in size; they are non-cancerous. It is possible that a woman might be unaware of their growth because fibroids don’t always cause symptoms. One in three women may experience them, most commonly between the ages of 30 and 50 years. 

Possible symptoms can include:

• Heavy or painful periods.

• Pain in the abdomen and pelvis.

• Discomfort or pain in the lower back.

• More frequent need to urinate than usual and constipation.

• Discomfort or pain during sex.

For more information about fibroids, their treatment and management, visit: www.britishfibroidtrust.org.uk andNICE guidance on Heavy menstrual bleeding.

Cysts

There are various types of cysts that can appear under the skin or within other parts of the body. They are usually fluid-filled sacs of tissue and are usually benign (non-cancerous). Cysts often have no symptoms and can come and go without any associated problems or pain. However, if they grow large or become infected, they can become painful and unpleasant. Two kinds of cysts are associated with a woman’s reproductive organs: vaginal cyst and ovarian cyst. 

Possible symptoms can include:

• Pelvic pain – this can range from a dull, heavy sensation to a sudden, severe and sharp pain.

• Pain during sex.

• Difficulty emptying your bowels.

• A frequent need to urinate.

• Heavy periods, irregular periods or lighter periods than normal.

• Bloating and a swollen tummy (and feeling full after eating little).

For more information about cysts, their treatment and management, visit: www.pelvicpain.org.uk 

Pelvic inflammatory disease (PID)

PID is caused by an infection which can affect the pelvic organs such as the uterus, cervix and fallopian tubes. It usually involves sexual contact where bacteria enter the cervix and then spread, although it can develop as a result of childbirth, a termination of pregnancy or pelvic surgery.

Possible symptoms can include:

• Pain in the lower abdomen and pelvic area.

• Pain during sex.

• Discomfort or pain when urinating.

• Vaginal bleeding after sex.

• Heavy and painful periods.

• Abnormal vaginal discharge that may appear yellow or green.

• Fever, nausea and vomiting.

For more information about pelvic inflammatory disease (PID), its treatment and management, visit: www.rcog.org.uk 

Vulval pain or vulvodynia

The vulva is the external area of a woman’s sex organs or genitals. It gives protection to the sex organs and the urinary tract. It is directly between a woman’s legs and is the key site of sexual arousal and response. Vulvodynia can affect women of all ages and in otherwise healthy women. It is persistent, unexplained pain around the vulva, the skin at the entrance to the vagina. It is often a long-term (chronic problem) and can be uncomfortable and distressing. The vulva may look no different but the pain may take a number of forms.

Possible symptoms can include:

• A burning, stinging sensation.

• Pain provoked by touch such as during sex.

• Pain brought on by inserting a tampon.

• Low-level pain, but apparent all the time.

• More pronounced pain when sitting for a while.

• Pain may be just in the vulva.

• Pain might be spread beyond the vulva and around the buttocks and inner thighs.

• Sometimes, vulval pain is apparent with other conditions such as IBS, painful periods or cystitis.

For more information about vulval pain or vulvodynia, its treatment and management, visit: www.vulvalpainsociety.org or www.pelvicpain.org.uk 

Pelvic organ prolapse

This is a condition where one or more pelvic organs such as the uterus, vagina, bowel and bladder, start to come down from their original positions within the pelvis and push against the vagina. This is often as a result of childbirth which can weaken the pelvic floor or damage the walls of the vagina.

Possible symptoms can include:

• A feeling of pressure or of tissue/organs pushing against the vagina.

• The sense that these organs are starting to descend into the vagina and which might require pushing back again.

• A dragging feeling in or around the vagina.

• Discomfort during sex or difficulty accessing the vagina because of bulges from descending organs.

• A sensation of pulling or stretching in the groin or lower back which might be associated with aches or pains.

• Difficulty passing water or leakage of urine associated with stress incontinence.

• Problems with bowel movements or a feeling that the passage is blocked so that it is hard to have a bowel movement.

For more information about pelvic organ prolapse, its treatment and management, visit: our ‘Pelvic floor and PGP’ web page and www.rcog.org.uk 

Pelvic cancer

As mentioned above, pelvic pain can be a sign of a number of different problems, but in rare instances it can indicate cancer. 

Cervical cancer

A regular cervical/vaginal swab test for cancer is the best way to check for cervical health. Sometimes there are no apparent symptoms. However, it is possible to have symptoms with cancer that are similar to other conditions.

Possible symptoms can include:

• Vaginal spotting, where blood appears between periods. Anything unusual might suggest cancer symptoms but, again, these symptoms are common to other conditions.

• Vaginal discharge: usually some discharge is healthy but any that appears to be different – watery, thick, foul smelling or include mucus – could indicate cancer but it could also suggest other issues.

• Painful sex and pain during urination.

For more information about cervical cancer, its treatment and management, visit: www.cancerresearchuk.org and www.macmillan.org.uk 

Ovarian cancer

Ovarian cancer often develops without any obvious symptoms, and as a result it has been called the ‘silent killer’. It is not picked up through a routine vaginal swab test for cancer, but it is relatively rare.

Possible symptoms or signs can include:

• Bloating which doesn’t seem to be linked to eating particular foods (such as gluten, lentils and pulses) but is present most, if not all, of the time. If it persists for two weeks without fading at all, it is worth checking with your GP.

• Pelvic pain is common in all kinds of conditions, but if you experience pelvic pain like menstrual cramps or ovulation pain and the pain is not coinciding with these stages in your menstrual cycle, it is possible that this is an early sign of ovarian cancer.

• Feeling full quickly when eating when you haven’t eaten much or you haven’t finished eating a very modest portion (and you don’t normally experience this feeling) could be an indication of ovarian cancer.

• Frequent urination or a strong urge to urinate (although this can occur with other conditions).

For more information about ovarian cancer, its treatment and management, visit: www.cancerresearchuk.org, www.macmillan.org.uk and NICE guidance on Ovarian cancer.

Return to ‘If it’s not PGP, then what could it be?’ page.

Content added in 2017.