There are many issues that can cause pain and discomfort, including:
endometriosis or adenomyosis, which occur when the cells that line the uterus begin growing elsewhere
ectopic pregnancy, ovarian or uterine cancer
cysts or fibroids
vulvodynia, pain around the vagina which has no identifiable cause
uterine or vaginal prolapse, when the uterus or vagina descend as a result of weakened pelvic floor muscles
pelvic inflammatory disease
sexually-transmitted infection or other infection
Some women also may have significant abdominal pain during menstruation or ovulation, and many causes of pain, including fibroids and cysts, may develop as a result of underlying hormonal fluctuations.
Any type of vaginal pain warrants a careful exam to determine its cause. The first step in identifying the cause of pain is to have a Pap test and physical exam. In most cases, you may also be asked to undergo additional diagnostic testing, which may include ultrasound or CT exams, urinalysis, blood work and a more-in-depth internal exam of your vagina, cervix and uterus.
A hysteroscopy is an exam that can be used to determine the cause of abdominal and pelvic pain. It uses a special instrument called a hysteroscope to see inside your uterus and our fallopian tubes to check for abnormalities that could be causing pain. It's also used to help determine the causes of infertility. Hysteroscopy can also be used to perform certain procedures, including removal of fibroids and ablation (removal) of the uterine lining in cases of heavy menstrual bleeding. The procedure is performed in the office and you may be given a sedative or local anesthesia to prevent discomfort.
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