OB-GYN (Obstetrician-Gynecologist) Questions Vaginal pain

Why do I have severe vaginal itching and soreness during my periods?

During my periods my vagina itches and becomes sore, causing severe discomfort. What could be the reason for this? I use pads instead of tampons but I've been doing this ever since I got my first period and am not noticing any problem until now (I'm 31).

5 Answers

It can be simple ovulation or endometriosis. I suggest you see your ob/gyn and get checked.
It is difficult to answer this question without more details as well as without an exam. There are multiple reasons one can have itching on a routine basis: hormonal changes, other medical problems, new lifestyle changes, emotional stress, etc. I would recommend an open discussion with your physician to further delineate the most likely cause in your case.

Judy
Great question.

During your menstrual cycle, the blood can change the pH of the vagina and make yeast infections or bacterial vaginosis more prevalent. I would recommend having a vaginal culture near the tail end of your menses to check for these issues. Blood is an irritant and the vagina is very sensitive, and it can become worse after the birth of a child as well.

Sincerely,

Richard T. Burke, MD
Thanks for your question. I have another question to ask: is there any malodor associated with this itchiness or pruritic? If so, the most common is a fishy or rotten fish odor that is usually indicative of BV, or bacterial vaginosis; this is caused by a pH change in the vagina to a more alkaline vs. acidic environment. The change in pH from 5.5 to 8.0 can be caused by recent intercourse, as semen has a pH of 8.0-9.0 and, when mixed with acid, causes a reaction. This reaction usually doesn’t bother us unless we have it too little (infrequent timing) or too much. BV can be treated with either "washing it out" by our menstrual flow, but that doesn’t always work. It can also be treated with Metrogel vaginal in an applicator x 1-3 consecutive nights (while not menstruating at the same time) or by oral Flagyl (antibiotic). Check with your healthcare provider.

If you are getting recurrent vaginal pruritis without malodor, then this may actually be an indicator of hormone imbalance. Many women may make more male hormone than the normal range (approx. 15% of a normal laboratory range for Free Testosterone is my rule of thumb), and that can cause a decrease in the amount of female hormone (Estradiol + Progesterone) that your ovary would otherwise make. This imbalance does not always cause abnormal periods or spotting between periods, but it can. If intercourse is uncomfortable, it may also be a sign that your vaginal vault has decreased elasticity or stretchability, and that is also a sign of "low E." The best way to know what your hormone levels are is to have your blood tested by labdraw on d21 of your cycle on a conventional 28-day cycle; this is the day that your body makes its peak of Progesterone and Estradiol (2 days on either side of d21 is also okay or d19-23 of your cycle). Ask your healthcare provider to do bloodwork on you. They would use the ICD-10 code for abnormal menstruation of N62.5 or painful intercourse (Dyspareunia) with IC-10 code R68.82. If you have acne, use L70.0 for ICD-10 code.

If your Free Testosterone comes back higher than 15% of the normal laboratory range, then you may need further evaluation to rule out PCO, or polycystic ovary. PCO is also associated with other Excess Testosterone symptoms such as hair loss to your head, acne, mid-abdominal weight gain, and excess hair to your upper lip or chin. Or you may not have any other symptoms, but still have an elevated Free Testosterone, those are the silent sufferers of Excess Testosterone who are usually never diagnosed or diagnosed late; it can even lead to infertility or late fertility with its increased risks.

Lastly, another hormone that can also cause changes in your female/male hormone balance is your AM Cortisol. Cortisol is made in your adrenals and helps you to manage stress, "WHO HAS STRESS?" When your cortisol levels are too high (stress) or too low (distress), that can also interfere with your female/male hormone balance. Ask your healthcare provider to add AM Cortisol to your laboratory requisition form along with your hormone levels above. This needs to be drawn before 9:00AM to best capture the peak production of Cortisol in your body; the ICD-10 code is F43.0.

In summary, your lab requisition should be for Estradiol, Progesterone, Total Testosterone, Free Testosterone, and AM Cortisol with the ICD-10 codes listed above, drawing before 9:00AM. It’s okay to eat and definitely drink fluids before you go in so your blooddraw goes easily for you.

If none of the above answer your concerns, then you may need to see a GYN specialist who deals in bio-identical hormone replacement as they have a very good understanding of how hormone balance works and how to best rebalance you. Or, contact my office through my website, victoriajmondlochmdsc.com, and we will try to help.
It could be second art to change in vaginal ph due to menses. Try probiotics, acidophilus.