For girls and women

SHAC - Sexual Health Advice Centre

Painful sex

What will I notice?

You might experience soreness or pain during sex. This can be either when your partner starts to put his penis, finger or a sex toy, into your vagina or when you are penetrated more deeply. It can also happen with your female partner with deep penetration of a sex toy. You might also have a discharge or itchiness. You might have small sores, ulcers or blisters. You might also have pain when you urinate.

What is the most likely cause?

If you experience pain or soreness at the start of sex, it might be caused by:

Candida, 'thrush': A yeast infection which is not caught during sex.
Genital herpes: A viral infection caught during sex or by close skin-to-skin contact.

If you experience pain or soreness on deeper penetration, it might be caused by:

Chlamydia: A bacterial infection caught by having unprotected sex.
Cervicitis: An infection of the cervix sometimes caused by chlamydia.
Gonorrhoea: A bacterial infection, which is caught by having unprotected sex with someone who is infectious.
Pelvic infection which can be caused by chlamydia or gonorrhoea.

What other causes are possible?

Vulvar vestibulitis: a condition causing inflammation (soreness) at the entrance to the vagina. We can help diagnose and treat this at SHAC.
Trichomonas vaginalis, TV: A protozoan infection caught by having unprotected sex with someone who is infectious.
Psychosexual reasons, there might be psychological or emotional reasons why you experience pain during sex. We can talk to you about this and help you with it.
You could also try talking to your partner or family or friends. Talking helps to sort out our problems and is very healthy.
Vaginismus: this means spasm of the muscles at the opening to the vagina and can be triggered by previous painful sex.

What should I do?

Candida (genital thrush) can be treated easily with medicines that you can buy 'over the counter' from a pharmacist. However, if it doesn't get better soon, go to see a doctor, who can give you advice and different medicines.
For any of the other causes go and see a doctor who can test you for infections that you might have caught during sex.
Don't have unprotected sex, especially if you think that you might have caught an infection.

What if I just ignore it?

Candida usually clears up on its own or after treatment with over-the-counter products that you can get from a pharmacist.
If you have an untreated infection, it can damage your health and also that of your partner and anyone else you or they have sex with in the future. Some of these infections can also make you or your partner infertile.

How can I avoid this pain?

We don't know much about why some people get candida, but there are ways that will help you to avoid getting it in the future:

Don't have unprotected sex, especially if you are worried that you or your partner might have an infection.
Learn about safer sex.

Bleeding from your the vagina

What will I notice?

You might be losing just a little blood, called spotting, or quite a lot and you might have pain with this. You might also feel unwell and, or, feverish at the same time. You might bleed suddenly or bleeding might come on slowly. You might bleed after urinating,peeing, after sex or after someone has hurt you.

What is the most likely cause?

The commonest cause of bleeding from the vagina is period blood. Some girls and women have very regular periods, others have periods that vary in the amount of blood that is lost and when it starts and finishes.

Irregular period: if you experience bleeding that is similar to your normal period but it is happening early or late, it might just be an irregular period.
It might be a reaction to hormonal contraceptives: often hormonal contraceptives, such as the contraceptive pill, or injections, or implants can affect your usual periods in the short term or long term.
Cystitis: If you experience pain or a burning sensation on urinating, or seem to be going to the toilet more frequently and also have bleeding, you might have a bladder infection.
Chlamydia: If you are bleeding between periods, or after sex you might have an infection with chlamydia. This is a very common infection.

What other causes of bleeding are possible?

You might be having a miscarriage of a pregnancy.
You might be having an ectopic pregnancy. If you are concerned about this you should go to your doctor immediately, especially if you feel unwell at the same time, have pain, or have missed a period and have bleeding that is not normal for you.
Trauma/assault: if someone has hurt you, maybe during sex, you might have torn something and might bleed.
Very rarely, bleeding can be a symptom of a tumour.

What should I do if I am bleeding?

What you should do and when depends on the likely cause of the bleeding:

Irregular periods: if you are worried about having an irregular period, especially if you think that you might be pregnant, get yourself 'checked out'. Go to see a doctor at a genitourinary medicine clinic such as SHAC at Clinic 1A, or a family planning clinic or your GP's surgery, where you can have a pregnancy test.
If you have cystitis with bleeding, you should go to a doctor for treatment or advice.
If you have had unprotected sex and think that you might have chlamydia, you should go to see a doctor at SHAC .
Don't have unprotected sex.

What might happen if I just ignore vaginal bleeding?

Irregular periods will probably just "settle down" but you might be pregnant, so it might be best to get yourself tested if you have had unprotected sex.
Most reactions to hormonal contraceptives settle down, but your doctor might be able to help you cope with the symptoms you are getting, or decide that you might be better off on another type of contraceptive.
Increase your intake of fluids to flush out the infection, cystitis will generally clear up without treatment. If you have bleeding together with cystitis or the symptoms last for more than one day, it is best to get yourself 'checked out' in case the infection spreads to your kidneys.
If you have an untreated infection it can damage your health and also that of your partner and anyone else you or they have sex with in the future. Chlamydia is very common, often it gives no symptoms, but can be serious and can make you infertile. Some other infections can also make you or your partner infertile.

Itching

What will it feel like?

You might have a mild itch or a 'real scratcher'. You might have itching generally around your genitals, and on other areas of your skin, or just inside or around your vagina. You might have other symptoms including soreness and increased vaginal discharge.

What is the most likely cause?

Candida: Itching accompanied by a vaginal discharge which can be slightly grey and watery, or thick and white, is usually caused by candida, which isn't caught during sex. Candida can also make you quite sore.
Genital itching in girls and women may be due to a skin allergy to something or to a skin condition.

What other causes of itching are possible?

Trichomonas vaginalis: Severe itching in the genital area, usually together with a vaginal discharge. You might have caught Trichomonas by having sex with someone who is infectious.
Skin conditions that can affect any part of the body also affect the genitals. These include: seborrhoeic dermatitis, contact dermatitis, psoriasis, eczema and lichen sclerosus.

What should I do?

What you should do and when depends on the likely cause of the bleeding:

Try changing your soap, shower gel or clothes-washing powder to reduce any potential irritations.
Try using a bland soap or substitute, eg an aqueous cream, which can be bought from any chemist.
If you think that you might have candida, you can usually treat yourself easily with medicines that you can get 'over the counter' from a pharmacy.
If the itching doesn't clear up after using this candida treatment, you should go to a doctor, who can test you for infections or other skin conditions.
Don't have unprotected sex in case you have an infection that can be caught during sex. It may be a good idea to avoid sex anyway, until you are less itchy.

What might happen if I just ignore the itching?

If you have an untreated infection it can damage your health and also that of your partner and anyone else you or they have sex with in the future. Chlamydia is very common, often it gives no symptoms, but can be serious and can make you infertile. Some other infections can also make you or your partner infertile.

Pain when you urinate, 'pee'

What will I notice?

It is quite common to experience a burning sensation either while you are urinating, peeing, or shortly afterwards. You might also want to urinate more often. If you feel unwell at the same time, your condition might be more serious.

What is the most likely cause?

Pain on urinating is usually a symptom of an infection in your bladder called cystitis.

What other causes are possible?

Chlamydia: caught by having unprotected sex with someone who has a chlamydial infection. Chlamydia is very common in young people.
Genital herpes: a virus infection, which is caught by having sex or close genital contact with someone who is infectious.
Bladder infection, cystitis: usually a bacterial infection, but this is quite uncommon in boys/men.

What should I do?

If you feel unwell at the same time as having pain when you pee, you should go to see a doctor urgently. You are more likely to develop serious complications if you do not start treatment early.

If you have cystitis, you can treat yourself. If the symptoms don't clear up within 2 to 3 days, come to SHAC or another genitourinary medicine clinic, you might need some treatments that you can't just buy over the counter.
If you have candida, genital thrush, you can also treat yourself. If the symptoms don't clear up within 2 to 3 days go to your general practitioner, or come to SHAC or another genitourinary medicine clinic, to get yourself 'checked out' for other infections.
Don't have unprotected sex until you have been checked by a doctor.

What if I just ignore it?

Cystitis and candida: can clear up without treatment. They can't be given to your partner if you have unprotected sex (but other infections can!). If the infection doesn't go away soon, or gets worse, and you don't get any treatment, it can make you very unwell. Sometimes a bladder infection, which can give you pain on urinating, can spread to your kidneys and make you feel generally unwell.
If you have an untreated infection, it can damage your health and also that of your partner and anyone else you or they have sex with in the future. Some of these infections can also make you or your partner infertile.
Genital herpes: if you have a herpes infection and you just 'wait and see' or ignore it, you can become very unwell. If you feel ill at the same time as having pain or a burning sensation when you urinate, you might have a herpes infection.
Chlamydia: can be a serious infection. It can cause infertility. The good news is that it is easy for a doctor to test you for a chlamydial infection and it can be easily treated with antibiotics.

How can I avoid getting this pain?

At SHAC, we can examine you to check for any of these causes of pain when you urinate. We are always happy to test you for infections, to help put your mind at rest. We can also give you advice and information about staying healthy.

To avoid some of the complications of herpes infections or bladder infections, get yourself 'checked out' soon, especially if you feel unwell at the same time as having pain when urinating.
Some girls and women are very susceptible to getting cystitis. Being even more careful to keep your genitals clean might help, some girls and women find that peeing after sex can reduce their chances of getting cystitis. Also, wiping from front to back after going to the toilet can reduce the risk of infection. If you are bothered by cystitis do get yourself 'checked out' at SHAC (at Clinic 1A) or another genitourinary medicine clinic, by your GP.
If you or your partner has had unprotected sex in the past get yourselves 'checked out' by a doctor.
Don't have unprotected sex.
Learn about safe sex.

Painful breasts

What will I notice?

It is quite common to experience general aches or local pains in your breasts. Parts of your breasts might also become sore to touch. These symptoms might come and go at regular intervals or seem to 'flare up' quite suddenly. If you experience a pain, you should also look for other changes in the size, shape, appearance or feel of your breasts. This will help you to decide whether the pain is just 'normal for you', or something you should speak to a doctor about.

What are the most likely causes?

If you are still a girl and your breasts are still growing, painful or sore breasts might just be caused by your breasts growing. You don't need to worry about this unless it is bothering you. If it does bother you, try talking to your family and friends to help reassure you.
Your breasts might just be reacting to the hormones circulating in your body. Many girls and women find that their breasts feel different and even sore just before their period. Some women get sore or painful breasts when they first start using hormonal contraception.
Some girls and women get sore breasts if they have been running or doing other types of exercise that jolts the breasts repeatedly. If you experience a sudden pain or soreness in one breast, it might be caused by a benign cyst, a fluid-filled lump, or an infection.
Breasts can feel tender during early pregnancy. If you have missed a period after recently having sexual intercourse it might be a good idea to get a pregnancy test. We can do a pregnancy test for you at SHAC, or you can go to your doctor, or to a family planning clinic.
If you are breastfeeding, your breasts can feel sore when your baby is first suckling the milk. If you are very sore go to see a doctor because soreness can be a sign of mastitis, an infection of the breast tissue, which can be cleared up with medication.

What should I do if I have painful breasts?

Try to decide if the soreness is just normal for you and whether you can live with it. If you are worried go to see your GP soon, while you still have the symptoms. They will examine you and decide whether you should be referred to a specialist breast clinic.

Discharge from vagina

What might I notice?

A discharge is a change in the amount or type of fluid that normally comes out of your vagina. You might notice this when you wipe yourself after going to the toilet, or see it as a stain in your underwear. You might notice:

A change from a clear fluid to one that is whitish or yellow.
A change from being almost odourless to one that has a noticeable smell.
An increase in amount of fluid.
Itching or soreness around the area.
A discharge comes on suddenly, including after sex, or that the amount and nature of it changes depending on your menstrual cycle, in relation to your period.

What is the most likely cause of vaginal discharge?

A small increase in the amount of discharge might be quite 'normal' for you, just the influence of your hormones.

If you have had unprotected sex, it might be a symptom of an infection that you have caught during sex. The most common ones that give this symptom are:

Chlamydia
Gonorrhoea
Non-specific cervicitis. An infection of the cervix
Candida, 'thrush'. Especially if you also have itching in the same place
Bacterial vaginosis, BV. Especially if it has a stronger fish-like smell

What should I do if I notice vaginal discharge?

If you haven't had unprotected sex it is unlikely to be caused by an infection that you have caught during sex. It might just be 'normal for you' and will probably clear up on its own. If you have a smelly discharge that is bothering you, even if you haven't had sex, a doctor at SHAC or another genitourinary medicine clinic can examine you and give you treatment to clear it up, usually by a course of antibiotics. If you think you might have candida, vaginal thrush, you can treat yourself with 'over the counter medicines' from a pharmacist. If it doesn't clear up within a few days, go to see a doctor who can give you some different treatments. If you have ever had unprotected sex, and think you might have caught an infection, go to see a doctor who can test you for infections.

What if I just ignore the discharge?

If you have an untreated infection, it can damage your health and also that of your partner and anyone else you or they have sex with in the future. Some of these infections can also make you or your partner infertile. Usually, the problem can be easily sorted out with tablets and general advice. Chlamydia can be a serious infection (it can cause infertility too). The good news is that it is easy for a doctor to test you for chlamydial infection and it can be easily treated with antibiotics.

How can I make sure I stay healthy?

We don't know much about why people get candida, thrush. It is very common and not something to worry about if you only occasionally get it. We don't know much about why some girls and women get bacterial vaginosis either, again it is very common and is easily treated.

If you and or your partner has had unprotected sex in the past, get 'checked out' by a doctor at SHAC (Clinic 1A) or another genitourinary medicine clinic. Don't have unprotected sex, especially if you are worried that your partner might have an infection. Learn about safer sex.

At SHAC (at Clinic 1A), we can examine you to check for any of these causes of vaginal discharge. We are always happy to test you for infections, to help put your mind at rest. We can also give you advice and information about staying healthy.

Lumps, bumps and spots, including warts, on your genitals

What will I notice?

It is quite normal to have small lumps and bumps on your genitals, have a look using a mirror. Your lumps or spots might be white, yellow, purplish, pink or brown, and might be any size from a tiny pinhead to quite large. They might look like small, skin-coloured cauliflowers. The skin folds surrounding the genitals can be quite 'frilly' and small, painless lumps might be 'normal for you'. You might see small, painless, finger-like bits of skin around the vagina, which are quite normal.

What are they most likely to be?

Sebaceous glands: The skin of the genitals has lots of small sebaceous glands, which produce an oily substance, and can become enlarged and look like small, yellowish spots. They can also become blocked and infected for a day or so, and might be quite sore.
Vulval micropapillae, little tags of skin, which are quite normal for you and will do you no harm.
Genital warts: A viral infection. These are caught by having sex with someone who has genital warts and can look like small, skin-coloured cauliflowers. The same virus can also infect the anus, back passage. Having genital warts in and around your anus doesn't imply you have had anal sex.
Molluscum contagium: A viral infection of the skin which is caught during close skin-to-skin contact, or sharing towels and flannels. It can look a little like genital warts and is often treated in the same way.
Some lumps and bumps are symptoms of general skin conditions such as, lichen planus (purplish areas), lichen sclerosus (white or red areas) or psoriasis.
Very rarely, lumps and bumps on the genitals can be a symptom of syphilis.

What should I do?

If you notice a change that is not 'normal for you', you should get yourself 'checked out' by a doctor, who can do tests for infections.

If you are worried about any lumps and bumps on your genitals, get yourself 'checked out' by a doctor at SHAC, or by your GP, who can help you decide what is the cause. This might involve doing tests for other infections.
If you have a blocked sebaceous gland, washing it gently in warm, salty water might soothe it until it clears on its own.
Get yourself 'checked out' by a doctor at SHAC or another genitourinary medicine clinic, where they can do the right tests for infections.
Don't have unprotected sex, especially if you have a lump and don't know what it is (you might have an infection, which your partner might catch and give back to you later).

What if I just ignore it?

Most lumps and bumps are 'normal for you' and others will go away on their own. Some of them, however, might look like other lumps and will need to be treated, so it is best to get them 'checked out' by a doctor, especially if you haven't noticed them before and have had them for more than a few days.
If you have an untreated infection, it can damage your health and also that of your partner and anyone else you or they have sex with in the future.

How can I avoid getting them?

Most of the causes of lumps and bumps on the genitals can't be avoided except if they are caught during sex.

If you or your partner has had unprotected sex in the past, get yourselves 'checked out' by a doctor.
Don't have unprotected sex, especially if you are worried that you or your partner might have an infection.
Learn about safe sex.

Irregular periods

What is an irregular period?

An irregular period can include, a late, an early, a missed period, or bleeding between cycles. You might also have much heavier or lighter periods that might last longer or shorter than usual.

What is normal for me?

What is, or will become, a regular menstrual cycle for you will probably be different from that of your female friends and family. A 'typical' regular period is a monthly menstrual cycle that is 28 days long, four weeks, with period bleeding lasting for 4–5 days without bleeding in between. In the first year, or so, of girls having their periods it is quite common for their periods to be very light or heavy and start at irregular times. It can take some time for them to settle down to what will become 'normal for them'. Some girls and women always have a slightly irregular menstrual cycle.

What is the most likely cause?

Irregular periods are usually a reaction to a change in your hormones this might be because you are stressed, have changed your diet, or have started to take, or changed, the type of hormonal contraception. If you have had sex recently it is possible that you are pregnant even if you have been using contraception because it might not have worked.

What other causes are possible?

If you have bleeding between periods or after sex you might have an infection, including chlamydia.

What should I do if I have irregular periods?

If you don't think the irregularity is just 'normal for you', or if your periods are causing you distress go to see your doctor or family planning clinic. They should be able to give you some treatment and advice. If you are being looked after at a family planning clinic, you might like to go back to the same clinic in case it is the contraceptives that are causing the irregularities.

If your period is late or you have missed a period you might want to test yourself for pregnancy. If you have had unprotected sex and think you might have an infection, go to your GP or another doctor who can test you for infections. At SHAC (at Clinic 1A), we can examine you to see if you have a problem, and we can test you for infections or pregnancy. The Laurels - Contraception & Sexual Health Service in Cambridge City Centre can also offer you advice and pregnancy testing.

What if I just ignore irregular periods?

If you haven't had sex recently and aren't taking hormonal contraceptives your periods will probably re-set themselves or settle down. If you have had sex recently and have any worries that you might be pregnant, get yourself tested soon, so that you can put your mind at rest or decide what to do. If you have an untreated infection, it can damage your health and also that of your partner and anyone else you or they have sex with in the future. Some of these infections can also make you or your partner infertile. Usually the problem can be easily sorted out with tablets and general advice.

How can I avoid getting irregular periods?

Most causes of irregular periods are difficult to prevent but having a healthy lifestyle can help. It is important for your health to eat well, take regular exercise and try to reduce your stress levels. It is best not to go on a diet except under medical advice.

Pain in lower abdomen, tummy, or pelvis

Why can I get pains in the lower abdomen and pelvis?

Your abdomen is full of different organs and structures including your stomach, intestines, appendix, liver, pancreas, kidneys, bladder, womb and ovaries. All of these can develop problems that you feel as a 'pain'.

Which pains should I seek help for?

Some pains will go away on their own, and others will get worse and can lead to serious problems. It is, therefore, quite difficult to give advice here to help you decide which pains are worth seeking advice about and which ones are 'normal for you' or will go away on their own. Some serious problems give serious pains that stop you doing what you normally can do. An exception to this is period pain, this is often a cramp-like pain in your tummy, just below your navel (belly button) in the lower abdomen. You might get this just before or during your period. You might also get a cramp-like pain in the middle of your menstrual cycle in the area around your ovaries when they are getting ready to release an egg.

What other symptoms can mean that I should seek medical advice when I have a pain?

Symptoms to look out for, that can mean you should seek help from a doctor, are:

Pain between your periods
Increased vaginal discharge and a pain
Feeling unwell and having a pain
Bleeding between periods and having a pain
Pain during sexual intercourse
Bleeding soon after having sexual intercourse

What is lower abdominal pain most likely to be?

Most abdominal pain experienced by girls and women is just 'period pain', which you might expect just before and during your periods. You can reduce the discomfort of this pain, but the pain itself won't do you any harm.

If you are getting pains at other times of the month and you have had unprotected sex, you might have a chlamydial infection. Chlamydia is very common but should be tested for and treated to prevent more serious problems and maybe infertility.

What other causes are possible?

If you have severe pain, feel unwell, have a temperature above 37ºC, and are losing blood, you might have an infection of the fallopian tubes, or the ovaries called pelvic inflammatory disease or PID. Another possibility is that you have an ectopic pregnancy a pregnancy that is developing in one of the fallopian tubes. Both these conditions are serious and you should urgently go to a doctor.

What should I do?

If you have severe pain, feel unwell at the same time or have bleeding from your vagina, go to see your doctor or the Accident and Emergency Department immediately.
If you are worried about any pain, you should go and get yourself 'checked out' by your GP, or a doctor at SHAC (Clinic 1A), or another genitourinary medicine clinic. You might be catching a problem early, problems identified early are usually treated more easily.
If you think that the pain you are having is not just period pain, you should go to see a doctor soon in case you have an infection. Even if it is bad period pain, your doctor still might be able to help you.
Don't have unprotected sex, in case you give an infection to your partner or make your infection worse.

What if I just ignore it?

Some of the causes of lower abdominal pain can be medical emergencies and can be very serious.

If you have an untreated infection, it can damage your health and also that of your partner and anyone else you or they have sex with in the future. Some of these infections can also make you or your partner infertile.
If you 'just' have period pain, it won't do you any harm and will often get easier to cope with as you get older.

Protect yourself from getting infections that are caught during sex.

If you or your partner has had unprotected sex in the past get yourselves 'checked out' by a doctor.
Don't have unprotected sex.
Learn about safe sex.

Print this page