What causes vaginal pain despite negative UTI tests?

Question

Hello doctor,

I have been experiencing pain in the vaginal area for about one year. I have been tested multiple times for a UTI, but the results have always been negative.

The pain is located near the bladder area and inside the vagina. It has become so severe that at times it is difficult to breathe, walk, or perform normal daily activities. At one point, the pain became so intense that I had to visit the emergency room, where again the test for UTI was negative.

Despite negative results, doctors have treated me for UTI. After completing antibiotics, the pain improved for about one week, but then it returned. What could be the possible cause, and what should be done next?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

The symptoms described require careful evaluation, especially since the pain has been persistent for a long duration, and repeated tests for urinary tract infection (UTI) have been negative.

Pain in the vaginal and bladder region for such an extended period may not always be due to a UTI. Other possible causes that should be considered include:

Interstitial cystitis (a chronic condition causing bladder pain without infection).
Vaginal infections, such as fungal infection (candidiasis).
Pelvic inflammatory conditions.
Vulvodynia (chronic pain in the vulvar region).
Pelvic floor muscle spasm or dysfunction.

Temporary relief after antibiotics may sometimes occur due to their anti-inflammatory effect or placebo response, but recurrence suggests that the underlying cause may be different.

I would suggest the following measures:

Drink plenty of water and maintain adequate hydration.
Maintain proper genital hygiene using plain water.
Avoid harsh soaps or chemical-based vaginal washes.
Wear loose, breathable cotton undergarments.
Avoid using public toilets when possible or ensure proper hygiene if unavoidable.

Medications (only after medical consultation):

Fluconazole may be prescribed if a fungal infection is suspected.
Urinary alkalizers such as Disodium hydrogen citrate may help reduce urinary discomfort.

I would suggest that further evaluation is strongly recommended:

Urine routine examination and urine culture.
Ultrasound of the abdomen and pelvis.
Kidney, ureter, and bladder (KUB) imaging.
Complete blood count (hemogram).
Blood sugar levels.
Gynecological examination to check for local causes.

It is important to consult a gynecologist for a detailed physical examination and targeted investigations. Persistent pain should not be treated repeatedly as a UTI without confirmation, as this may delay the correct diagnosis.

If symptoms such as itching, redness, abnormal discharge, or pain during intercourse are present, they should be reported, as they can help in identifying the cause.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.