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Narrow Introitus - Causes, Symptoms, and Treatment

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Narrow introitus can cause discomfort and pain in the pelvic region. This article explains the causes, symptoms, and treatment for narrow introitus.

Written byDr. Asha. C

Medically reviewed byDr. Priyadarshini Tripathy

Published At November 15, 2022
Reviewed AtMarch 2, 2023

What is Introitus?

An introitus refers to the external opening of the vagina, which leads to the vaginal canal. The vagina is a muscular tunnel that continues to the cervix (the opening of the uterus). During penetration, there is stretching and elongation of the vaginal canal. But after the penetration, the introitus and the vagina shrink and return to their original size.

What Is the Anatomy of the Introitus?

The introitus is the opening of the vaginal canal; it is a muscular canal extending from the outer part of the female genitalia to the cervix (the lower end of the uterus). The introitus is situated toward the back of the vulva (external female genitalia). The vulva has inner and outer folds of fleshy skin. The inner fold of the skin is known as labia minora, and the outer fold of the skin is known as labia majora. So the position of the introitus is between the labia minora and just below the urethral opening and the clitoris. Before the first sexual penetration or intercourse, the introitus is covered by a thin and tough sheath of tissue known as the hymen. An intact hymen is usually a half-moon shape and covers only part of the vaginal opening to allow menstrual blood to pass out of the body.

Which Condition Causes Narrowing of the Introitus?

Vaginal stenosis is a condition causing closing, narrowing, or loss of flexibility of the introitus and vaginal opening. It commonly occurs due to vaginal surgery, as a side effect of radiation treatment, and sometimes due to hormone changes over the lifespan. It causes scar tissue, dryness of the vagina, and loss of mobility of the vaginal tissue.

What Is the Cause of Narrow Introitus?

The causes for the narrowing of introitus vary from one woman to the other. The common causes are as follows:

  • Episiotomy - A small cut at the opening of the vagina made by the doctor during childbirth is called an episiotomy. It is done if the birth canal may not be large enough to deliver a baby vaginally. Episiotomy can result in changes in the shape of the vagina or scar tissues, resulting in vaginal stenosis.

  • Radiation Therapy - Radiation therapy is a standard treatment for cancer. It helps kill cancer cells and prevent the development of new cancer cells. Even though radiation therapy is very important for survival, it can cause many side effects, such as vaginal narrowing, painful sexual intercourse, etc.

  • Vaginal Reconstructive Surgery - This procedure is done to create an artificial vagina after a vaginectomy (the removal of the vagina). This surgery can also cause scars which can lead to the narrowing of the introitus.

  • Congenital Adrenal Hyperplasia (CAH) - It is a rare disease that prevents the secretion of certain hormones like androgens. This can create issues with the formation of genitals.

  • Gender Reassignment Surgery - This surgery changes females to males (FTM) or males to females (MTF). In the case of MTF, a new vagina is created with the skin of the penis. After the procedure, the new vagina needs therapy to expand and stretch the vaginal tissue. If these therapies are not properly followed, it can lead to vaginal stenosis.

What Are the Symptoms of Narrow Introitus?

Narrowing of the introitus can cause many symptoms that include severe pelvic pain, extreme dryness of the vagina, abnormal vaginal atrophy, vaginal tissues can become thin and tender, scar tissue build-up, and itching or discomfort. All of these symptoms can affect a woman's sexual life.

What Is the Treatment for Narrow Introitus?

The following treatment can help in treating narrow introitus:

1) Vaginal Dilators - Vaginal dilators can be used to stretch gently and enhance the elasticity of the vagina. It is a safe method, and the healthcare provider will provide vaginal dilator training. They choose a set of instruments with progressive sizes that will gently and progressively improve the width and depth of the vaginal opening after narrowing the introitus. During the training session, the dilators are gently compressed into the opening of the vagina and held for 30 seconds to a minute, and moved around in a clockwise direction. This training is used to stretch and train the pelvic floor muscles and their surrounding tissues to improve the ability to tolerate penetration.

2) Hormone Therapy - Hormonal therapy replaces the missing hormones in the body with natural ones, such as estrogen. Normally, the levels of estrogen decrease during aging. This hormonal imbalance can cause vaginal atrophy. So hormonal therapy can help improve moisture and reduce chronic pelvic pain.

3) Use Plenty of Lubrication - This helps in improving the use of dilators, daily hygiene, and sexual activity. Using a lubricant significantly improves comfort during sex and dilator training. At least 1 to 2 tablespoons can be helpful, and by using a suspension dropper, the lubricant can be injected into the vaginal vault. An organic balm can also be used many times to help moisturize the entrance to the vagina and the vulva.

4) Pelvic Floor Release Stretches - Performing pelvic floor release stretches daily will be helpful. The stretching of pelvic floor muscles compliments dilator training and helps to relax the muscles that share a connection with the vaginal opening, making penetration more comfortable.

5) Vibration Therapy - Using vibration therapy improves blood flow to the area. Vibration can stimulate circulation and soften radiated and scarred tissue when treatment is completed. Vibrating wands are used for vibration therapy. A pelvic wand can be used to massage and release the trigger points of the pelvic floor muscles. It has ten different frequencies of vibration that helps stimulate blood flow and helps to relax the tissue of the pelvic floor muscles and the vagina. This can successfully help to regain the elasticity of the vagina and provides healing toward pain-free sex.

6) Healthy Diet - A healthy diet rich in minerals and vitamins increases the natural moisturizer in the body. The best foods to eat that help to increase vaginal health include avocados, sweet potatoes, cranberries, and leafy greens.

Conclusion -

The introitus is the external opening of the vagina that leads to the vaginal canal. The Introitus can become narrow due to many reasons, like radiation therapy, episiotomy, vaginal surgery, or changes in the hormone. Due to the narrowing of the Introitus, there can be symptoms like vaginal dryness, pain during sex, pelvic pain, itching, and discomfort. If you face any of these symptoms, consult a doctor; many treatments will help dilate the introitus.

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Frequently Asked Questions

An introitus is described as an opening to a hollow organ. However, it is also described as the vaginal opening. The introitus can also be affected by conditions harming the vagina and vulva, and the person may experience a range of symptoms such as itching, pain, or burning.
The introitus pain feels like a burning sensation or stinging pain that may get exaggerated during sexual intercourse or even when inserting products like tampons. The pain may last for a long time, leading to soreness that takes time to recede. This is usually seen in women aged 20 to 50, often due to an underlying lower genital infection.
The hymen and introitus are both different anatomical parts. The hymen is a thin fold of mucous membrane present within the vaginal orifice on the interior aspect of the introitus. The internal surfaces of the fold are usually in contact with each other, and the vaginal orifice appears as a fissure between them. And introitus is an external opening to the vaginal canal and external female genitalia to the cervix (the opening to the uterus).
The introitus can be tightened by performing some surgical procedures. In these procedures, the excess skin tissues and the vaginal lining are removed to tighten the vaginal muscles and the soft tissues. This procedure can be done using lasers or sharp instruments like a scalpel. This surgery helps reduce the width and length of the vaginal opening and tighten the muscles surrounding it.
Hymen is a thin fold of tissue present within the vagina. It is nearly impossible to see the hymen with the naked eye, even if a person uses a flashlight. This is because it is the same color as the inner side of the vagina, and it is impossible to feel it physically using fingers.
The healthy hymen is the same color as the skin around the vagina (flesh-colored). However, it is not possible to see the hymen with the naked eye. But it does look like a crescent moon shape, which is the normal shape of a hymen just beneath the vaginal opening or surrounding the vaginal opening. Moreover, it should not cover the vaginal opening, as it will cause the accumulation of menstrual blood.
Bleeding is a normal thing to happen while having penetrative sex for the first time. However, it can also occur if the male partner has a large girth, but it is only experienced when the hymen gets torn during the first sexual intercourse. The size usually does not cause pain or bleeding later in life.
Hymen cannot grow back once they are broken. However, it is a common misconception among females that the hymen will grow back on its own if enough time has passed since it was broken. Therefore, there are some hymen repair surgeries through which it can be repaired.
The hymen is a tiny, thin membrane that surrounds the opening of the vagina. This does not extend deep into the vagina. Instead, it is located just half an inch inside the vagina and can break down even before a person has intercourse.
Not everyone has a hymen. Sometimes the hymen has very small openings or tiny holes, which is negligible, and this problem may not be discovered until puberty. Therefore, some girls are born without a hymen, which is normal and healthy.
The hymen is a piece of tissue surrounding the vaginal opening. It is formed during the developmental stage and is usually present during birth. However, in some cases, it might not be there. As a person ages, the hymen gets thin and tear.
The normally shaped hymen looks like a half moon, leaving a space for the menstrual blood to flow out of the vagina during periods. However, in the case of an imperforate hymen, the hymen completely covers the opening of the vagina, blocking the flow of menstrual blood. As a result, this blood accumulates in the vagina and can eventually reach the uterus or fallopian tubes.
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Dr. Priyadarshini Tripathy from iCliniq
Dr. Priyadarshini Tripathy

Obstetrics and Gynecology

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