Charles Butrick, MD (retired)

During pregnancy varicose veins involving the vulvar area can cause one side to become larger (esp if you have other varicose veins in your legs).  These veins often will shrink after the delivery and symmetry will return.

Please find a doctor that specializes in chronic pelvic pain.  Please read about PPOP.  The cause of your pain is likely pelvic floor myalgia (muscle pain).  When we have pain after surgery we all will tense up our pelvic floor muscles.  This can lead to pelvic floor pain.  This can cause a feeling of pressure, burning, heaviness and will be worse with or after physical activity and especially sitting.  This last symptom is why providers and patients have so offen confused pudendal neuralgia with pelvic floor myalgia.  Please go to the website of the International Pelvic Pain Society to find a provider to help your symptoms.  Therapy directed toward your muscles should resolve the PF pain, therapy directed towards the nerve will not-because it is very unlikely you have PN.

What is obvious is a woman that is 22 and has never had children should not have anatomic problems unless there are other issues that need to be evaluated and managed.  Your history is classic for hypertonic pelvic floor dysfunction causing chronic constipation and obstructed defecation.  When you can't relax your muscles to pass stool you must push and strain for long periods of time and this is just like the pushing that occurs when you have a vaginal delivery.  This is why you have anatomic problems.  Any surgery that is done to correct these anatomic problems will not correct your functional problems therefore your anatomic problems will very likely return shortly after surgery.  Please be carefully evaluated by a trained pelvic floor specialist prior to making decisions to have surgery.  My website discusses this problem and provides you with articles that I have written on this subject.  

While your photo is helpful, a one on one exam with your gynecologist is always the best.  What I think you are concerned with is the redundant vaginal wall that has dropped into view at the vaginal opening.  It is called a urethrocele and just below that is a small cystocele.  These are the small round structures just inside the opening and is often the result of minor injury to the support of the urethra and the bladder at the time of a vaginal delivery.  A careful evaluation by a urogynecologist and a minor out patient procedure should correct this nicely.  I have used FemiLift- an office based laser for vaginal tightening- for minor support problems like yours.  No downtime or recovery for the FemiLift.  Hope this was helpful.

Your picture demonstrates very nicely vestibular papillae.  They classically are found at the opening of the vagina in clusters or lines just like your picture.  They typically are asymptomatic and should not require any therapy.  The status of hormones might affect the prominence of this normal variant.