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1.
a term meaning "pain in the ass" to an exponentially higher intensity.

an annoyance that pisses you off in a degree of this much intensity is reasoned through the logic that the pain is not only centered in the posterior region, but rather to the whole body. And not any body either, that of a bitch.
Doing homework can be a pain in the ass, but dealing with my parents is a real pain in the bitch.

Stupid people.

Assholes.

Bush.

Long lines for the bathroom after you've had three cups of coffee and a large energy drink.
by Ms. Deviant August 18, 2007
 
2.
Something that is mentally grievous or painful to the speaker, provided the speaker themselves are a bitch.
"Those new sandpaper tampons are a real pain in the bitch."
by Gribby Bullock April 01, 2008