Adenomyosis and pain during sex

Deep penetration may move or press on a tender uterus, while repeated pain can lead pelvic floor muscles to tighten. Burning or pain at the vaginal opening points toward a different set of possible causes. You do not need to continue any activity that hurts.

Deep central aching, cramping or pain that lingers after sex may fit uterine tenderness associated with adenomyosis. Endometriosis, an ovarian endometrioma, pelvic inflammatory disease and pelvic floor muscle tension can cause overlapping deep pain.

Pain at the entrance, itching, skin changes, dryness or burning can instead suggest vulvodynia, lichen sclerosus, infection or genitourinary syndrome of menopause. Pain during sex cannot by itself determine the diagnosis. A clinician may ask about exact location, cycle timing, discharge, bleeding and bladder or bowel symptoms.

Pause when pain starts and communicate which touch or depth is uncomfortable. Positions that let you control depth and pace may reduce deep pressure, while a plain water-based lubricant may help friction-related discomfort. These measures should not replace assessment of persistent or worsening pain.

Record whether pain is at the entrance or deep inside, whether it occurs during or after sex, and how it relates to periods. A gynaecology visit may involve discussion, an examination only with your consent, and imaging when indicated. Treatment can address uterine symptoms, pelvic floor tension, dryness, skin disease or infection according to the cause.

Seek prompt medical assessment for severe or rapidly worsening pelvic pain, fever, fainting, repeated vomiting, heavy bleeding, or pain with a possible pregnancy. New pelvic pain with fever or unusual discharge may indicate infection and should not wait for a routine check.

Arrange an appointment for repeated pain, bleeding after sex, new vulval skin changes, persistent burning or pain that affects intimacy. If an examination feels difficult, tell the clinician; consent can be withdrawn at any time and the assessment can proceed in stages.

Does the location suggest uterine, ovarian, pelvic floor, vaginal or vulval pain? Could more than one condition be contributing? What will the examination involve, and can I pause it? Would imaging, infection testing or pelvic floor physiotherapy help? How could treatment affect bleeding, contraception and pregnancy plans?