What to know about severe pain during sex

Pain may occur at the vaginal opening, deeper in the pelvis, or after sex. Its location, timing, and associated symptoms help a clinician narrow down the cause.

Pain at the entrance may reflect dryness, irritation, infection, a skin condition such as lichen sclerosus, vulvodynia, or involuntary tightening of the pelvic-floor muscles. Hormonal changes around menopause can make vaginal and vulval tissues thinner, drier, and more sensitive.

Deep pain can occur when endometriosis, an ovarian endometrioma, pelvic inflammatory disease, an ovarian cyst, or another pelvic problem affects tissues moved during penetration. Endometriosis commonly presents with deep pain during sex, but the symptom alone does not identify its cause.

Stop any activity that hurts; there is no need to push through severe pain. Until you are assessed, consider non-penetrative intimacy, more time for arousal, a simple water- or silicone-based lubricant, and positions that let you control depth and pace. Avoid fragranced washes or products if the vulval skin feels irritated.

Arrange an appointment and note whether pain is superficial or deep, when it began, whether it follows your menstrual cycle, and whether discharge, urinary symptoms, bleeding, dryness, or bowel pain occurs. Assessment may include a gentle examination, infection testing, or pelvic imaging; you can ask to pause the examination at any time.

Seek urgent medical care for sudden or intense pelvic pain, fainting, dizziness, shoulder-tip pain, heavy bleeding, fever, vomiting, or pain when you may be pregnant. These features can accompany bleeding, infection, ovarian torsion, or an ectopic pregnancy and should not wait for a routine visit.

Book a prompt non-emergency assessment if pain keeps returning, is getting worse, prevents intimacy, or is associated with sores, unusual discharge, bleeding after sex, or persistent urinary symptoms.

Ask which causes fit the exact location and timing of your pain, whether infection tests or an ultrasound are appropriate, and what can make an examination more comfortable. You can also discuss vaginal moisturisers, local hormonal treatment, pelvic-floor physiotherapy, pain management, or referral to a gynaecologist, depending on the suspected cause.