Burning and pain during sex: causes and next steps

Pain may occur at the vulva or vaginal entrance, during penetration, deep in the pelvis, or afterwards. Its location and timing help narrow the possibilities. Recurrent pain deserves assessment; you do not need to continue an activity that hurts.

Burning at the entrance may accompany low lubrication, irritation from fragranced products, thrush or another infection, vulvodynia, or a vulval skin condition such as lichen sclerosus. Genitourinary syndrome of menopause can present with dryness, soreness, burning and pain during penetration as oestrogen levels change.

Deep pain can occur with endometriosis, an ovarian endometrioma, pelvic inflammatory disease or pelvic-floor muscle tension. These conditions do not account for every episode, and symptoms alone cannot identify the cause. Discharge, itching, urinary symptoms, bleeding, fever, cycle timing and whether pain is superficial or deep give the clinician useful clues.

Pause penetration when it burns or hurts. Allow more time for arousal, try a plain water-based or silicone-based lubricant, and choose sexual activities or positions that let you control depth and pace. Avoid douching, scented washes and other products that irritate the vulva.

Make an appointment if pain persists, returns or affects intimacy. A clinician may ask about the pain pattern, periods, menopause symptoms, medicines and sexual health, then offer an external or internal examination with your consent. Depending on the findings, useful next steps may include infection testing, treatment for dryness or a skin disorder, pelvic-floor physiotherapy, imaging or gynaecology referral.

Seek prompt care for pain with fever or chills, unusual or foul-smelling discharge, sores, pain when urinating, or bleeding between periods or after sex. Arrange sexual-health testing if you could have been exposed to a sexually transmitted infection, and avoid sexual contact until you have received appropriate advice.

Get urgent assessment for sudden severe pelvic or abdominal pain, fainting, marked dizziness, vomiting, or pain with heavy bleeding. If pregnancy is possible, pelvic pain with vaginal bleeding or shoulder-tip pain needs urgent evaluation.

Ask whether the pattern points to vulval irritation, vaginal dryness, pelvic-floor tension, infection or a deeper pelvic cause; which examination or tests would change management; and what you can use safely while the cause is being assessed. You can also ask to stop the examination at any time, request a chaperone and discuss alternatives if an internal examination feels too painful.