Causes of pain during sex in females

Pain at the vaginal opening may be linked to insufficient lubrication, thrush or another infection, vulvodynia, lichen sclerosus, an injury, or involuntary tightening of the pelvic-floor muscles. Reduced oestrogen around and after menopause can make vaginal tissue thinner, drier and more sensitive, as part of genitourinary syndrome of menopause. Deeper pelvic pain can occur with endometriosis, an ovarian endometrioma, pelvic inflammatory disease, ovarian cysts, fibroids, scar tissue or bladder and bowel conditions. Anxiety or past distress can intensify muscle guarding and pain, but this does not make the symptoms imaginary.

Pause any activity that hurts; consent can be withdrawn at any point. Note whether pain is at entry or deep inside, whether it happens with every sexual encounter, and whether dryness, discharge, bleeding, urinary symptoms or menstrual pain occur alongside it. A water-based or silicone-based lubricant and more time for arousal may ease friction-related discomfort. Avoid perfumed washes and do not repeatedly self-treat presumed infection. A clinician may discuss symptoms, inspect the vulval skin, offer a gentle pelvic examination, test for infection or arrange imaging. You may ask to stop the examination whenever you wish. Management might involve treating infection or a skin disorder, vaginal moisturisers or prescribed hormonal treatment, pelvic-floor physiotherapy, or care directed at a pelvic condition.

Seek prompt medical assessment for sudden severe pelvic pain, especially with faintness, dizziness, shoulder-tip pain, vomiting, heavy bleeding or a possible pregnancy. Fever, worsening lower-abdominal pain, unusual discharge or feeling very unwell can accompany a pelvic infection and also needs urgent review. Book a non-emergency appointment when pain recurs, causes you to avoid intimacy, follows menopause, or occurs with bleeding after sex, visible skin changes, sores or persistent itching.

Consider asking which causes fit the precise site of your pain, whether infection testing or imaging would help, and how an examination can be adapted for comfort. Ask whether medicines, breastfeeding or menopause could affect lubrication, whether pelvic-floor physiotherapy is suitable, and what symptom changes require urgent reassessment.