What should you know about excruciating pain during sex?

Pain at the vaginal opening may relate to dryness, skin inflammation, pelvic-floor muscle tightening, or vulvodynia. Deep pain can occur with endometriosis, an ovarian endometrioma, pelvic inflammatory disease, or another pelvic condition. Genitourinary syndrome of menopause may cause dryness and fragile tissues after hormonal changes. Lichen sclerosus can affect vulval skin and make contact painful.

Pain can be burning, cutting, aching, or pressure, and it may begin with penetration, during deeper movement, or afterward. The pattern, bleeding, discharge, itching, urinary symptoms, and menstrual history all help guide the examination.

Stop when pain starts and do not push through it. Talk with your partner about positions, pace, and alternatives that do not hurt. A water- or silicone-based lubricant may reduce friction; avoid fragranced products on the vulva. Book a clinician visit if pain persists, returns, or affects intimacy. Treatment depends on the cause and may include treatment for infection or skin disease, vaginal moisturising, pelvic-floor therapy, or specialist care.

Seek urgent care for severe pain with heavy bleeding, faintness, fever, repeated vomiting, a rigid or swollen abdomen, or possible pregnancy. Prompt assessment is also needed for new pelvic pain with foul-smelling discharge or feeling acutely unwell, because infection or another urgent pelvic problem may be present.

Ask whether the pain is superficial or deep, which causes fit its pattern, whether you need infection testing or imaging, and whether pelvic-floor therapy or a referral would help.