What should you know about extreme pain during sex?

Pain at the entrance can be linked with dryness, irritation, tightened pelvic floor muscles, vulvodynia, or lichen sclerosus. Deep pain may occur with endometriosis, an ovarian endometrioma, pelvic inflammatory disease, or another pelvic problem. During the menopause transition, genitourinary syndrome of menopause can make vaginal tissues drier and more sensitive. Pain can also be affected by fear of pain, previous injury, or relationship stress; this does not make it imagined. A clinician can ask where pain starts, whether it is burning or deep, and whether it continues afterward.

Stop or change sexual activity when pain begins, and agree with your partner on a clear signal. Allow more time for arousal, consider a water-based lubricant, and avoid fragranced washes or products that sting. Do not use leftover creams or antibiotics without advice. Arrange an appointment if pain is severe, recurrent, associated with bleeding or discharge, or affecting intimacy. Assessment may include a gentle external or pelvic examination, swabs, urine testing, or imaging depending on the pattern.

Seek urgent care for severe pelvic pain with fever, vomiting, fainting, heavy bleeding, a swollen abdomen, or feeling acutely unwell. Prompt review is also needed for new pain during pregnancy or after a procedure.

Is the pain more likely to be at the entrance or deeper in the pelvis? Could infection, endometriosis, tissue changes, or pelvic floor tension be involved? What testing and treatment options are appropriate?