Feeling pains during sex: what to know

Pain at the vaginal opening may relate to dryness, skin inflammation, pelvic-floor muscle tightening, or vulvodynia. Deeper pain may be linked with endometriosis, ovarian endometrioma, pelvic inflammatory disease, or another pelvic problem. Around and after menopause, genitourinary syndrome of menopause can cause dryness and fragile tissues. Itching, skin changes, unusual discharge, bleeding, urinary symptoms, or pain outside sex provide useful clues. Lichen sclerosus can affect vulvar skin and needs medical assessment.

Stop or change activity when pain begins; consent includes being able to pause. Allow more time for arousal, consider a suitable lubricant, and use positions that control depth. Avoid fragranced washes and products that sting. Do not self-treat persistent discharge, sores, or skin changes without advice. A clinician can check the vulva, vagina, pelvic floor, and pelvis, then tailor treatment; some people may also benefit from pelvic-floor physiotherapy or counselling support.

Arrange an appointment if pain recurs, causes fear, or affects closeness or daily life. Seek prompt care for fever, pelvic pain, foul-smelling discharge, bleeding after sex, sores, new swelling, or pain with pregnancy possibility. Urgent assessment is needed for severe sudden pelvic pain, fainting, heavy bleeding, or feeling very unwell. Do not continue intercourse to test whether the pain improves.

Explain whether pain is superficial or deep, when it began, and what makes it better or worse. Ask which examinations and infection tests are appropriate, whether medicines or hormonal changes may contribute, and whether a specialist referral or treatment such as laparoscopic excision of endometriosis is relevant.