What should you know about female pain during sex?

Pain at the vaginal opening can relate to dryness, irritation, skin changes, pelvic-floor muscle tightening, or vulvodynia. Deeper pain may occur with endometriosis, an ovarian endometrioma, pelvic inflammatory disease, or other pelvic conditions. Hormonal changes around menopause can thin and dry vaginal tissues; genitourinary syndrome of menopause is one possible explanation. Lichen sclerosus can also affect vulval skin. The symptom has several possible causes, so its presence alone does not identify one condition.

Pause any activity that hurts and note where the pain is, when it begins, whether it is linked to penetration or position, and whether it continues afterwards. A clinician may ask about periods, contraception, childbirth, infections, medicines, and menopause symptoms, then examine the vulva, vagina, and pelvis if appropriate. Lubricant may reduce friction when dryness contributes, but persistent pain deserves an assessment. Treatment depends on the cause and may include addressing infection, skin disease, pelvic-floor tension, hormonal tissue changes, or endometriosis; laparoscopic excision of endometriosis is one surgical option for selected patients.

Arrange medical care for repeated or worsening pain, pain with unusual discharge, bleeding, sores, urinary symptoms, or a change after menopause. Seek urgent help for severe or rapidly increasing pelvic pain, fainting, heavy bleeding, fever with feeling very unwell, or possible pregnancy with pain or bleeding.

Could the pain be coming from the vaginal tissues, pelvic floor, cervix, uterus, ovaries, or an infection? What examination or tests fit my symptoms? Which treatments can protect comfort and sexual wellbeing while the cause is investigated?