What should you know about friction pain during sex?

Pain may be felt at the vaginal opening, on the vulval skin or deeper in the pelvis. Dryness can follow hormonal changes, breastfeeding, some medicines or menopause. Burning, itching, cracks or pale skin can point to a skin condition such as Lichen Sclerosus. Long-lasting vulval pain without a clear injury may be Vulvodynia. Deep pain can occur with Endometriosis, an Ovarian Endometrioma or Pelvic Inflammatory Disease; the condition presents with pain, but pain alone does not identify its cause.

Bleeding, unusual discharge, sores, fever or pain that continues after sex changes the picture and should not be dismissed as simple friction.

Stop or change sexual activity when pain starts. Allow irritated skin time to settle, avoid fragranced washes and use a plain, water-based lubricant generously. A longer, gentler build-up may help the tissues produce more natural moisture; do not force penetration. Note where the pain occurs, what it feels like, and whether it relates to your cycle, condoms, products or a new medicine.

A clinician can check the skin, infection symptoms, pelvic muscles and deeper pelvic causes. Genitourinary Syndrome of Menopause may need targeted treatment. If Endometriosis is suspected, treatment options can include Laparoscopic Excision of Endometriosis after an individual assessment.

Arrange a medical review if pain is new, repeated, worsening or affecting intimacy, or if lubricants and rest do not help. Seek prompt care for severe pelvic pain, fever, heavy bleeding, faintness, a new sore or marked swelling. Urgent assessment is also appropriate when pain follows an injury or occurs during pregnancy.

Could dryness, a skin condition, infection, pelvic muscle tension or a deeper pelvic condition explain my symptoms? What examination or tests are appropriate? Which lubricant or treatment is suitable for my tissues? Should I pause penetration, and what symptoms should prompt urgent help?