What should you know about insertional dyspareunia?

Pain may feel burning, stinging, raw, tight, or sharply sore at the opening. It can happen with a penis, finger, tampon, menstrual cup, or examination. Reduced lubrication can contribute, including around menopause; genitourinary syndrome of menopause may cause dryness and fragile vaginal tissue. Vulvodynia can cause persistent vulval pain without an obvious visible change. Lichen sclerosus may cause itching, soreness, or skin changes. Pelvic inflammatory disease, endometriosis, or an ovarian endometrioma may be relevant when pain is deeper or comes with pelvic symptoms. The symptom does not identify one diagnosis by itself.

Stop or change an activity that causes pain rather than pushing through it. Allow more arousal time, use a plain water- or silicone-based lubricant, and avoid fragranced washes or douches on the vulva. Tell your clinician whether pain is at the entrance or deeper, whether it occurs with tampons, and whether there is itching, discharge, bleeding, urinary discomfort, or pelvic pain. Assessment may include a gentle examination and infection testing. Pelvic-floor physiotherapy, treatment for dryness or skin disease, or counselling for pain-related muscle guarding may be considered after the cause is clearer.

Arrange prompt care for new pain with fever, unusual discharge, bleeding, sores, severe pelvic pain, or pain during possible pregnancy. Seek urgent help for severe worsening pain, faintness, or heavy bleeding. Make a routine appointment if pain persists, affects intimacy, or makes tampons or examinations difficult; recurrent pain deserves assessment even when there are no visible changes.

Could dryness, infection, a skin condition, pelvic-floor tightening, or endometriosis explain the location of my pain? What examination or tests are appropriate? Would pelvic-floor physiotherapy or treatment for vaginal dryness help?