What should you know about intense pain during sex?

Pain at entry may reflect low lubrication, a skin disorder such as lichen sclerosus, a sensitive vulval pain condition, or involuntary pelvic-floor tightening. Deep pain can occur with endometriosis, an ovarian endometrioma, or pelvic inflammatory disease. New discharge, fever, bleeding, urinary symptoms, or a new sexual exposure changes the assessment and may point toward infection or inflammation.

Stop when pain begins; do not push through it. Avoid scented washes and use a plain lubricant if you choose sexual activity later. Note whether pain is at entry or deep, which positions trigger it, and whether it follows the menstrual cycle. A clinician may examine the vulva, pelvic floor, and pelvis, test for infection, and discuss hormonal or pain-related factors. Treatment is tailored to the cause; laparoscopic excision is considered only for selected endometriosis findings.

Arrange an appointment for recurring or severe pain, bleeding after sex, unusual discharge, sores, pain when urinating, or symptoms affecting intimacy. Seek urgent care for severe pelvic pain with fever, vomiting, faintness, heavy bleeding, or possible pregnancy. Prompt review is also appropriate when pain starts suddenly or follows a new sexual exposure.

Is my pain superficial or deep, and what causes fit that pattern? Could dryness, pelvic-floor tension, infection, or endometriosis be involved? Do I need an examination, swabs, or imaging? What can I use for comfort now? When should I return if treatment does not help?