What should you know about internal pain during sex?

Internal pain during sex can have several causes, including pelvic conditions, muscle tension, inflammation and hormonal changes, so persistent or severe pain deserves medical assessment. Pain felt deeper in the pelvis may differ from soreness at the vaginal opening. The timing, location and associated symptoms can help a clinician narrow the possibilities. You do not need to continue sexual activity through pain.

Deep pain can be associated with endometriosis, an ovarian endometrioma or pelvic inflammatory disease. Hormonal changes around menopause can make genital and urinary tissues more sensitive, including in genitourinary syndrome of menopause. Pelvic floor muscles may tighten in response to pain or stress and can make deeper penetration uncomfortable. The pain may be aching, sharp, burning or pressure-like, and it may occur only in certain positions or at particular times in the menstrual cycle. Bleeding, unusual discharge, fever, urinary symptoms or pelvic pain outside sex are useful details to mention. A symptom alone cannot identify its cause; an examination and, when appropriate, tests help distinguish these possibilities.

Pause or change any activity that causes pain, and tell your partner what feels uncomfortable. Keeping a brief record of where the pain occurs, when it begins, its relation to your period, and any bleeding or discharge can make an appointment more useful. A clinician may ask about contraception, pregnancy possibility, infections, previous pelvic procedures and bowel or bladder symptoms. Treatment depends on the cause and may involve treating an infection, addressing vaginal or hormonal tissue changes, physiotherapy for pelvic floor muscles, or care for an underlying pelvic condition. Do not use leftover antibiotics or insert products that irritate the area.

Arrange a clinical appointment if internal pain keeps returning, affects intimacy, is new without a clear explanation, or occurs with bleeding after sex, unusual discharge, painful urination, changes in bowel habits or ongoing pelvic pain. Seek urgent medical help for severe or rapidly worsening pelvic pain, fainting, heavy bleeding, fever with pelvic pain, repeated vomiting, or pain when pregnancy is possible. These warning signs can need prompt assessment, regardless of how often the pain occurs.

You could ask: What might explain pain that feels deep rather than at the opening? Do I need an examination, infection testing or an ultrasound? Could pelvic floor muscle tension, endometriosis or hormonal changes be contributing? Which activities are suitable while we investigate the cause? What symptoms should prompt urgent help?