Pain and discomfort during sex: what should you know?

Pain at the vaginal opening may come from dryness, skin irritation, involuntary pelvic-floor tightening, or conditions such as Vulvodynia or Lichen Sclerosus. Deeper pain can be linked with Endometriosis, an Ovarian Endometrioma, or Pelvic Inflammatory Disease. Genitourinary Syndrome of Menopause may cause dryness and fragile tissues after hormonal changes.

The location, timing, depth, and associated symptoms help guide assessment. Pain during sex is a symptom, not a diagnosis, and it does not by itself identify one specific condition.

Stop or change sexual activity when pain begins. Allow more time for arousal, consider a suitable lubricant, and avoid scented washes or products around the vulva. Note whether pain is at entry or deeper, whether it follows a cycle, and whether there is itching, discharge, urinary discomfort, or bleeding. A clinician can examine the area and discuss testing or pelvic-floor care.

Seek prompt care for severe pelvic pain, fever, vomiting, faintness, heavy bleeding, or a possible pregnancy. Arrange an appointment for pain that persists, returns, causes avoidance of sex, or occurs with unusual discharge, sores, bleeding, or urinary symptoms.

Where does the pain seem to come from? Could dryness, infection, pelvic-floor tension, or a pelvic condition explain it? What examination or tests are appropriate, and what options could make sex more comfortable?