Pain during penetrative sex: what to know

Pain at the entrance can reflect dryness, inflammation, a skin condition such as lichen sclerosus or vulvodynia. Deeper pain may occur with endometriosis, an ovarian endometrioma or pelvic inflammatory disease. Genitourinary syndrome of menopause can make vaginal tissue drier and more sensitive after menopause.

Pelvic floor muscles may tighten in anticipation of pain, creating a cycle of guarding and discomfort. Tell the clinician whether pain happens on entry, with deeper thrusting, after sex or with particular positions, and mention bleeding, discharge, urinary symptoms or period-related pain.

Do not continue through pain. Use more time for arousal, a suitable lubricant and positions where you control depth and pace. Avoid fragranced washes and douching. If symptoms continue, a clinician can assess for infection, skin changes, pelvic floor tension or a pelvic condition and may suggest targeted treatment or pelvic floor physiotherapy.

Seek an appointment when pain is repeated, worsening or affecting your relationship or daily life. Get prompt care for fever, severe pelvic pain, unusual discharge, sores, bleeding after sex or difficulty passing urine. Sudden severe pain with faintness or vomiting needs urgent attention.

Ask which body area is most likely causing the pain and whether you need an examination, infection tests or imaging. Discuss lubricant choices, pelvic floor therapy and whether endometriosis, menopause-related changes or a skin condition should be considered.