What should you know about painful penetration sex?

Pain at the entrance may be linked with vaginal dryness, irritation, infection, skin changes, or involuntary tightening of the pelvic floor. Deeper pain can relate to pelvic inflammation, endometriosis, prolapse, or another pelvic condition. Fear of pain, stress, previous painful experiences, and lack of arousal can also increase muscle tension; this does not mean the pain is imagined.

Hormonal changes around menopause can reduce vaginal moisture and make tissue more sensitive. Menopause may also occur with vaginal dryness, hot flushes, night sweats, periods stopped, mood changes, or low sex drive. These related symptoms can help a clinician understand the wider pattern.

Stop or change any activity that hurts; continuing through pain can increase guarding and tension. Take time for arousal, communicate about depth and pace, and consider a water-based lubricant if dryness is contributing. Avoid scented washes or products that irritate the vulva. A clinician can discuss vaginal moisturisers, hormone-related options, pelvic-floor physiotherapy, or treatment for infection when appropriate.

Arrange an appointment if pain recurs, affects intimacy, causes bleeding, or leads you to avoid sex. You can request a slow explanation, ask to pause an examination, and bring a trusted support person if allowed.

Seek prompt medical help for severe pelvic pain, fever, heavy bleeding, new sores, foul-smelling discharge, pain with possible pregnancy, or sudden worsening. Pain after menopause, bleeding after sex, or a new bulge or pressure sensation also warrants clinical review.

Is the pain at the entrance, deeper inside, or both? Could dryness, infection, muscle tension, menopause, or prolapse contribute? What examination or tests are needed? Which lubricant, moisturiser, therapy, or treatment is suitable for me?