Perineal pain during sex

Pain at the opening may reflect dryness, irritation, a healing birth injury, lichen sclerosus, or vulvodynia. Deeper pain can occur with endometriosis, an ovarian endometrioma, or pelvic inflammatory disease. Hormonal changes around menopause can contribute through genitourinary syndrome of menopause. The location, timing, depth, skin changes, discharge, and relationship to the menstrual cycle help guide assessment.

Stop if pain starts rather than pushing through it. Try more time for arousal, a suitable lubricant, and positions that control depth. Avoid fragranced washes and products that irritate the vulval skin. If symptoms continue, a clinician can examine the skin, assess pelvic muscles, check for infection, and discuss pelvic-floor therapy or targeted treatment. Laparoscopic Excision of Endometriosis may be relevant only after an appropriate assessment.

Arrange an appointment for recurring pain, bleeding after sex, unusual discharge, itching, sores, urinary symptoms, or pain that limits intimacy. Seek prompt care for severe pelvic pain, fever, vomiting, faintness, or possible pregnancy with pain or bleeding.

Is the pain at the entrance or deeper, and what examinations might clarify the cause? Could dryness, pelvic-floor tension, infection, endometriosis, or a skin condition be involved?