Reasons for pain during sex

Pain at the vaginal opening can be linked with dryness, skin inflammation, involuntary tightening of the pelvic floor or vulvodynia. Lichen sclerosus can affect the vulval skin and cause soreness or splitting. Deeper pain may be associated with endometriosis, an ovarian endometrioma, pelvic inflammatory disease or another pelvic problem. The timing, depth and character of pain help distinguish these possibilities.

Genitourinary Syndrome of Menopause can make vaginal tissues drier and more fragile after hormonal changes. Pain is a symptom, not a diagnosis, and it does not identify one condition by itself. A clinician may ask about discharge, bleeding, urinary symptoms, periods, childbirth, menopause and medicines, then examine the vulva and pelvis if you agree.

Pause or change any activity that hurts. A water-based lubricant, slower penetration and more time for arousal may reduce friction, but persistent pain deserves assessment. Avoid perfumed washes and products that sting the vulva. Note whether pain is superficial or deep, when it began, its relationship to your cycle and whether discharge, itching or urinary symptoms occur.

Treatment depends on the cause. It may include treating infection, supporting tissue comfort, addressing pelvic-floor tension or managing a condition such as endometriosis. Laparoscopic excision of endometriosis is one specialist treatment that may be discussed for selected patients.

Arrange prompt medical care for new severe pelvic pain, fever, vomiting, faintness, unusual bleeding, sores or foul-smelling discharge. Seek urgent help if pain is sudden and intense, especially with pregnancy possibility. Pain after sexual assault also warrants compassionate medical and emotional support; you can seek care even without visible injury.

Ask whether the pain seems superficial or deep, whether an examination or infection tests are needed, what could explain its timing, and which treatments protect comfort and sexual wellbeing.