Spotting and pain during sex

Friction, low lubrication, vaginal dryness, or a sensitive cervix can lead to small amounts of bleeding and pain. Genitourinary syndrome of menopause can make vaginal tissue thinner and drier. Infection, including pelvic inflammatory disease, may cause pain with discharge, fever, or lower abdominal tenderness.

Pain deeper in the pelvis can occur with endometriosis or an ovarian endometrioma. Skin conditions such as lichen sclerosus and nerve-related vulvodynia can cause pain at the opening. These symptoms do not point to one diagnosis by themselves.

Stop or change activity if it hurts, and note whether pain is at the entrance or deeper inside. A water-based lubricant may reduce friction when dryness is involved. Arrange an appointment for repeated spotting, persistent pain, new discharge, or symptoms after a new sexual partner.

Do not douche or use scented products on the vulva. A clinician may offer an examination, infection testing, or treatment directed at the underlying cause.

Seek urgent care for heavy bleeding, severe or worsening pelvic pain, fainting, fever, vomiting, or feeling acutely unwell. Get prompt advice for pain with a positive pregnancy test, or bleeding after menopause.

Ask whether the pain location suggests a vaginal or pelvic source, whether infection testing is appropriate, and what products or treatments are safe for dryness. Tell the clinician about cycle timing, contraception, discharge, urinary symptoms, and prior pelvic conditions.