What should you know about sudden pain during sex?

Pain at the entrance may relate to dryness, skin irritation, involuntary pelvic-floor tightening, or a condition such as vulvodynia or lichen sclerosus. Deeper pain may be linked with endometriosis, an ovarian endometrioma, or pelvic inflammatory disease. Genitourinary syndrome of menopause can make vaginal tissues drier and more sensitive.

A single episode can follow friction, a change in position, or not having enough lubrication. Pain that returns, causes bleeding, comes with unusual discharge, or affects daily life should be assessed rather than endured.

Stop if sex becomes painful and give irritated tissue time to settle. A water-based lubricant, slower pace, more arousal, and positions that control depth may reduce friction. Do not insert products or use creams that burn or worsen symptoms.

Record whether pain is superficial or deep, its timing, triggers, bleeding, discharge, urinary symptoms, and cycle pattern. A clinician can check for infection, skin changes, pelvic tenderness, and muscle tension. Treatment depends on the finding; laparoscopic excision of endometriosis may be discussed only when endometriosis is confirmed and appropriate.

Get urgent help for severe or escalating pelvic pain, faintness, heavy bleeding, fever, vomiting, or pain with a possible pregnancy. Seek prompt review for new bleeding after sex, sores, marked swelling, or foul-smelling discharge.

Is the pain at the entrance or deeper in the pelvis? Could dryness, infection, skin disease, pelvic-floor tension, or endometriosis explain it? Do I need an examination or tests? What can I use safely while the cause is being assessed?