What should you know about unbearable pain during sex?

Pain at the entrance may relate to dryness, irritation, lichen sclerosus, vulvodynia, or involuntary tightening of the pelvic floor. Deep pain can occur with endometriosis, an ovarian endometrioma, pelvic inflammatory disease, or other pelvic problems. Genitourinary syndrome of menopause can make vaginal tissue drier and more fragile. Pain during sex is a symptom rather than a diagnosis, and the same symptom can have more than one contributor.

Stop if sex hurts and avoid pushing through severe pain. Note whether pain is superficial or deep, when it began, whether it follows a cycle, and whether there is discharge, bleeding, urinary discomfort, or pelvic pain. A clinician may examine the vulva and vagina, assess the pelvic floor, test for infection, or arrange imaging. Treatment depends on the cause and may include targeted medical care, pelvic-floor therapy, lubrication, or specialist surgery.

Seek urgent care for severe pelvic pain with fainting, heavy bleeding, fever, vomiting, shoulder-tip pain, or a possible pregnancy. Prompt assessment is also needed for new pain with foul-smelling discharge, pain after sexual assault, or pain that is rapidly worsening. Emergency symptoms should not be attributed to a known diagnosis without examination.

Tell your clinician where the pain starts, how long it lasts, and what makes it worse. Ask which examinations or tests are appropriate, what treatment options fit the suspected cause, and how to protect intimacy while healing.