Vaginal itching and pain during sex: what to know

Vaginal itching and pain during sex can have several causes, so the pattern and accompanying symptoms guide the next step. Irritation from scented products, thrush, other infections, low moisture, vulval skin conditions and pelvic pain conditions can overlap. A symptom combination does not identify one diagnosis by itself.

Notice whether the itch is on the outer skin or deeper inside, and whether sex causes burning at the entrance or aching deeper in the pelvis. Discharge, odour, sores, urinary burning, bleeding after sex or fever add useful clues. Endometriosis, pelvic inflammatory disease and ovarian endometrioma can present with pain during sex; vulvodynia can cause persistent vulval pain. Lichen sclerosus may cause itchy, fragile vulval skin. Pain during sex deserves assessment even when itching is mild.

Pause penetration if it hurts, and use plain water to cleanse the vulva without scrubbing. Avoid douching, fragranced washes, deodorants and products that sting. Loose cotton underwear and keeping the area dry may reduce irritation. Do not insert an over-the-counter treatment unless a clinician or pharmacist has helped identify the likely cause, especially if you are pregnant or have sores, bleeding or recurrent symptoms. Arrange a gynaecology or sexual-health assessment for an examination and, when needed, swabs or urine testing.

Seek prompt medical care for severe or worsening pelvic pain, fever, vomiting, faintness, unusual bleeding, new sores, or pain with pregnancy. Arrange an appointment soon if symptoms persist, recur, follow a new sexual partner, or come with abnormal discharge or urinary symptoms. Urgent assessment matters because pelvic infection can worsen without treatment; symptoms alone cannot confirm the cause.

Ask: Could this be irritation, thrush, an infection, a skin condition or a pelvic pain condition? Do I need an examination, swabs or urine tests? Which lubricants or treatments are suitable for me? What should I do if sex remains painful after the itch settles?