Vulva pain during sex: causes and care

Pain at the entrance may reflect dryness, friction, irritated skin, infection, involuntary pelvic-floor tightening, or vulvodynia. Deeper pain can present with endometriosis, an ovarian endometrioma, or pelvic inflammatory disease. Lichen sclerosus may cause fragile, itchy, or sore vulval skin, while genitourinary syndrome of menopause can reduce moisture and tissue flexibility. The location, timing, and quality of pain provide useful clues but do not establish a diagnosis.

Tell the clinician whether pain starts with touch or penetration, appears only in certain positions, continues afterwards, or occurs with discharge, bleeding, urinary symptoms, itching, or skin changes. Pain during sex is not something you need to tolerate to protect a relationship.

Stop when pain begins and allow the area to recover. Use a plain, suitable lubricant, take more time for arousal, and choose activities or positions that avoid pressure on the sore area. Avoid fragranced washes, antiseptics, and internal cleansing. Arrange an appointment if the problem recurs; examination may include the skin, pelvic floor, and pelvic organs. Treatment depends on the cause and can include targeted skin care, treatment for infection, pelvic-floor work, or hormonal options when appropriate.

Seek prompt care for new sores, ulcers, marked swelling, fever, pelvic pain, foul-smelling discharge, bleeding after sex, or pain with possible pregnancy. Urgent assessment is appropriate for severe pain, fainting, heavy bleeding, or feeling acutely unwell. Persistent pain without these signs still merits a planned review, especially when it affects intimacy or causes fear of touch.

Is the pain superficial, deep, or related to pelvic-floor muscles? Could a skin condition, infection, hormonal change, or endometriosis explain it? Which lubricant or treatment is suitable? Would pelvic-floor physiotherapy or another referral help?