What causes pain during sex?

Pain at the entrance may follow vaginal dryness, skin inflammation, an infection, or involuntary tightening of the pelvic floor muscles. Deep pain can be associated with endometriosis, ovarian or uterine conditions, or pelvic inflammation. After menopause, thinning and reduced lubrication related to genitourinary syndrome of menopause can make friction uncomfortable. Itching, pale or fragile skin, or small tears may point to lichen sclerosus. The location, timing, and pattern of pain help distinguish these possibilities; pain during sex does not by itself identify one diagnosis.

Pause when pain starts and use a generous water-based lubricant; allow more arousal and choose positions that control depth. Avoid scented washes and products that irritate vulval skin. A clinician can examine the skin, check for infection, and assess pelvic muscles. Treatment may include pelvic floor physiotherapy, vaginal dilator therapy, or vaginal oestrogen therapy when hormonal tissue changes are involved. Endometriosis-related pain may need a gynaecology assessment and, in selected cases, laparoscopic excision of endometriosis.

Arrange medical care if pain is new, persistent, worsening, or affecting intimacy, or if you have unusual discharge, bleeding after sex, sores, itching, urinary symptoms, or pelvic pain outside sex. Seek urgent help for severe or rapidly increasing pelvic pain, fainting, heavy bleeding, fever with feeling very unwell, or possible pregnancy with pain or bleeding.

Could the pain be from dryness, infection, skin changes, endometriosis, or pelvic floor muscles? What examination or tests are appropriate? Which lubricant or treatment is suitable for me? Would pelvic floor physiotherapy help, and what symptoms should prompt urgent care?