What if vaginal oestrogen therapy does not relieve pain during sex?

Vaginal oestrogen can improve hormone-related dryness and tissue sensitivity, but pain may also come from pelvic-floor muscle tightening, infection, skin conditions, scar tissue, endometriosis, or pain deeper in the pelvis. Burning at the entrance and deep pain have different possible explanations. Ongoing symptoms do not by themselves show that the treatment was used incorrectly or that one diagnosis is certain.

Check with your prescriber that the product, dose, application method, and schedule are suitable for you; do not alter them independently. Note whether pain is at the entrance or deeper, and whether dryness, discharge, itching, bleeding, or urinary symptoms occur. A clinician can examine the tissues and pelvic floor, review medicines and contraception, and discuss lubricants or another treatment when appropriate. See [Pain During Sex](/symptoms/pain-during-sex/) and [Vaginal Oestrogen Therapy](/treatments/menopause-and-hormone-therapy/vaginal-oestrogen-therapy/).

Arrange prompt assessment for bleeding after sex, new sores, unusual discharge, fever, or worsening pain. Seek urgent help for severe pelvic pain, fainting, or heavy bleeding. These symptoms need examination rather than simply adding more product or continuing painful intercourse.

Ask whether the pain pattern fits tissue dryness, whether infection or a skin condition should be checked, whether pelvic-floor assessment is needed, and when the treatment plan should be reviewed.