Pain During Sex: Causes, Diagnosis and Treatment

Pain may occur at the vaginal opening, on penetration, with deeper thrusting, or after sex. It can feel burning, stinging, aching, sharp or tight. Some people notice dryness, soreness, itching or a feeling that the pelvic muscles are closing involuntarily. The timing matters: pain at entry points clinicians toward different causes than pain that develops deeper in the pelvis.

Pain during sex can result from dryness, pelvic muscle tightening, skin conditions, infection or pain deeper in the pelvis, so assessment focuses on the location and pattern of pain.

Seek prompt medical care for severe or rapidly worsening pelvic pain, faintness, heavy bleeding, fever, vomiting, or pain with unusual discharge. Arrange an appointment if pain keeps returning, causes bleeding, follows a new sexual-health concern, or makes penetration difficult. Avoid sex that hurts until you have been assessed; pain is a symptom to investigate, not something you need to push through.

The causes below are listed alphabetically, not by likelihood. Endometriosis can present with deep pain during sex, particularly alongside period pain. Genitourinary Syndrome of Menopause can cause dryness, burning and fragile vaginal tissue when oestrogen levels are lower. Lichen Sclerosus can affect vulval skin and make contact painful. Ovarian Endometrioma can cause deeper pelvic pain. Pelvic Inflammatory Disease can present with pelvic pain, pain during sex and discharge. Vaginismus involves involuntary tightening around attempted penetration. Vulvodynia is persistent vulval pain without one single visible cause.

A clinician will ask where the pain starts, when it appears, whether it relates to periods or menopause, and whether there is bleeding, discharge, itching or urinary pain. They may gently examine the vulva, vagina and pelvis, stopping if the examination is too uncomfortable. Depending on the findings, tests for infection, pregnancy or other pelvic conditions may be offered, and an ultrasound may help assess pelvic organs. You can ask for an explanation before each step and request a pause.

Treatment is individualised. Dryness related to menopause may respond to moisturising care or Vaginal Oestrogen Therapy. Pelvic muscle overactivity or painful guarding may improve with Pelvic Floor Physiotherapy and, for selected people, Vaginal Dilator Therapy. Infection needs the appropriate antimicrobial treatment. Endometriosis or an ovarian endometrioma may need hormonal management, pain relief or specialist treatment; Laparoscopic Excision of Endometriosis is one surgical option for selected cases. Skin conditions need gentle care and prescribed treatment.

Use enough water-based lubricant, allow arousal to build, and choose positions where you control depth and pace. Stop when pain begins rather than continuing through it. Avoid perfumed washes and products that irritate vulval skin. If pelvic muscles tense in anticipation, gradual exercises guided by a pelvic-floor clinician can help rebuild comfort. Treating vaginal or pelvic symptoms early may prevent a short episode from becoming an ongoing pain pattern.

Tell a clinician about period pain, heavy bleeding, vulval itching or skin changes, vaginal dryness, unusual discharge, fever, urinary symptoms, or pain outside sexual activity. These details help separate surface irritation, pelvic-floor symptoms, infection and deeper pelvic causes.

Keep a short record of the pain location, trigger, severity, cycle timing and associated symptoms. A gynaecology or primary-care assessment can then target the examination and tests. Treatment may involve one clinician or a combination of gynaecology, pelvic-floor physiotherapy and sexual-health care.