Pain during sex

Pain during sex can be felt around the vaginal opening, inside the vagina or deeper in the pelvis. Get frequent or severe pain assessed. You do not have to push through pain to complete penetration.

Dyspareunia is a medical term for pain with vaginal sex. The term describes the pain but does not explain what causes it. A clinician considers your symptoms and history, sometimes with an examination or tests, before suggesting treatment.

Different causes need different help

Vaginal dryness can make sex sore. It can occur during menopause, pregnancy or breastfeeding, and with some medicines. Irritation from products, infections, skin conditions and conditions such as endometriosis can also cause pain. Several possibilities may need checking. Where it hurts is only part of the picture.

Pain can also follow tears or an episiotomy during birth. ACOG lists physical therapy among possible treatments. Tell the clinician if pain started after giving birth. You can ask for help with it.

When muscles tighten automatically

Vaginismus involves vaginal muscles tightening on their own when something approaches or enters the vagina. It can make penetration painful or difficult, including with a tampon, finger, sex toy or penis. Cervical screening may also be difficult. This reaction is not under your conscious control.

It can happen after previously painless penetrative sex and does not necessarily prevent arousal or enjoyment of other sexual contact. Treatment may combine psychosexual therapy, relaxation and carefully guided exercises. Vaginal trainers are one option, with a specialist therapist guiding you at first.

Finding what feels comfortable

Choose activities that do not hurt, if you want sexual contact at all. Tell a partner where and when pain happens and what feels comfortable. ACOG suggests alternatives to painful intercourse and nonsexual touch such as massage. Sexual contact does not have to involve penetration.

For dryness, water-based lubricant before sex or a vaginal moisturiser may help. Avoid perfumed washes and douching, and use products intended for the vagina rather than ordinary body creams inside it. Ask a pharmacist or doctor if you are unsure which product is suitable.

Talking through an assessment

You may be asked about medicines, health conditions and past experiences that affect how you feel about sex. Depending on what is found, a clinician may involve a pelvic physiotherapist or a skin specialist. Pelvic floor physical therapy is an option for some pelvic pain problems; ask what the treatment aims to help with.

Before an examination, discuss how to make it more comfortable. For suspected vaginismus, the NHS says you can bring someone you trust and ask for a female doctor. You could begin with: “Penetration hurts, and I want to talk about the examination before we start.”

If dryness is linked to hormone changes, a doctor may discuss oestrogen treatment. This is not suitable for everyone, so ask about the benefits and whether it suits you. Book a GP appointment for persistent dryness, unusual discharge or bleeding after sex, even if you have been trying lubricant to help with the problem.

Get help today from an urgent GP service or NHS 111 (UK), or your doctor or urgent care service (US or elsewhere), if bleeding comes with pelvic pain. Use the emergency care advice below for heavy bleeding or other emergency symptoms with pelvic pain.

For the appointment, describe the experience in your own words: where it hurts, what was happening and what you want help with. It is fine to say you are unsure. A useful opening might be: “It hurts at the entrance, and I have started avoiding intimacy because I am worried about pain.”

When pain needs faster care

Go to A&E in the UK, an emergency department in the US, or your local emergency service now if pelvic pain is severe or worsening, or comes with faintness, shoulder-tip pain, difficulty breathing, heavy vaginal bleeding or sudden confusion.

Contact an urgent GP service or NHS 111 today in the UK, or your doctor or urgent care service in the US or elsewhere, for pelvic pain with fever, unusual discharge or bleeding, or possible pregnancy. For pain during sex that keeps happening, book a GP or sexual health appointment in the UK, or see your doctor elsewhere.