Painful sex

Pain during sex, called dyspareunia, is common and always has a reason. Locating the pain is most of the diagnosis, and it is the one thing a person can do before they ever reach an appointment.

Locate it first

Before anything else, work out the answer to four questions. Where is the pain: at the opening, or deeper inside? When does it happen: on first contact, on entry, during movement, deep at the end of a thrust, or afterwards? Is it every time, or only sometimes and in some positions? Has it always been there, or did it start at an identifiable point?

Those answers narrow the field dramatically, and they are the first things a clinician will ask. Writing them down before an appointment is worth more than any amount of reading.

Pain at the entrance

Dryness

The commonest cause at any age. Thin or dry tissue tears microscopically under friction, which produces burning during and stinging afterwards. It is the first thing to treat because it is the easiest, and because untreated friction sets up guarding that then persists on its own. Generous lubricant applied at the start and reapplied, plus a moisturiser used regularly if dryness is constant, addresses most of it. See vaginal dryness.

Skin conditions

Lichen sclerosus, eczema and other dermatoses cause fragile skin that splits, most often at the back of the vaginal opening. Splitting produces a sharp, specific pain at a consistent point. These need diagnosis and prescribed treatment.

Infection and irritation

Thrush produces soreness and itching with a characteristic discharge; bacterial vaginosis produces a distinctive smell rather than pain; some sexually transmitted infections produce discomfort with discharge. Contact irritation from soap, wipes, fragranced products or a new lubricant is extremely common and resolves when the product stops. See thrush and bacterial vaginosis and vulval hygiene.

Pelvic floor overactivity

Muscles that will not release make the opening feel tight and produce burning or a sense of hitting a wall. This is a very common finding and is often secondary to something else that caused pain first. See an overactive pelvic floor.

Scarring

Perineal tears, an episiotomy or previous surgery can leave a scar that remains tender for months. Scar tissue responds to massage and to physiotherapy, and does not simply have to be waited out. See the pelvic floor after childbirth.

Vulvodynia

Persistent burning or rawness with no visible cause, often provoked by touch at specific points around the opening. It is a diagnosis reached after other causes are excluded, and it has recognised treatments. See vulvodynia.

Vaginismus

Involuntary tightening that prevents penetration or makes it very painful, sometimes present from the first attempt and sometimes appearing later. See vaginismus.

Deep pain

Endometriosis and adenomyosis

Deep pain during sex, particularly with certain positions and often worse around the period, is a classic feature. Where it occurs with painful periods, pain opening the bowels during a period, or fertility difficulty, it should be actively investigated. See endometriosis.

Pelvic inflammatory disease

Infection spreading upward from the cervix causes deep pain, often with abnormal discharge, pain low in the abdomen and sometimes fever. It needs prompt treatment because delay is associated with lasting damage.

Ovarian cysts and fibroids

Both can cause deep pain depending on size and position. Sudden severe one sided pain needs urgent assessment.

Pelvic floor and musculoskeletal causes

Tender points in the deep pelvic muscles refer pain that is felt internally. Hip and lower back problems contribute. These are assessed by examination rather than by scanning.

Bladder and bowel conditions

Bladder pain syndrome and irritable bowel syndrome both produce pain that can be provoked by sex, and both are frequently missed in this context.

What an assessment involves

A history covering the four questions above, the cycle, bowel and bladder symptoms, discharge, previous births and surgery, medication and what has been tried. Then, with consent, an examination: inspection of the vulva for skin change, a gentle single finger examination to locate tenderness and assess muscle tone, and a speculum examination if it is tolerable and likely to add information. Swabs are taken where infection is possible. An ultrasound scan is arranged where deep pain suggests a pelvic cause.

An examination should not be forced. If it is too painful, that itself is information, and treatment can begin without it.

What to do while waiting

Stop pushing through. Repeated painful attempts strengthen the guarding response and make treatment slower. Use generous lubricant. Remove every product that touches the area except water. Choose positions that allow control of depth and speed. Keep other kinds of contact going if that is wanted, since the aim is not to shut everything down but to stop provoking the pain.

Reducing friction is the one change that helps regardless of the eventual diagnosis, which is why some retailers group the products intended for painful sex separately from the rest of their range, as inWonderstate does. That is a way of narrowing a search rather than a treatment: whatever the cause turns out to be, lubrication reduces the tissue damage that keeps the cycle going while the cause is being identified.

Last reviewed: September 2026