Pain during sex: common causes and when to see a gynaecologist

English version

What does pain during sex mean?

Pain during or after sexual intercourse is medically known as dyspareunia. It may occur occasionally because of temporary dryness or irritation, but persistent or recurring pain should not be accepted as normal or silently endured.

Pain may be felt around the vaginal opening, during penetration or deeper inside the pelvis. Describing where and when it occurs can help a doctor identify the possible cause.

What can cause pain during sex?

• Insufficient lubrication or sexual arousal.
• Vaginal dryness during breastfeeding, perimenopause or menopause.
• Irritation from perfumed products, soaps, condoms or spermicides.
• Vaginal or sexually transmitted infections.
• A skin condition affecting the vulva.
• Involuntary tightening of the pelvic-floor muscles, sometimes called vaginismus.
• Pain or tenderness following childbirth, injury or surgery.
• Pelvic inflammatory disease.
• Endometriosis or adenomyosis.
• Ovarian cysts, uterine fibroids, or bladder, bowel and other pelvic conditions.

Emotional distress, fear of pain or a previous difficult experience may also contribute to muscle tightening and discomfort. This does not mean the pain is imaginary—it remains real and deserves sensitive assessment.

Endometriosis can cause painful sex together with severe period pain, persistent pelvic pain, heavy bleeding or difficulty conceiving. Pain during sex alone, however, does not confirm endometriosis.

When should you arrange a consultation?

Consult a gynaecologist if:

• Pain occurs repeatedly or is becoming worse.
• Penetration is consistently painful or impossible.
• Pain continues for a significant time after intercourse.
• You have dryness that is not improving.
• There is itching, burning, unusual discharge or unpleasant odour.
• You experience bleeding during or after sex.
• You have severe periods or pelvic pain at other times.
• Symptoms started after childbirth, surgery or menopause.
• Pain is affecting intimacy, emotional wellbeing or relationships.
• You are trying to conceive and also have pelvic pain.

Evaluation depends on the symptoms and may include a medical history, gentle examination, infection testing or ultrasound. Not every patient requires every test.

What may help temporarily?

Allow adequate time for arousal and consider a water-based lubricant. Avoid perfumed intimate washes, vaginal douching and products that cause irritation. Do not continue penetration through significant pain.

Depending on the cause, treatment may involve infection treatment, vaginal moisturisers, appropriate hormonal treatment, pelvic-floor physiotherapy or management of an underlying condition. Hormonal treatments are not suitable for everyone and require medical advice.