Common, treatable, and rarely raised. Most causes have a straightforward answer.
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Seek prompt assessment for:
Also seek assessment for white, thickened or shiny patches of vulval skin, which may indicate lichen sclerosus and needs specific treatment.
Pain during sex affects a substantial proportion of women at some point and a smaller number of men. It goes unreported far more often than it occurs, partly through embarrassment and partly because people assume it is simply how things are now.
It usually is not. Most causes are identifiable and most are treatable, and the single most useful diagnostic question is where it hurts — at the entrance, or deep inside.
Pain at the entrance
Deep pain — endometriosis, where deep pain during or after sex is one of the most characteristic symptoms; ovarian cysts; fibroids; pelvic inflammatory disease; and IBS or bladder pain referring into the pelvis.
In men — prostatitis, tight foreskin, skin conditions, or infection.
This is the most important thing on the page, and it is the opposite of what most people do.
Repeatedly having sex that hurts teaches the pelvic floor muscles to tighten protectively in anticipation. That tightening then makes penetration more painful, which causes more guarding — a self-reinforcing loop that turns a treatable problem into a persistent one. Every episode of pushing through makes the next one harder.
Pause penetrative sex while this is being sorted out. That does not mean pausing intimacy.
This single distinction determines almost everything that follows:
Note also whether it is always, or only in certain positions or at certain points in your cycle — pain that is much worse around your period points strongly towards endometriosis.
A vaginal moisturiser is a different product from a lubricant — used every few days regardless of sex, it rehydrates the tissue itself rather than easing a single occasion. Many people benefit from using both.
Soap, shower gel, bubble bath, wipes and "intimate" washes strip and irritate vulval skin, and are a common cause of pain at the entrance. Plain water on the outside only. Avoid biological detergents and fabric softener on underwear.
Vaginal oestrogen is likely to be the answer, and it is substantially under-prescribed. Falling oestrogen thins and dries the vaginal tissue, which causes burning, tearing sensations and pain — and unlike hot flushes, this does not improve with time. It progresses.
Vaginal oestrogen is applied locally, is very poorly absorbed into the bloodstream, works well, and can be used long term. It is a different proposition from systemic HRT. Many women who have had breast cancer can also use it — that is a discussion to have with your oncology team rather than an automatic no.
Breastfeeding causes the same low-oestrogen dryness temporarily, and lubricant plus time usually resolves it.
That is vaginismus — an involuntary protective tightening of the pelvic floor. It is not something you are doing, and it is not solved by relaxing or by a glass of wine.
It responds well to treatment — graded vaginal trainers used at your own pace, pelvic floor physiotherapy, and psychosexual therapy — with good success rates. It is one of the more rewarding things to treat and one of the most often endured in silence.
A remote consultation is, for many people, a considerably easier setting in which to raise this than a surgery — and twenty minutes is enough to do it properly rather than at the end of an appointment about something else.
The consultation establishes location, timing, whether it has always been the case or is new, and what else is going on. Entrance pain and deep pain point in entirely different directions, and that alone narrows it substantially.
Where relevant we arrange STI screening, hormone testing, or pelvic ultrasound, and treat infections directly.
For dryness after menopause, vaginal oestrogen is the answer and it is markedly under-prescribed. It is safe, works locally with minimal absorption, and can be used long term.
Where the picture suggests endometriosis, we take it seriously and refer — average time to diagnosis in the UK is around eight years, and deep pain during sex is one of the symptoms most often normalised.
No — and this is the single most damaging piece of common advice about painful sex. Continuing through pain conditions the pelvic floor to brace against penetration, which makes the pain worse and more persistent. It converts a straightforward problem into one that takes months to unwind.
"Just relax", "have a glass of wine" and "you're too tense" are not treatment, and pain during sex is not something to be got through politely.
Enormously — it is the first question any clinician will ask, and the two have almost entirely separate causes.
Superficial pain — burning, stinging or tearing at the entrance — suggests dryness, thrush or bacterial vaginosis, a skin condition such as lichen sclerosus or dermatitis, vulvodynia, scarring after childbirth, or pelvic floor tension.
Deep pain — an ache felt inside on deeper penetration, often persisting afterwards — suggests endometriosis, pelvic inflammatory disease, fibroids, ovarian cysts, or bowel and bladder conditions.
Water-based or silicone-based, and plain. Avoid glycerin, flavourings, and anything advertised as warming or tingling — these commonly cause irritation. Silicone lasts longer but should not be used with silicone toys.
Never use oil-based products with condoms — coconut oil, baby oil, massage oil and Vaseline all damage latex and cause condoms to break. Use far more than seems necessary, and reapply during rather than only at the start.
Yes for most women, and it is considerably under-used. It is applied directly, absorption into the bloodstream is very low, and it does not carry the considerations that apply to systemic HRT. It treats the underlying tissue change rather than masking it, and it can be continued long term — which matters, because symptoms return when it is stopped.
Women with a history of breast cancer are frequently told it is off-limits automatically. That is often too absolute: many can use it after a discussion with their oncology team, particularly where quality of life is significantly affected. It is a conversation to have, not a closed door.
An involuntary tightening of the pelvic floor muscles that makes penetration painful or impossible. It is not conscious, it is not a failure to relax, and it is often the body's protective response to previous pain, fear, or a difficult experience — though sometimes there is no identifiable trigger at all.
It treats well. The combination of graded vaginal trainers used entirely at your own pace, pelvic floor physiotherapy, and psychosexual therapy has good success rates. What it needs is the right treatment rather than more attempts.
It needs assessing rather than watching. The commonest causes are benign — a cervical ectropion, a polyp, or inflammation from infection — but bleeding after sex is also a symptom of cervical changes, so it warrants examination and a check that your cervical screening is up to date.
Bleeding after sex in a postmenopausal woman is urgent and should be assessed on a two-week pathway.
Yes, and it is discussed even less. Common causes include a tight foreskin, thrush — which men do get, and which can be passed back and forth — a short frenulum that tears, prostatitis causing pain on ejaculation, and Peyronie's disease, where scar tissue causes curvature and pain.
Most of these are treatable, and several are straightforwardly so. The main barrier is that they go unmentioned.
Directly, and with the two details that matter most: whether the pain is at the entrance or deep inside, and whether it is there every time or only sometimes. Those two facts do most of the diagnostic work.
Then add: how long it has been happening, what you have already tried, whether there is bleeding, and where you are in relation to the menopause or childbirth. You are not wasting anyone's time — painful sex is common, it is treatable, and it is one of the symptoms most often endured for years unnecessarily.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 23, 2026
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