Pain During Sex: Common Causes, When to Seek Help and How Pelvic Ultrasound Can Help
Pain during sex is more common than many people realise, but it is often underreported because patients may feel embarrassed, anxious, or unsure whether their symptoms are normal. The medical term for pain during sexual intercourse is dyspareunia.
This patient-friendly guide explains the common causes of painful sex, the difference between superficial and deep dyspareunia, when to seek medical advice, and how pelvic ultrasound can help investigate deeper pelvic causes.
Quick Answer: What Causes Pain During Sex?
Pain during sex, also called dyspareunia, can be caused by many different conditions. Some causes are superficial, such as vaginal dryness, vulvodynia, vaginismus or infection. Others are deeper pelvic causes, including endometriosis, pelvic inflammatory disease, ovarian cysts, fibroids, adenomyosis, pelvic adhesions, bladder pain or bowel-related pelvic pain.
Pelvic ultrasound is particularly useful when pain is felt deep inside the pelvis, especially if it is associated with pelvic pain, abnormal bleeding, ovarian symptoms, painful periods, fertility concerns or suspected pelvic disease.
What Is Dyspareunia?
Dyspareunia means pain associated with sexual intercourse. The pain may occur before penetration, at the start of penetration, during deep penetration, after intercourse, only in certain positions, or at specific times in the menstrual cycle.
Dyspareunia is not a diagnosis on its own. It is a symptom that can be caused by different gynaecological, pelvic, hormonal, muscular, nerve-related, bladder, bowel or psychological factors.
Superficial vs Deep Pain During Sex
Superficial Dyspareunia
This refers to pain felt at the entrance of the vagina or around the vulva. It may feel like burning, stinging, rawness, sharp pain, tightness or difficulty with penetration.
Common causes include vaginal dryness, vulvodynia, vaginismus, thrush, vaginal infection, skin conditions, childbirth-related scarring and hormonal changes after menopause.
Deep Dyspareunia
This refers to pain felt deeper inside the pelvis during intercourse. It may feel like deep aching, pelvic pressure, sharp internal pain, cramping after sex or pain in certain positions.
Common causes include endometriosis, adenomyosis, ovarian cysts, fibroids, pelvic inflammatory disease, pelvic adhesions, pelvic congestion and bladder or bowel-related pelvic pain.
Why It Matters
Deep pain during sex may be linked to pelvic conditions that can be assessed using pelvic ultrasound, while superficial pain often needs vaginal, vulval, hormonal or pelvic floor assessment.
Why Pain During Sex Should Not Be Dismissed
Many women delay seeking help because they feel embarrassed or because they have been told pain is part of being sexually active, having periods, having children or getting older. However, pain during sex is not something patients should simply tolerate.
- Intimacy
- Emotional wellbeing
- Self-confidence
- Relationships
- Fertility planning
- Mental health
- Pelvic floor function
- Sexual desire
Common Causes of Pain During Sex
Endometriosis
Endometriosis is one of the most important causes of deep pain during sex. It occurs when tissue similar to the lining of the womb grows outside the uterus. This tissue can affect the ovaries, pelvic lining, bowel, bladder, uterosacral ligaments and other pelvic structures.
- Painful periods
- Deep pain during sex
- Pain when opening the bowels
- Chronic pelvic pain
- Fertility difficulties
- Fatigue
- Bloating
- Pain after sex
A pelvic ultrasound may detect ovarian endometriomas and some signs of deep endometriosis, but a normal scan does not completely exclude endometriosis.
Pelvic Inflammatory Disease
Pelvic Inflammatory Disease, or PID, is an infection of the upper female reproductive tract. It may affect the uterus, fallopian tubes, ovaries and surrounding pelvic tissues.
- Lower abdominal or pelvic pain
- Deep pain during sex
- Abnormal vaginal discharge
- Bleeding between periods
- Bleeding after sex
- Fever or feeling unwell
- Pain when passing urine
- Fertility concerns
Ovarian Cysts
Ovarian cysts are fluid-filled sacs that develop in or on the ovary. Many are harmless and resolve naturally, but some can cause pain, pressure or discomfort.
Ultrasound is one of the best first-line investigations for ovarian cysts. It can assess the size, appearance and internal structure of a cyst.
Fibroids
Fibroids are benign growths arising from the muscular wall of the uterus. They may cause pain during sex if they enlarge the uterus, create pelvic pressure, distort the uterine shape, or press on the bladder or bowel.
Adenomyosis
Adenomyosis occurs when tissue similar to the womb lining grows into the muscular wall of the uterus. This can make the uterus enlarged, tender and bulky, causing deep pain during sex, heavy periods and chronic pelvic pain.
Vaginal, Vulval and Pelvic Floor Causes
Vaginal Dryness and Hormonal Changes
Vaginal dryness is a common cause of pain during sex, especially after menopause, during breastfeeding, after childbirth, during some hormonal treatments, after cancer treatment or with certain medications.
Vaginismus
Vaginismus occurs when the muscles around the vagina tighten involuntarily during attempted penetration. This can make sex painful, difficult or impossible. It may also affect tampon use, smear tests, gynaecological examinations and transvaginal ultrasound.
Vulvodynia
Vulvodynia is chronic vulval pain lasting at least three months without an obvious identifiable cause. The pain may feel like burning, stinging, rawness, soreness or sensitivity to touch.
Thrush, Bacterial Vaginosis and Sexually Transmitted Infections
Vaginal infections may cause pain during sex due to inflammation and irritation. Sexually transmitted infections such as chlamydia and gonorrhoea may also cause cervicitis or PID.
Pelvic Floor Dysfunction
When pelvic floor muscles become too tight, weak, irritated or poorly coordinated, pain may occur during intercourse. Pelvic floor physiotherapy can be very helpful for many patients.
When Should You Seek Medical Advice?
You should seek medical assessment if pain during sex is:
- New
- Persistent
- Worsening
- Deep inside the pelvis
- Associated with bleeding
- Associated with abnormal discharge
- Associated with fever
- Linked to painful periods
- Linked to fertility problems
- Occurring after menopause
- Preventing intercourse or intimacy
- Associated with pelvic pain
Seek urgent help if you experience severe pelvic pain, fainting, shoulder-tip pain, heavy bleeding, fever, vomiting, a positive pregnancy test with pelvic pain, or suspected ectopic pregnancy.
How Is Pain During Sex Diagnosed?
Diagnosis begins with careful history-taking. A clinician may ask where the pain is felt, when it started, whether it is superficial or deep, and whether there are menstrual symptoms, bleeding patterns, discharge, pregnancy possibility, previous infections, fertility concerns, menopause symptoms or previous surgery.
- Pelvic examination
- Swabs for infection
- Pregnancy test
- Urine test
- Blood tests
- Pelvic ultrasound
- Gynaecology referral
- Pelvic floor assessment
How Can Pelvic Ultrasound Help?
Pelvic ultrasound is one of the most useful first-line investigations when deep pelvic pain during sex is suspected.
- Uterus
- Endometrium
- Ovaries
- Fallopian tube region
- Pelvic fluid
- Fibroids
- Ovarian cysts
- Adenomyosis features
- Endometriomas
- Some signs of PID
- Some pelvic masses
- Structural causes of pain
Ultrasound can help identify structural causes of deep dyspareunia and guide whether further tests, treatment or specialist referral are needed.
Transabdominal and Transvaginal Ultrasound
Transabdominal Ultrasound
This is performed through the lower abdomen and gives a broad overview of the pelvis.
Transvaginal Ultrasound
This uses a small internal probe to provide more detailed images of the uterus, ovaries and pelvic structures.
Consent and Comfort
Patients should always be offered clear explanation and consent. If transvaginal ultrasound is not comfortable or suitable, the scan can be adapted.
What Ultrasound Cannot Always Detect
Although pelvic ultrasound is very useful, it cannot diagnose every cause of pain during sex.
- Endometriosis
- Early PID
- Vulvodynia
- Vaginismus
- Pelvic floor dysfunction
- Bladder pain syndrome
- Nerve-related pain
- Some bowel-related causes
This is why symptoms, examination, infection testing and specialist assessment remain important.
Treatment Options Depend on the Cause
- Antibiotics for PID or infection
- Hormonal treatment for endometriosis or adenomyosis
- Treatment of vaginal dryness
- Pelvic floor physiotherapy
- Pain management
- Psychosexual therapy
- Treatment of ovarian cysts or fibroids where needed
- Gynaecology referral
- Fertility specialist referral where appropriate
- Support for bladder or bowel-related pain
Private Pelvic Ultrasound for Pain During Sex in London
London Private Ultrasound provides private pelvic ultrasound scans for women with deep pelvic pain, painful sex, abnormal bleeding, suspected ovarian cysts, fibroids, adenomyosis, endometriosis-related concerns, PID concerns and fertility-related symptoms.
Frequently Asked Questions
What is the medical term for pain during sex?
The medical term for pain during sexual intercourse is dyspareunia. It may be superficial, felt at the vaginal entrance, or deep, felt inside the pelvis.
What causes deep pain during sex?
Deep pain during sex may be caused by endometriosis, pelvic inflammatory disease, ovarian cysts, fibroids, adenomyosis, pelvic adhesions, bladder pain syndrome, bowel-related pain or pelvic floor dysfunction.
Can pelvic ultrasound find the cause of painful sex?
Pelvic ultrasound can help identify structural causes such as ovarian cysts, fibroids, adenomyosis features, endometriomas, pelvic fluid, some pelvic masses and some signs of PID. However, a normal ultrasound does not exclude every cause.
Is pain during sex normal after menopause?
Pain during sex after menopause is common but should not be ignored. Vaginal dryness and hormonal changes are frequent causes, but bleeding after sex or postmenopausal bleeding should always be assessed.
When should I seek urgent help?
Seek urgent help if you have severe pelvic pain, fainting, heavy bleeding, fever, vomiting, a positive pregnancy test with pelvic pain, shoulder-tip pain or symptoms suggestive of ectopic pregnancy or pelvic infection.
Final Thoughts
Pain during sex can be physically painful, emotionally distressing and difficult to discuss. However, it is a common symptom and there are many possible explanations.
Some causes are local and superficial, such as vaginal dryness, vulvodynia, vaginismus or infection. Others are deeper pelvic conditions such as endometriosis, PID, ovarian cysts, fibroids or adenomyosis.
Pelvic ultrasound is particularly useful when deep pelvic pain, abnormal bleeding, ovarian symptoms, fertility concerns or suspected pelvic disease are present. It can help identify structural causes and guide the next steps in care.
Book a Private Pelvic Ultrasound Scan in London
If you have deep pain during sex, pelvic pain, abnormal bleeding, painful periods, ovarian symptoms or fertility concerns, a pelvic ultrasound may help identify structural causes and guide the next step.
References
Article Preparation and Clinical Review
This patient information page was prepared with AI-assisted editorial support and reviewed for clinical accuracy by:
Dr Pedram Aghaei — Vascular Scientist, SVT reg. SVT 679 · Registered Clinical Technologist, RCT reg. 93290 · BMUS 20702
Dr Hosna Rashidi — BMUS 29386 · SVT reg. M11114