Pain in and around the vulva and entrance to the vagina can take many forms. The pain can feel stinging, throbbing, burning, dry or sore. It can be sharp, dull or intense. For some people the pain is limited to specific areas, such as the opening of the vagina or the clitoris, and for others it is more widespread.  Vulval pain may be spontaneous and unprovoked. The pain may be intermittent, recurrent and/or peristent.

This booklet is aimed at people who experience vulval pain when they become sexually aroused and/or the outside of their genitals is touched. Some people experience painful sex when penetration of the vagina is attempted. Please see our Difficulties with vaginal penetration booklet if this applies to you.

The level of pain can range from mild to severe. Sometimes sexual touch, or any touch, can feel impossible. Repeated unsuccessful attempts at sexual contact can leave you feeling frightened and frustrated. It is unsurprising that having these kinds of experiences may result in wanting to avoid sexual contact altogether. 

As well as finding sexual touch painful, some people also experience difficulty with gynaecological examinations or with using tampons (or may feel afraid to try). Some people experience pain on other types of touch or pressure to the vulval including during activities such as riding a bicycle or even wearing tight fitting trousers or underwear.

Feeling unwanted pain during sex is fairly common, but it is not something you should endure. Any unexplained recurrent or persistent pain should always be checked out by a doctor.

What can cause or contribute to vulval pain during sex?

There are a variety of reasons that you might experience difficulties with painful sex including physical or medical problems, sensitivity to products, and psychological difficulties.
 

A number of physical or medical factors can cause and contribute to persistent pain. They include:

  • A history of thrush, bacterial vaginosis or UTIs
  • A sexually transmitted infection (STI)
  • Skin problems (for example, lichen sclerosis or eczema)
  • Hormonal changes or endocrine disorders (like diabetes)
  • Changes associated with pregnancy, birth, or breast feeding
  • Ageing or menopause-related changes
  • Trapped nerves
  • Previous surgery

It is important to have a medical assessment by an appropriately trained medical professional, such as a specialist in sexual problems, to ascertain the role of any physical or medical factors contributing to vulval pain. Your GP may be able to help with this, or signpost you to an appropriate service.

Sometimes persistent pain can be worsened by irritation or sensitivity to products such as:

  • Condoms
  • Soaps and shower gels
  • Vaginal deodorants and wipes, even those advertised as being for sensitive skin
  • Pantyliners and menstrual products (e.g. tampons and pads)
  • Lubricants and vaginal moisturisers

Changing the products you use can help to reduce any irritation caused by them. Tight fitting clothes and certain fabrics can also increase irritation in some people.

Difficulties with painful sex can also be related to psychological factors including:

  • Beliefs about sex (for example, that it is shameful)
  • Unwanted, or negative, previous sexual experiences
  • Worrying about or expecting sex to be painful
  • Not being aroused by the situation, feeling sexually bored, or other feelings about your sexual practices and partners
  • Stress, depression, and anxiety
  • Tiredness
  • Relationship problems
  • Body image concerns
  • Having other things on your mind and not being able to be in the sexual moment
  • Having another sexual difficulty, or your partner experiencing sexual difficulties 

Some people never find out the exact cause of their persistent pain, and there might be a number of factors involved in causing and maintaining the problem. Many people are confident that the cause is or was something physical but also feel that psychological factors have also started to play a role in their ongoing difficulties. For some people, they may experience increased sensitivity to pain (through continued activation of the sensory nerves and/or pain receptors in the brain and central nervous system) even when the initial cause has resolved.